M23.629
BillableOther spontaneous disruption of posterior cruciate ligament of unspecified knee
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M23.629 an HCC code?
No. M23.629 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
M23.629 is the ICD-10-CM diagnosis code for other spontaneous disruption of posterior cruciate ligament of unspecified knee. A tear or rupture of the posterior cruciate ligament (PCL) in an unspecified knee that occurs suddenly without a major injury. M23.629 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).
M23.629 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 knee laterality cannot be determined from available documentation.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M23.629 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when knee laterality cannot be determined from available documentation
- •Attempt to clarify laterality through imaging reports or clinical assessment before defaulting to this code