M06.869 ICD-10-CM Code: Other specified rheumatoid arthritis, unspecified knee
M06.869 maps to CMS-HCC V28 93. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Inflammatory polyarthropathies (M05-M14)
M06.869
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther specified rheumatoid arthritis, unspecified knee
A form of rheumatoid arthritis affecting the knee joint when the specific side (left or right) is not documented or is bilateral.
Buddy Insight
Other specified rheumatoid arthritis of unspecified knee indicates an atypical RA variant affecting a major weight-bearing joint when laterality is not documented or bilateral involvement exists.
CMS-HCC V28
MappedHCC 93
Coefficient HCC 93: 0.617 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 056
Code-level coefficient reference
ESRD/PACE
MappedHCC 40
Code-level coefficient reference
RXHCC
MappedHCC 83
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for M06.869. Check the code and parent instructions in the Code Book.
Excludes 2
Official- arthropathic psoriasis (L40.5-)Inherited from M00-M99
- certain conditions originating in the perinatal period (P04-P96)Inherited from M00-M99
- certain infectious and parasitic diseases (A00-B99)Inherited from M00-M99
- compartment syndrome (traumatic) (T79.A-)Inherited from M00-M99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from M00-M99
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from M00-M99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from M00-M99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from M00-M99
- neoplasms (C00-D49)Inherited from M00-M99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from M00-M99
Related Codes
Includes
OfficialNo Includes notes are included in this display for M06.869. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for M06.869. Check the code and parent instructions in the Code Book.
Code First
OfficialNo Code First sequencing instructions are included in this display for M06.869. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for M06.869. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for M06.869. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 M06.869 an HCC code?
Yes. M06.869 (Other specified rheumatoid arthritis, unspecified knee) maps to HCC 93, Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.617. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: M06.869 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
- M06.869
- Description
- Other specified rheumatoid arthritis, unspecified knee
- HCC (V28)
- HCC 93 — Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders
- RAF reference coefficient
- 0.617
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work M06.869 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for M06.869
For M06.869, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
M06.869 is the ICD-10-CM diagnosis code for other specified rheumatoid arthritis, unspecified knee. A form of rheumatoid arthritis affecting the knee joint when the specific side (left or right) is not documented or is bilateral. M06.869 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, M06.869 maps to Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders (HCC 93) with a source-labeled community, non-dual, aged reference coefficient of 0.617. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Use this code only when knee involvement is documented but laterality is not specified. For M06.869, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for M06.869 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when knee involvement is documented but laterality is not specified
- •If bilateral knee involvement is documented, consider whether separate codes for each knee should be assigned
Clinical Significance
Other specified rheumatoid arthritis of unspecified knee indicates an atypical RA variant affecting a major weight-bearing joint when laterality is not documented or bilateral involvement exists. Knee arthritis significantly impacts mobility, ambulation, and functional independence.
Documentation Requirements
- ✓Established rheumatoid arthritis diagnosis with documented atypical features
- ✓Documentation of knee involvement without laterality specification
- ✓Clinical characteristics that classify this as 'other specified' RA variant
- ✓Assessment of knee function, stability, and weight-bearing limitations
- ✓Laboratory support for active rheumatoid inflammatory process
- ✓Evidence that laterality is truly unspecified or bilateral involvement
- ✓Functional evaluation of mobility, ambulation distance, and assistive device needs
- ✓Treatment approach addressing inflammatory control and functional mobility
Commonly Confused Codes
- •M06.861: Other specified rheumatoid arthritis, right knee (when laterality is documented)
- •M06.862: Other specified rheumatoid arthritis, left knee (when laterality is documented)
- •M06.80: Other specified rheumatoid arthritis, unspecified site (when knee location documented)
- •M05.869: Other rheumatoid arthritis with rheumatoid factor of unspecified knee (different RA classification)
- •M25.569: Pain in unspecified knee (symptom without inflammatory diagnosis)