Question 1

What is ICD-10 code M23.206?

Accepted Answer

M23.206 is the ICD-10-CM diagnosis code for derangement of unspecified meniscus due to old tear or injury, right knee. Damage to the cartilage (meniscus) of the right knee from an old tear or injury, when the specific type of meniscus is not specified. M23.206 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering other joint disorders (m20-m25).

M23.206 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.

This code is used when documentation does not clearly identify whether the damage is to the medial or lateral meniscus.

Question 2

Is M23.206 an HCC code?

Accepted Answer

No. M23.206 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is M23.206 billable?

Accepted Answer

Yes. M23.206 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. M23.206 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.

Question 4

What is the V28 vs V24 difference for M23.206?

Accepted Answer

M23.206 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards M23.206 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting M23.206?

Accepted Answer

This code is used when documentation does not clearly identify whether the damage is to the medial or lateral meniscus Review imaging reports and operative notes to determine if a more specific code (medial vs. lateral) can be assigned

M23.206

Is M23.206 an HCC code?

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