M08.969 ICD-10-CM Code: Juvenile arthritis, unspecified, unspecified knee
M08.969 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
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)
M08.969
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceJuvenile arthritis, unspecified, unspecified knee
A type of arthritis that develops in children affecting the knee, but the specific knee (left or right) is not documented or is bilateral.
Buddy Insight
Juvenile arthritis of unspecified knee indicates chronic inflammatory joint disease in a weight-bearing joint that can significantly affect ambulation and development in children.
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 M08.969. 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 M08.969. Check the code and parent instructions in the Code Book.
Excludes 1
Official- arthropathy in Whipple's disease (M14.8)Inherited from M08, M08.9
- Felty's syndrome (M05.0)Inherited from M08, M08.9
- juvenile dermatomyositis (M33.0-)Inherited from M08, M08.9
- psoriatic juvenile arthropathy (L40.54)Inherited from M08, M08.9
- juvenile rheumatoid arthritis, unspecified (M08.0-)Inherited from M08, M08.9
Code First
OfficialNo Code First sequencing instructions are included in this display for M08.969. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for M08.969. Check the code and parent instructions in the Code Book.
Code Also
Official- any associated underlying condition, such as:Inherited from M08
- regional enteritis [Crohn's disease] (K50.-)Inherited from M08
- ulcerative colitis (K51.-)Inherited from M08
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 M08.969 an HCC code?
Yes. M08.969 (Juvenile arthritis, unspecified, 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: M08.969 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
- M08.969
- Description
- Juvenile arthritis, unspecified, 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 M08.969 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for M08.969
For M08.969, 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
Get the V28 mapping + MEAT cheat sheet
One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
M08.969 is the ICD-10-CM diagnosis code for juvenile arthritis, unspecified, unspecified knee. A type of arthritis that develops in children affecting the knee, but the specific knee (left or right) is not documented or is bilateral. M08.969 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, M08.969 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.
This unspecified code should only be used when laterality is truly unknown or not documented. For M08.969, 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 M08.969 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This unspecified code should only be used when laterality is truly unknown or not documented
- •Query the provider if laterality can be determined from imaging or clinical findings
Clinical Significance
Juvenile arthritis of unspecified knee indicates chronic inflammatory joint disease in a weight-bearing joint that can significantly affect ambulation and development in children. This condition requires specialized pediatric rheumatology care and ongoing monitoring to prevent long-term joint damage and functional limitations.
Documentation Requirements
- ✓Patient age at arthritis onset (under 16 years)
- ✓Evidence of chronic arthritis lasting 6 weeks or longer
- ✓Knee joint involvement without laterality specification
- ✓Documentation of inflammatory signs and symptoms
- ✓Exclusion of other arthritis causes (infectious, traumatic)
- ✓Functional impact assessment on mobility
- ✓Current medications and treatment response
- ✓Appropriate imaging and laboratory studies