M12.869
BillableOther specific arthropathies, not elsewhere classified, unspecified knee
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M12.869 an HCC code?
No. M12.869 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
M12.869 is the ICD-10-CM diagnosis code for other specific arthropathies, not elsewhere classified, unspecified knee. A joint disorder affecting the knee (side not specified) that doesn't fit into other specific arthropathy categories. This code is used when laterality cannot be determined from the documentation. M12.869 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).
M12.869 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.
Use only when documentation does not specify right or left knee; query provider if laterality can be determined.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M12.869 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when documentation does not specify right or left knee; query provider if laterality can be determined
- •This is a less specific code; attempt to obtain laterality information for more precise coding