Skip to main content

M00.269 ICD-10-CM Code: Other streptococcal arthritis, unspecified knee

Compare with another codeCheck this code on a claim

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

Coding at a Glance

Tabular directives
1 Excludes2 · 1 use-additional code
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 39

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too; the Instructions section marks which is which.

Use additional codeReport with this code when documented
  • code (B95.0-B95.2, B95.4-B95.5) to identify bacterial agent
Excludes2Not included here; may be reported together
  • infection and inflammatory reaction due to internal joint prosthesis (T84.5-)

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

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 v44, Appendix B.

  • 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 M00.269 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on M00.269 itself; “inherited from” names the category or block whose note applies here.

Excludes2 — Not Included Here

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

Source: inherited from M00

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code (B95.0-B95.2, B95.4-B95.5) to identify bacterial agent
    B95.0-B95.2: B95.0, B95.1, B95.2B95.4-B95.5: B95.4, B95.5

Source: inherited from M00.2

Coder workflow for M00.269

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

Before you code M00.269

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, M00.269 may be the appropriate code. Check the record for detail that supports a more specific sibling. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    ReviewM00.261, M00.262

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: unspecified). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

    ReviewM00.261 · right, M00.262 · left

    Guide: Laterality coding →

Choose the right path

  1. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — M00.269 is appropriate when the documentation goes no further.

    ReviewM00.261, M00.262

  2. Is the side documented?
    Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
    No → Use the unspecified-side code only when the record states no side; a query is the alternative.

    ReviewM00.261 · right, M00.262 · left

Consider M00.269. Then work the Use Additional Code note, and 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).
Laterality
Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes2 — not part of M00.269(1 note)

    Coding workflow: The conditions named in this note are not included in M00.269. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareT84.5

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

  • Use Additional Code — after identifying M00.269(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with M00.269 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

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

Documentation: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the specific siblings in this subcategory and what each requires the record to state.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

ReviewM00.261, M00.262

Documentation: The record documents the condition on one side only.

Coding question: Which code in this family applies?

Path: Select the sibling code for the documented side.

Reason: Laterality is assigned from the documented side; the unspecified-side code is for records that state no side (Guidelines I.B.13).

ReviewM00.261 · right, M00.262 · left

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with M00.269?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

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.

Don’t confuse M00.269 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of M00.269 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • M00.261— Laterality relationship (Review)

    Same condition; these differ only in which side is documented.

    The same condition on the other side; the documented side decides, and a bilateral code, where one exists, replaces the pair when both sides are documented.

    What moves you there: A documented right side moves the case to M00.261.

    Full comparison: M00.269 vs M00.261 →

  • M00.262— Laterality relationship (Review)

    Same condition; these differ only in which side is documented.

    The same condition on the other side; the documented side decides, and a bilateral code, where one exists, replaces the pair when both sides are documented.

    What moves you there: A documented left side moves the case to M00.262.

    Full comparison: M00.269 vs M00.262 →

  • T84.5— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of infection and inflammatory reaction due to internal joint prosthesis adds T84.5; it is not part of this code and both may be reported when both are documented.

    Full comparison: M00.269 vs T84.5 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Other streptococcal arthritis, unspecified knee is a billable ICD-10-CM diagnosis code (M00.269).

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

Verify Before Coding

  • CC as a secondary diagnosis (FY2027). Can raise the stay's MS-DRG severity tier.

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-derived relationships — computed from published CMS and AHRQ datasets

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 447 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: 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):MUS001 — Infective arthritis (default); INF003 — Bacterial infections.

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 condition, opposite side

Same category and title, differing only in which side of the body is affected.

M00.261 — Other streptococcal arthritis, right knee (right)Compare M00.269 vs M00.261 →, M00.262 — Other streptococcal arthritis, left knee (left)Compare M00.269 vs M00.262 →

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.

M00.232 — Other streptococcal arthritis, left wrist, M00.239 — Other streptococcal arthritis, unspecified wrist, M00.241 — Other streptococcal arthritis, right hand, M00.242 — Other streptococcal arthritis, left hand, M00.249 — Other streptococcal arthritis, unspecified hand, M00.251 — Other streptococcal arthritis, right hip, M00.252 — Other streptococcal arthritis, left hip, M00.259 — Other streptococcal arthritis, unspecified hip, M00.261 — Other streptococcal arthritis, right knee, M00.262 — Other streptococcal arthritis, left knee, M00.271 — Other streptococcal arthritis, right ankle and foot, M00.272 — Other streptococcal arthritis, left ankle and foot, M00.279 — Other streptococcal arthritis, unspecified ankle and foot, M00.28 — Other streptococcal arthritis, vertebrae, M00.29 — Other streptococcal polyarthritis, M00.80 — Arthritis due to other bacteria, unspecified joint, M00.811 — Arthritis due to other bacteria, right shoulder, M00.812 — Arthritis due to other bacteria, left shoulder, M00.819 — Arthritis due to other bacteria, unspecified shoulder, M00.821 — Arthritis due to other bacteria, right elbow, +588 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Infective arthritis, Bacterial infections).

M00.232 — Other streptococcal arthritis, left wrist, M00.239 — Other streptococcal arthritis, unspecified wrist, M00.241 — Other streptococcal arthritis, right hand, M00.242 — Other streptococcal arthritis, left hand, M00.249 — Other streptococcal arthritis, unspecified hand, M00.251 — Other streptococcal arthritis, right hip, M00.252 — Other streptococcal arthritis, left hip, M00.259 — Other streptococcal arthritis, unspecified hip, M00.261 — Other streptococcal arthritis, right knee, M00.262 — Other streptococcal arthritis, left knee, M00.271 — Other streptococcal arthritis, right ankle and foot, M00.272 — Other streptococcal arthritis, left ankle and foot, M00.279 — Other streptococcal arthritis, unspecified ankle and foot, M00.28 — Other streptococcal arthritis, vertebrae, M00.29 — Other streptococcal polyarthritis, M00.80 — Arthritis due to other bacteria, unspecified joint, M00.811 — Arthritis due to other bacteria, right shoulder, M00.812 — Arthritis due to other bacteria, left shoulder, M00.819 — Arthritis due to other bacteria, unspecified shoulder, M00.821 — Arthritis due to other bacteria, right elbow, +411 more

Same Index main term, other category

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

E85.4 — Organ-limited amyloidosis (in, amyloidosis), E88.9 — Metabolic disorder, unspecified (in, metabolic disorder NEC), G95.0 — Syringomyelia and syringobulbia (in, syringomyelia), G98.0 — Neurogenic arthritis, not elsewhere classified (in, neurological disorder NEC), J98.9 — Respiratory disorder, unspecified (in, respiratory disorder NEC), L40.50 — Arthropathic psoriasis, unspecified (psoriatic), L40.52 — Psoriatic arthritis mutilans (mutilans), L40.54 — Psoriatic juvenile arthropathy (juvenile, psoriatic), L51.9 — Erythema multiforme, unspecified (in, erythema, multiforme), L52 — Erythema nodosum (in, erythema, nodosum), M04.1 — Periodic fever syndromes (in, Mediterranean fever, familial), M05.70 — Rheumatoid arthritis with rheumatoid factor of unspecified site without organ or systems involvement (rheumatoid, seropositive, without organ involvement), M05.71 — Rheumatoid arthritis with rheumatoid factor of shoulder without organ or systems involvement (rheumatoid, seropositive, without organ involvement, shoulder), M05.72 — Rheumatoid arthritis with rheumatoid factor of elbow without organ or systems involvement (rheumatoid, seropositive, without organ involvement, elbow), M05.73 — Rheumatoid arthritis with rheumatoid factor of wrist without organ or systems involvement (rheumatoid, seropositive, without organ involvement, wrist), M05.74 — Rheumatoid arthritis with rheumatoid factor of hand without organ or systems involvement (rheumatoid, seropositive, without organ involvement, hand joint), M05.75 — Rheumatoid arthritis with rheumatoid factor of hip without organ or systems involvement (rheumatoid, seropositive, without organ involvement, hip), M05.76 — Rheumatoid arthritis with rheumatoid factor of knee without organ or systems involvement (rheumatoid, seropositive, without organ involvement, knee), M05.77 — Rheumatoid arthritis with rheumatoid factor of ankle and foot without organ or systems involvement (rheumatoid, seropositive, without organ involvement, ankle), M05.79 — Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement (rheumatoid, seropositive, without organ involvement, multiple sites), +153 more

Contextual Map

Every relationship of M00.269 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.

Hierarchy

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

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2027
  • DRG 548 — SEPTIC ARTHRITIS WITH MCC[MS-DRG]: “SEPTIC ARTHRITIS WITH MCC (MDC 08)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027
  • DRG 549 — SEPTIC ARTHRITIS WITH CC[MS-DRG]: “SEPTIC ARTHRITIS WITH CC (MDC 08)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027
  • DRG 550 — SEPTIC ARTHRITIS WITHOUT CC/MCC[MS-DRG]: “SEPTIC ARTHRITIS WITHOUT CC/MCC (MDC 08)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027

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. 18,439 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Nearest codes (40)

Change history

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

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 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 — v44 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-derived 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 editorial 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 20, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "M00.269 — Other streptococcal arthritis, unspecified knee." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/m00.269-other-streptococcal-arthritis-unspecified-knee

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Other streptococcal arthritis, unspecified knee

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, 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 M00.269 in its code family, with their registry titles.

View all codes in the M00 family