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M08.4A ICD-10-CM Code: Pauciarticular juvenile rheumatoid arthritis, other specified site

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

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, 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.

Official Registry Overview & Definition

Pauciarticular juvenile rheumatoid arthritis, other specified site is a billable ICD-10-CM diagnosis code (M08.4A).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for M08.4A in the official ICD-10-CM tabular list.

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).

Code Also

Additional codes that may be required to fully describe the encounter.

  • any associated underlying condition, such as:
  • regional enteritis Crohn's disease
  • ulcerative colitis (K51.-)

Indexed Clinical Terms (1)

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code.

  • Arthritis, arthritic (acute) (chronic) (nonpyogenic) (subacute), juvenile, pauciarticular, specified site NEC

Frequently Compared Codes

The official Excludes notes on M08.4A name these codes. Each comparison page covers when the two can — or must not — be reported together.

Change history

  • FY2021 — 2020-10-01
    Added to the code set
    Pauciarticular juvenile rheumatoid arthritis, other specified site
    FY2021 changes

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.

Relationships & Classification

Official ICD-10-CM tabular notes on other codes that name M08.4A or its code family.

1 Excludes1 notes: M05 (via M08.-).

Potential MS-DRG Relationships (FY2026)

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

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):MUS004 — Juvenile arthritis (default).

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

Contextual Map

Every relationship of M08.4A 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

  • M00-M99 — Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) (M00-M99) [Hierarchy]
  • M00-M25 — Arthropathies [Hierarchy]
  • M05-M14 — Inflammatory polyarthropathies [Hierarchy]

Referenced by Excludes1 notes

  • M05 — Rheumatoid arthritis with rheumatoid factor [Excludes1](via M08.-): “juvenile rheumatoid arthritis (M08.-)” · check together

Clinical classification (CCSR)

  • MUS004 — Juvenile arthritis [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)”

Potential MS-DRG

  • DRG 545 — CONNECTIVE TISSUE DISORDERS WITH MCC [MS-DRG]: “CONNECTIVE TISSUE DISORDERS WITH MCC (MDC 08)”
  • DRG 546 — CONNECTIVE TISSUE DISORDERS WITH CC [MS-DRG]: “CONNECTIVE TISSUE DISORDERS WITH CC (MDC 08)”
  • DRG 547 — CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC [MS-DRG]: “CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC (MDC 08)”

MDC crossing · procedures (18508)

  • 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.”
  • 005T0ZZ — Destruction of Spinal Meninges, Open Approach [Same-MDC procedure]: “Destruction of Spinal Meninges, Open Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005T3ZZ — Destruction of Spinal Meninges, Percutaneous Approach [Same-MDC procedure]: “Destruction of Spinal Meninges, Percutaneous Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005T4ZZ — Destruction of Spinal Meninges, Percutaneous Endoscopic Approach [Same-MDC procedure]: “Destruction of Spinal Meninges, Percutaneous Endoscopic Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005W0Z3 — Destruction of Cervical Spinal Cord using Laser Interstitial Thermal Therapy, Open Approach [Same-MDC procedure]: “Destruction of Cervical Spinal Cord using Laser Interstitial Thermal Therapy, Open Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005W0ZZ — Destruction of Cervical Spinal Cord, Open Approach [Same-MDC procedure]: “Destruction of Cervical Spinal Cord, Open Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • and 18503 more

Index entries

  • Arthritis, arthritic (acute) (chronic) (nonpyogenic) (subacute), juvenile, pauciarticular, specified site NEC[Index term]

Nearest codes (40)

  • M08 — Juvenile arthritis [Sibling]
  • M08.431 — Pauciarticular juvenile rheumatoid arthritis, right wrist [Sibling]
  • M08.432 — Pauciarticular juvenile rheumatoid arthritis, left wrist [Sibling]
  • M08.439 — Pauciarticular juvenile rheumatoid arthritis, unspecified wrist [Sibling]
  • M08.44 — Pauciarticular juvenile rheumatoid arthritis, hand [Sibling]
  • M08.441 — Pauciarticular juvenile rheumatoid arthritis, right hand [Sibling]
  • M08.442 — Pauciarticular juvenile rheumatoid arthritis, left hand [Sibling]
  • M08.449 — Pauciarticular juvenile rheumatoid arthritis, unspecified hand [Sibling]
  • and 32 more

Change history

  • FY2021 — Added to the code set [Change history]

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M08.4A in its code family, with their registry titles.

  • M08.47 — Pauciarticular juvenile rheumatoid arthritis, ankle and foot
  • M08.471 — Pauciarticular juvenile rheumatoid arthritis, right ankle and foot
  • M08.472 — Pauciarticular juvenile rheumatoid arthritis, left ankle and foot
  • M08.479 — Pauciarticular juvenile rheumatoid arthritis, unspecified ankle and foot
  • M08.48 — Pauciarticular juvenile rheumatoid arthritis, vertebrae
  • M08.8 — Other juvenile arthritis
  • M08.80 — Other juvenile arthritis, unspecified site
  • M08.81 — Other juvenile arthritis, shoulder
  • M08.811 — Other juvenile arthritis, right shoulder
  • M08.812 — Other juvenile arthritis, left shoulder

View all codes in the M08 family