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A54.42 ICD-10-CM Code: Gonococcal arthritis

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
2 Excludes1 · 2 Excludes2
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 39

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 485 — KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC (MDC 08)
  • MS-DRG 486 — KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC (MDC 08)
  • MS-DRG 487 — KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC (MDC 08)
  • MS-DRG 548 — SEPTIC ARTHRITIS WITH MCC (MDC 08)
  • MS-DRG 549 — SEPTIC ARTHRITIS WITH CC (MDC 08)
  • MS-DRG 550 — SEPTIC ARTHRITIS WITHOUT CC/MCC (MDC 08)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis

Other models: CMS-HCC V22 HCC 39

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for A54.42 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on A54.42 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from A50-A64

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Coder workflow for A54.42

MedCoder structured workflow — derived from this code’s own official record

Before you code A54.42

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with A54.42. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in A54.42’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewN34.1, M02.3

Consider A54.42. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Official instructions as workflow

  • Excludes1 — check before selecting A54.42(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with A54.42: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareN34.1, M02.3

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of A54.42(2 notes)

    Coding workflow: The conditions named in this note are not included in A54.42. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareA54.41, B20

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition A54.42 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewN34.1, M02.3

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Gonococcal arthritis is a billable ICD-10-CM diagnosis code (A54.42).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (6)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name A54.42 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: M01 — Direct infections of joint in infectious and parasitic diseases classified elsewhere.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 7 Excludes2 notes across 2 chapters: N34 — Urethritis and urethral syndrome (via A54.-), P35 — Congenital viral diseases (via A54.-), P35-P39 — Infections specific to the perinatal period (P35-P39) (via A54.-), P36 — Bacterial sepsis of newborn (via A54.-), P37 — Other congenital infectious and parasitic diseases (via A54.-), P38 — Omphalitis of newborn (via A54.-), P39 — Other infections specific to the perinatal period (via A54.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 6 MS-DRGs: DRG 485 (MDC 08), DRG 486 (MDC 08), DRG 487 (MDC 08), DRG 548 (MDC 08), DRG 549 (MDC 08), DRG 550 (MDC 08).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):INF010 — Sexually transmitted infections (excluding HIV and hepatitis) (default); MUS001 — Infective arthritis.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis) for risk-adjusted payment.

A01.04 — Typhoid arthritis, A01.05 — Typhoid osteomyelitis, A02.23 — Salmonella arthritis, A02.24 — Salmonella osteomyelitis, A39.83 — Meningococcal arthritis, A39.84 — Postmeningococcal arthritis, A50.55 — Late congenital syphilitic arthropathy, A54.40 — Gonococcal infection of musculoskeletal system, unspecified, A54.41 — Gonococcal spondylopathy, A54.43 — Gonococcal osteomyelitis, A54.49 — Gonococcal infection of other musculoskeletal tissue, A66.6 — Bone and joint lesions of yaws, A69.23 — Arthritis due to Lyme disease, B06.82 — Rubella arthritis, B26.85 — Mumps arthritis, B42.82 — Sporotrichosis arthritis, M00.00 — Staphylococcal arthritis, unspecified joint, M00.011 — Staphylococcal arthritis, right shoulder, M00.012 — Staphylococcal arthritis, left shoulder, M00.019 — Staphylococcal arthritis, unspecified shoulder, +588 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Sexually transmitted infections (excluding HIV and hepatitis), Infective arthritis).

A54.23 — Gonococcal infection of other male genital organs, A54.24 — Gonococcal female pelvic inflammatory disease, A54.29 — Other gonococcal genitourinary infections, A54.30 — Gonococcal infection of eye, unspecified, A54.31 — Gonococcal conjunctivitis, A54.32 — Gonococcal iridocyclitis, A54.33 — Gonococcal keratitis, A54.39 — Other gonococcal eye infection, A54.40 — Gonococcal infection of musculoskeletal system, unspecified, A54.41 — Gonococcal spondylopathy, A54.43 — Gonococcal osteomyelitis, A54.49 — Gonococcal infection of other musculoskeletal tissue, A54.5 — Gonococcal pharyngitis, A54.6 — Gonococcal infection of anus and rectum, A54.81 — Gonococcal meningitis, A54.82 — Gonococcal brain abscess, A54.83 — Gonococcal heart infection, A54.84 — Gonococcal pneumonia, A54.85 — Gonococcal peritonitis, A54.86 — Gonococcal sepsis, +270 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Hydrarthrosis”, “Arthritis, arthritic”; these codes share that main term but sit in a different category of the Tabular List.

A25.1 — Streptobacillosis (epidemic erythema), A30.9 — Leprosy, unspecified (in, leprosy), A31.8 — Other mycobacterial infections (due to or associated with, mycobacteria), A39.83 — Meningococcal arthritis (meningococcal), A39.84 — Postmeningococcal arthritis (postmeningococcal), A46 — Erysipelas (due to or associated with, erysipelas), A49.9 — Bacterial infection, unspecified (in, bacterial disease), A50.55 — Late congenital syphilitic arthropathy (syphilitic, congenital), A52.16 — Charcôt's arthropathy (tabetic) (syphilitic), A52.77 — Syphilis of bone and joint (syphilitic), A66.6 — Bone and joint lesions of yaws (of yaws), A69.23 — Arthritis due to Lyme disease (in, Lyme disease), A92.1 — O'nyong-nyong fever (in, O'nyong-nyong), B06.82 — Rubella arthritis (rubella), B26.85 — Mumps arthritis (in, mumps), B34.9 — Viral infection, unspecified (in, viral disease NEC), B42.82 — Sporotrichosis arthritis (in, sporotrichosis), B49 — Unspecified mycosis (mycotic NEC), B72 — Dracunculiasis (in, dracontiasis), B74.9 — Filariasis, unspecified (chylous), +208 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

HIV Screening Test

Contextual Map

Every relationship of A54.42 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run A54.42 with these 9 related codes in Claim Check

Hierarchy

Excludes2

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 08 — Diseases and Disorders of the Musculoskeletal System and Connective Tissue[MDC crossing]: “Diseases and Disorders of the Musculoskeletal System and Connective Tissue — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 18,508 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Arthritis, arthritic (acute) (chronic) (nonpyogenic) (subacute), blennorrhagic (gonococcal)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Arthritis, arthritic (acute) (chronic) (nonpyogenic) (subacute), gonococcal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Gonococcus, gonococcal (disease) (infection), joint[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Gonococcus, gonococcal (disease) (infection), musculoskeletal, arthritis[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Hydrarthrosis, gonococcal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Periarthritis (joint), gonococcal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (36)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Gonococcal arthritis

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to A54.42 in its code family, with their registry titles.

View all codes in the A54 family