Skip to content
HCC Buddy home

M05.069 ICD-10-CM Code: Felty's syndrome, unspecified knee

M05.069 maps to CMS-HCC V28 93 (RAF 0.617). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Inflammatory polyarthropathies (M05-M14)

M05.069

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Felty's syndrome, unspecified knee

Felty's syndrome affecting the knee when the specific knee (right or left) is not identified.

Buddy the Bee presenting code insight

Buddy Insight

Felty's syndrome with unspecified knee involvement represents the complete diagnostic triad affecting knee function without documented laterality.

CMS-HCC V28

HCC 93

RAF 0.617

CMS-HCC V24

HCC 40

RAF 0.421

ACA/HHS

HCC 56

Varies by metal level

ESRD/PACE

HCC 40

RAF 0.058

RXHCC

HCC 83

RAF 0.222

Code Book Path

Official
M05.0Felty's syndrome
M05.06Felty's syndrome, knee
M05.069Felty's syndrome, unspecified knee

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M05.069 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M05.069 in this effective period.

Related Child Codes

Official
M05.061Felty's syndrome, right knee
M05.062Felty's syndrome, left knee

Includes

Official

ICD-10-CM does not list Includes notes for M05.069 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M05.069 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M05.069 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M05.069 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M05.069 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Documentation of rheumatoid arthritis affecting knee without laterality specification
Evidence of splenomegaly through physical examination or imaging
Laboratory confirmation of neutropenia with specific values
Knee joint involvement noted but side not specified

MEAT Support

HCC Buddy guidance
Documentation of rheumatoid arthritis affecting knee without laterality specification
Evidence of splenomegaly through physical examination or imaging
Laboratory confirmation of neutropenia with specific values
Knee joint involvement noted but side not specified

Audit Caution

HCC Buddy guidance
Using unspecified code when laterality is documented elsewhere in the record
Misidentifying as osteoarthritis rather than inflammatory rheumatoid condition
Failing to verify presence of all three Felty's syndrome components
Missing opportunities for more specific coding when side is mentioned

Common Mistakes

HCC Buddy guidance
M05.061 or M05.062 — When knee laterality is actually documented in records
M05.9 — Rheumatoid arthritis seropositive without the complete syndrome
M17.9 — Osteoarthritis of knee unspecified without inflammatory basis
D70.9 — Neutropenia without associated rheumatoid arthritis

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is M05.069 an HCC code?

Yes. M05.069 (Felty's syndrome, unspecified knee) maps to Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders under the CMS-HCC V28 risk adjustment model (and Rheumatoid Arthritis and Inflammatory Connective Tissue Disease under V24), with a community non-dual aged RAF of 0.617. It is billable for payment year 2026.

Coder answer: M05.069 is billable and maps to V28 HCC 93, Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
M05.069
Description
Felty's syndrome, unspecified knee
HCC (V28)
HCC 93 — Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders
RAF
0.617
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 93, Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders
0.617
V24HCC 40, Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.421
ESRDHCC 40, Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.058
RxHCCHCC 83, Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.222

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work M05.069 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for M05.069

For M05.069 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

  • MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
  • EEvaluate: test results, medication response, or physical findings reviewed by the provider
  • AAssess: explicit mention in the assessment or plan with acknowledgment of status
  • TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed M05.069 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

Get the V28 RAF + MEAT cheat sheet

One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

M05.069 is the ICD-10-CM diagnosis code for felty's syndrome, unspecified knee. Felty's syndrome affecting the knee when the specific knee (right or left) is not identified. M05.069 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering inflammatory polyarthropathies (m05-m14).

Under the CMS-HCC V28 risk adjustment model, M05.069 maps to Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders (HCC 93) with a community, non-dual, aged base RAF weight of 0.617. Under the older CMS-HCC V24 model, M05.069 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease (HCC 40) with a community, non-dual, aged base RAF weight of 0.421. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Use only when knee involvement is documented but laterality cannot be determined; query provider for clarification. Because M05.069 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M05.069 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Use only when knee involvement is documented but laterality cannot be determined; query provider for clarification
  • •Prefer M05.061 or M05.062 when laterality is documented to ensure specificity

Clinical Significance

Felty's syndrome with unspecified knee involvement represents the complete diagnostic triad affecting knee function without documented laterality. This severe condition creates significant mobility challenges and life-threatening immunosuppression requiring comprehensive multidisciplinary management and intensive monitoring for infectious complications.

Documentation Requirements

  • ✓Documentation of rheumatoid arthritis affecting knee without laterality specification
  • ✓Evidence of splenomegaly through physical examination or imaging
  • ✓Laboratory confirmation of neutropenia with specific values
  • ✓Knee joint involvement noted but side not specified
  • ✓Assessment of weight-bearing function and mobility limitations
  • ✓History of infections or immunocompromised status
  • ✓Treatment protocol addressing all syndrome components
  • ✓Physical therapy and mobility assistance needs evaluation

Commonly Confused Codes

  • •M05.061 or M05.062: When knee laterality is actually documented in records
  • •M05.9: Rheumatoid arthritis seropositive without the complete syndrome
  • •M17.9: Osteoarthritis of knee unspecified without inflammatory basis
  • •D70.9: Neutropenia without associated rheumatoid arthritis
  • •M13.169: Monoarthritis of unspecified knee without systemic components

Child Codes

M05.061Felty's syndrome, right knee
HCC 93
M05.062Felty's syndrome, left knee
HCC 93
M05.069Felty's syndrome, unspecified knee
HCC 93

Code Hierarchy

└M05Rheumatoid arthritis with rheumatoid factor└M05.0Felty's syndrome└M05.06Felty's syndrome, knee└M05.069Felty's syndrome, unspecified knee
└M05.069Felty's syndrome, unspecified knee

Because M05.069 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

M05.069 maps to CMS-HCC V28 category 93, Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because M05.069 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

More on M05.069

Related condition guides

Work M05.069 in HCC Buddy

Open M05.069 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

Open in Code BookOpen in EncoderStart Pro