M08.469 ICD-10-CM Code: Pauciarticular juvenile rheumatoid arthritis, unspecified knee
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Inflammatory polyarthropathies (M05-M14)
M08.469
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePauciarticular juvenile rheumatoid arthritis, unspecified knee
A type of childhood arthritis affecting only a few joints in the knee area, but the specific side (left or right) is not documented or specified.
Buddy Insight
Pauciarticular juvenile rheumatoid arthritis affecting an unspecified knee represents a chronic inflammatory condition requiring specialized pediatric rheumatologic management.
CMS-HCC V28
MappedHCC 93
RAF 0.175
CMS-HCC V24
MappedHCC 40
RAF 0.307
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 40
RAF 0.0
RXHCC
MappedHCC 83
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for M08.469 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M08.469 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M08.469 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M08.469 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M08.469 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M08.469 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M08.469 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is M08.469 an HCC code?
Yes. M08.469 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease under the CMS-HCC V28 risk adjustment model (and Rheumatoid Arthritis and Inflammatory Connective Tissue Disease under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for M08.469
For M08.469to 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 M08.469 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
M08.469 is the ICD-10-CM diagnosis code for pauciarticular juvenile rheumatoid arthritis, unspecified knee. A type of childhood arthritis affecting only a few joints in the knee area, but the specific side (left or right) is not documented or specified. M08.469 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, M08.469 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease (HCC 93) with a community, non-dual, aged base RAF weight of 0.175. Under the older V24 model, M08.469 mapped to the same category but with a base RAF weight of 0.307, V28 recalibrated weights across the entire model. 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 this code only when knee involvement is confirmed but laterality cannot be determined. Because M08.469 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 M08.469 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 confirmed but laterality cannot be determined
- •Request clarification from the provider regarding which knee is affected
Clinical Significance
Pauciarticular juvenile rheumatoid arthritis affecting an unspecified knee represents a chronic inflammatory condition requiring specialized pediatric rheumatologic management. Knee involvement in juvenile arthritis can lead to significant functional impairment and growth abnormalities if not properly treated, making early intervention and ongoing monitoring essential for optimal outcomes.
Documentation Requirements
- ✓Established diagnosis of juvenile rheumatoid arthritis with pauciarticular pattern
- ✓Documentation of knee joint involvement without laterality specification
- ✓Clinical evidence of joint inflammation and functional limitation
- ✓Confirmation of pediatric age at onset
- ✓Laboratory studies supporting inflammatory arthritis diagnosis
- ✓Physical examination findings consistent with knee arthritis
- ✓Treatment protocols including anti-inflammatory medications
- ✓Monitoring plans for joint damage and growth complications
Commonly Confused Codes
- •M08.461: Specific right knee involvement versus unspecified knee
- •M08.462: Specific left knee involvement versus unspecified knee
- •M08.40: Unspecified site versus documented knee involvement
- •M25.569: Knee pain unspecified versus inflammatory arthritis
- •M08.2: Juvenile rheumatoid arthritis with systemic onset versus pauciarticular