M12.569
BillableTraumatic arthropathy, unspecified knee
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M12.569 an HCC code?
No. M12.569 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
M12.569 is the ICD-10-CM diagnosis code for traumatic arthropathy, unspecified knee. Joint damage in the knee caused by trauma or injury when the specific knee (right or left) is not specified. M12.569 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).
M12.569 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Avoid using this code if laterality can be determined; it is less specific than lateralized codes.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M12.569 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Avoid using this code if laterality can be determined; it is less specific than lateralized codes
- •Query provider documentation if knee involvement is mentioned without clear side specification