M33.11 ICD-10-CM Code: Other dermatomyositis with respiratory involvement
M33.11 maps to CMS-HCC V28 93 (RAF 0.617). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools
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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Systemic connective tissue disorders (M30-M36)
M33.11
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther dermatomyositis with respiratory involvement
Dermatomyositis in adults with involvement of the lungs and respiratory system.
Buddy Insight
Adult dermatomyositis with respiratory involvement represents one of the most serious manifestations, often associated with anti-synthetase syndrome or other poor prognostic factors.
CMS-HCC V28
MappedHCC 93
RAF 0.617
+ HCC 280
CMS-HCC V24
MappedHCC 40
RAF 0.421
+ HCC 112
ACA/HHS
MappedHCC 56, 162
Varies by metal level
ESRD/PACE
MappedHCC 40
RAF 0.058
+ HCC 112
RXHCC
MappedHCC 83
RAF 0.222
+ HCC 227
Code Book Path
Inclusion Terms
Official- Adult dermatomyositis
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M33.11 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M33.11 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M33.11 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M33.11 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M33.11 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M33.11 in this effective period.
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 M33.11 an HCC code?
Yes. M33.11 (Other dermatomyositis with respiratory involvement) maps to Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders under the CMS-HCC V28 risk adjustment model (and Rheumatoid Arthritis and Inflammatory Connective Tissue Disease under V24), with a community non-dual aged RAF of 0.617. It is billable for payment year 2026.
Coder answer: M33.11 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
- M33.11
- Description
- Other dermatomyositis with respiratory involvement
- HCC (V28)
- HCC 93 — Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders
- RAF
- 0.617
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so 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 segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work M33.11 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for M33.11
For M33.11 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed M33.11 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
M33.11 is the ICD-10-CM diagnosis code for other dermatomyositis with respiratory involvement. Dermatomyositis in adults with involvement of the lungs and respiratory system. M33.11 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering systemic connective tissue disorders (m30-m36).
Under the CMS-HCC V28 risk adjustment model, M33.11 maps to Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders (HCC 93) with a community, non-dual, aged base RAF weight of 0.617. Under the older CMS-HCC V24 model, M33.11 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease (HCC 40) with a community, non-dual, aged base RAF weight of 0.421. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Respiratory involvement in adult dermatomyositis is a serious complication; document specific pulmonary findings. Because M33.11 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for M33.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Respiratory involvement in adult dermatomyositis is a serious complication; document specific pulmonary findings
- •Consider coding additional respiratory conditions if interstitial lung disease or other specific lung pathology is present
Clinical Significance
Adult dermatomyositis with respiratory involvement represents one of the most serious manifestations, often associated with anti-synthetase syndrome or other poor prognostic factors. This complication requires immediate pulmonology consultation and aggressive immunosuppressive therapy.
Documentation Requirements
- ✓Confirmed adult dermatomyositis diagnosis
- ✓Documentation of respiratory system involvement
- ✓Pulmonary function tests showing restriction or impairment
- ✓High-resolution chest CT showing interstitial changes
- ✓Exclusion of infectious or malignant causes
- ✓Autoantibody testing (anti-synthetase antibodies)
- ✓Treatment plan including lung-protective strategies
- ✓Monitoring plan for respiratory function