What is ICD-10 code M08.249?

M08.249 is the ICD-10-CM diagnosis code for Juvenile rheumatoid arthritis with systemic onset, unspecified hand. A type of childhood arthritis affecting the hand with systemic symptoms when the specific side (left or right) is not documented or both sides are involved. M08.249 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. M08.249 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. M08.249 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. M08.249 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does M08.249 map to under V28?

M08.249 maps to CMS-HCC V28 HCC 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM M08.249: Juvenile rheumatoid

M08.249 maps to CMS-HCC V28 93. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupM08.249Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

M08.249

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

Juvenile rheumatoid arthritis with systemic onset, unspecified hand

A type of childhood arthritis affecting the hand with systemic symptoms when the specific side (left or right) is not documented or both sides are involved.

Buddy Insight

Juvenile rheumatoid arthritis with systemic onset represents a severe form of childhood arthritis with significant systemic inflammation requiring intensive management.

CMS-HCC V28

Mapped

HCC 93

Rheumatoid Arthritis and Othe...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 056

HHS-HCC 056 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 40

Rheumatoid Arthritis and Infl...

Code-level coefficient reference

RXHCC

Mapped

HCC 83

Rheumatoid Arthritis and Othe...

Code-level coefficient reference

Code Book Path

Official

M08.2Juvenile rheumatoid arthritis with systemic onset

M08.24Juvenile rheumatoid arthritis with systemic onset, hand

M08.249Juvenile rheumatoid arthritis with systemic onset, unspecified hand

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M08.249 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M08.249 in this effective period.

Related Child Codes

Official

M08.241Juvenile rheumatoid arthritis with systemic onset, right hand

M08.242Juvenile rheumatoid arthritis with systemic onset, left hand

Includes

Official

ICD-10-CM does not list Includes notes for M08.249 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M08.249 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M08.249 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M08.249 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M08.249 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Patient age at onset (must be under 16 years)

Evidence of systemic symptoms (fever, rash, lymphadenopathy, hepatosplenomegaly)

Documentation of hand joint involvement without laterality specification or bilateral involvement

Laboratory evidence of systemic inflammation (elevated ESR, CRP)

MEAT Support

HCC Buddy guidance

Patient age at onset (must be under 16 years)

Evidence of systemic symptoms (fever, rash, lymphadenopathy, hepatosplenomegaly)

Documentation of hand joint involvement without laterality specification or bilateral involvement

Laboratory evidence of systemic inflammation (elevated ESR, CRP)

Audit Caution

HCC Buddy guidance

Using this code when laterality is clearly documented in the record

Failing to query physician for laterality when hand involvement is mentioned

Coding adult rheumatoid arthritis codes when patient had juvenile onset

Confusing unspecified hand with multiple site involvement

Common Mistakes

HCC Buddy guidance

M08.241 — Use when right hand specifically documented

M08.242 — Use when left hand specifically documented

M08.3 — Juvenile rheumatoid polyarthritis seronegative (affects multiple joints without systemic symptoms)

M06.9 — Rheumatoid arthritis, unspecified (for adult-onset 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 M08.249 an HCC code?

Yes. M08.249 (Juvenile rheumatoid arthritis with systemic onset, unspecified hand) 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: M08.249 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: M08.249
Description: Juvenile rheumatoid arthritis with systemic onset, unspecified hand
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

V28HCC 93, Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders

0.617

ESRDHCC 40, Rheumatoid Arthritis and Inflammatory Connective Tissue Disease

Not separately weighted

RxHCCHCC 83, Rheumatoid Arthritis and Other Inflammatory Polyarthropathy

Not separately weighted

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 M08.249 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for M08.249

For M08.249 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 M08.249 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

M08.249 is the ICD-10-CM diagnosis code for juvenile rheumatoid arthritis with systemic onset, unspecified hand. A type of childhood arthritis affecting the hand with systemic symptoms when the specific side (left or right) is not documented or both sides are involved. M08.249 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, M08.249 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. No V24 mapping is shown for M08.249; use the applicable model and payment year when reviewing the V28 mapping. 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. 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 hand laterality is not specified in documentation. Because M08.249 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 M08.249 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 hand laterality is not specified in documentation
•Request clarification from provider regarding which hand(s) are affected for more precise coding

Clinical Significance

Juvenile rheumatoid arthritis with systemic onset represents a severe form of childhood arthritis with significant systemic inflammation requiring intensive management. This diagnosis indicates high healthcare resource utilization with potential for serious complications including growth retardation, joint destruction, and multi-organ involvement.

Documentation Requirements

✓Patient age at onset (must be under 16 years)
✓Evidence of systemic symptoms (fever, rash, lymphadenopathy, hepatosplenomegaly)
✓Documentation of hand joint involvement without laterality specification or bilateral involvement
✓Laboratory evidence of systemic inflammation (elevated ESR, CRP)
✓Exclusion of other causes of arthritis and systemic illness
✓Duration of symptoms (minimum 6 weeks for JRA diagnosis)
✓Physical examination findings of joint swelling, warmth, or limited range of motion
✓Assessment of functional impact on activities of daily living

Commonly Confused Codes

•M08.241: Use when right hand specifically documented
•M08.242: Use when left hand specifically documented
•M08.3: Juvenile rheumatoid polyarthritis seronegative (affects multiple joints without systemic symptoms)
•M06.9: Rheumatoid arthritis, unspecified (for adult-onset rheumatoid arthritis)
•M79.3: Panniculitis, unspecified (may be confused due to systemic symptoms)