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M06.38 ICD-10-CM Code: Rheumatoid nodule, vertebrae

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

Coding at a Glance

Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 40 · RxHCC V08 category 83

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 545 — CONNECTIVE TISSUE DISORDERS WITH MCC (MDC 08)
  • MS-DRG 546 — CONNECTIVE TISSUE DISORDERS WITH CC (MDC 08)
  • MS-DRG 547 — CONNECTIVE TISSUE DISORDERS 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 93 — Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders (supersedes HCC 94)

Other models: CMS-HCC V22 HCC 40 · RxHCC V08 HCC 83

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

Code Overview

Rheumatoid nodule, vertebrae is a billable ICD-10-CM diagnosis code (M06.38).

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 (1)

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 M06.38 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 2 Code First instructions: J84.170 — Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere (via M06.-), J84.178 — Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere (via M06.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

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 3 MS-DRGs: DRG 545 (MDC 08), DRG 546 (MDC 08), DRG 547 (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):MUS003 — Rheumatoid arthritis and related disease (default).

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 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders) for risk-adjusted payment.

M06.349 — Rheumatoid nodule, unspecified hand, M06.351 — Rheumatoid nodule, right hip, M06.352 — Rheumatoid nodule, left hip, M06.359 — Rheumatoid nodule, unspecified hip, M06.361 — Rheumatoid nodule, right knee, M06.362 — Rheumatoid nodule, left knee, M06.369 — Rheumatoid nodule, unspecified knee, M06.371 — Rheumatoid nodule, right ankle and foot, M06.372 — Rheumatoid nodule, left ankle and foot, M06.379 — Rheumatoid nodule, unspecified ankle and foot, M06.39 — Rheumatoid nodule, multiple sites, M06.80 — Other specified rheumatoid arthritis, unspecified site, M06.811 — Other specified rheumatoid arthritis, right shoulder, M06.812 — Other specified rheumatoid arthritis, left shoulder, M06.819 — Other specified rheumatoid arthritis, unspecified shoulder, M06.821 — Other specified rheumatoid arthritis, right elbow, M06.822 — Other specified rheumatoid arthritis, left elbow, M06.829 — Other specified rheumatoid arthritis, unspecified elbow, M06.831 — Other specified rheumatoid arthritis, right wrist, M06.832 — Other specified rheumatoid arthritis, left wrist, +487 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Rheumatoid arthritis and related disease).

+340 more

Same Index main term, other category

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

A52.77 — Syphilis of bone and joint (juxta-articular, syphilitic), A66.7 — Other manifestations of yaws (juxta-articular, yaws), B08.03 — Pseudocowpox [milker's node] (milker's), D26.1 — Other benign neoplasm of corpus uteri (endometrial), E04.1 — Nontoxic single thyroid nodule (thyroid), E05.20 — Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm (thyroid, with thyrotoxicosis), E05.21 — Thyrotoxicosis with toxic multinodular goiter with thyrotoxic crisis or storm (thyroid, with thyrotoxicosis, with thyroid storm), J38.2 — Nodules of vocal cords (singer's), J38.7 — Other diseases of larynx (larynx), M15.8 — Other polyosteoarthritis (Haygarth's), N40.2 — Nodular prostate without lower urinary tract symptoms (prostate), N40.3 — Nodular prostate with lower urinary tract symptoms (prostate, with lower urinary tract symptoms), N49.2 — Inflammatory disorders of scrotum (scrotum), N63.0 — Unspecified lump in unspecified breast (breast NEC), R09.89 — Other specified symptoms and signs involving the circulatory and respiratory systems (retrocardiac), R91.1 — Solitary pulmonary nodule (solitary, lung), R91.8 — Other nonspecific abnormal finding of lung field (solitary, lung, multiple)

Contextual Map

Every relationship of M06.38 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 M06.38 with these 2 related codes in Claim Check

Hierarchy

Referenced by Code First instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 93 — Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders [CMS-HCC]: “Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders — supersedes HCC 94 (Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders)”— 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

  • Nodule, nodular (s), rheumatoid, vertebra[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

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

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

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. "M06.38 — Rheumatoid nodule, vertebrae." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/m06.38-rheumatoid-nodule-vertebrae

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Rheumatoid nodule, vertebrae

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 M06.38 in its code family, with their registry titles.

View all codes in the M06 family