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94 HCC

Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders

CMS Model V28 71 Associated ICD-10 Diagnoses

Relative Risk Score Factors (Coefficients for HCC 94)

Enrollment Model Type Coeff Tag Year Weight Score
CFA HCC94 2026 + 0.237
CFD HCC94 2026 + 0.250
CNA HCC94 2026 + 0.268
CND HCC94 2026 + 0.239
CPA HCC94 2026 + 0.224
CPD HCC94 2026 + 0.196
INS HCC94 2026 + 0.297

Mapped ICD-10-CM Diagnoses (71)

The following diagnoses map directly to HCC 94 under the V28 risk adjustment model:

ICD-10 Code Clinical Diagnosis Description Guideline
M02.30 Reiter's disease, unspecified site Notes ↗
M02.311 Reiter's disease, right shoulder Notes ↗
M02.312 Reiter's disease, left shoulder Notes ↗
M02.319 Reiter's disease, unspecified shoulder Notes ↗
M02.321 Reiter's disease, right elbow Notes ↗
M02.322 Reiter's disease, left elbow Notes ↗
M02.329 Reiter's disease, unspecified elbow Notes ↗
M02.331 Reiter's disease, right wrist Notes ↗
M02.332 Reiter's disease, left wrist Notes ↗
M02.339 Reiter's disease, unspecified wrist Notes ↗
M02.341 Reiter's disease, right hand Notes ↗
M02.342 Reiter's disease, left hand Notes ↗
M02.349 Reiter's disease, unspecified hand Notes ↗
M02.351 Reiter's disease, right hip Notes ↗
M02.352 Reiter's disease, left hip Notes ↗
M02.359 Reiter's disease, unspecified hip Notes ↗
M02.361 Reiter's disease, right knee Notes ↗
M02.362 Reiter's disease, left knee Notes ↗
M02.369 Reiter's disease, unspecified knee Notes ↗
M02.371 Reiter's disease, right ankle and foot Notes ↗
M02.372 Reiter's disease, left ankle and foot Notes ↗
M02.379 Reiter's disease, unspecified ankle and foot Notes ↗
M02.38 Reiter's disease, vertebrae Notes ↗
M02.39 Reiter's disease, multiple sites Notes ↗
M04.1 Periodic fever syndromes Notes ↗
M04.2 Cryopyrin-associated periodic syndromes Notes ↗
M04.8 Other autoinflammatory syndromes Notes ↗
M04.9 Autoinflammatory syndrome, unspecified Notes ↗
M06.4 Inflammatory polyarthropathy Notes ↗
M12.00 Chronic postrheumatic arthropathy [Jaccoud], unspecified site Notes ↗
M12.011 Chronic postrheumatic arthropathy [Jaccoud], right shoulder Notes ↗
M12.012 Chronic postrheumatic arthropathy [Jaccoud], left shoulder Notes ↗
M12.019 Chronic postrheumatic arthropathy [Jaccoud], unspecified shoulder Notes ↗
M12.021 Chronic postrheumatic arthropathy [Jaccoud], right elbow Notes ↗
M12.022 Chronic postrheumatic arthropathy [Jaccoud], left elbow Notes ↗
M12.029 Chronic postrheumatic arthropathy [Jaccoud], unspecified elbow Notes ↗
M12.031 Chronic postrheumatic arthropathy [Jaccoud], right wrist Notes ↗
M12.032 Chronic postrheumatic arthropathy [Jaccoud], left wrist Notes ↗
M12.039 Chronic postrheumatic arthropathy [Jaccoud], unspecified wrist Notes ↗
M12.041 Chronic postrheumatic arthropathy [Jaccoud], right hand Notes ↗
M12.042 Chronic postrheumatic arthropathy [Jaccoud], left hand Notes ↗
M12.049 Chronic postrheumatic arthropathy [Jaccoud], unspecified hand Notes ↗
M12.051 Chronic postrheumatic arthropathy [Jaccoud], right hip Notes ↗
M12.052 Chronic postrheumatic arthropathy [Jaccoud], left hip Notes ↗
M12.059 Chronic postrheumatic arthropathy [Jaccoud], unspecified hip Notes ↗
M12.061 Chronic postrheumatic arthropathy [Jaccoud], right knee Notes ↗
M12.062 Chronic postrheumatic arthropathy [Jaccoud], left knee Notes ↗
M12.069 Chronic postrheumatic arthropathy [Jaccoud], unspecified knee Notes ↗
M12.071 Chronic postrheumatic arthropathy [Jaccoud], right ankle and foot Notes ↗
M12.072 Chronic postrheumatic arthropathy [Jaccoud], left ankle and foot Notes ↗
M12.079 Chronic postrheumatic arthropathy [Jaccoud], unspecified ankle and foot Notes ↗
M12.08 Chronic postrheumatic arthropathy [Jaccoud], other specified site Notes ↗
M12.09 Chronic postrheumatic arthropathy [Jaccoud], multiple sites Notes ↗
M30.0 Polyarteritis nodosa Notes ↗
M30.2 Juvenile polyarteritis Notes ↗
M30.8 Other conditions related to polyarteritis nodosa Notes ↗
M31.5 Giant cell arteritis with polymyalgia rheumatica Notes ↗
M31.6 Other giant cell arteritis Notes ↗
M31.7 Microscopic polyangiitis Notes ↗
M31.8 Other specified necrotizing vasculopathies Notes ↗
M31.9 Necrotizing vasculopathy, unspecified Notes ↗
M32.10 Systemic lupus erythematosus, organ or system involvement unspecified Notes ↗
M32.11 Endocarditis in systemic lupus erythematosus Notes ↗
M32.12 Pericarditis in systemic lupus erythematosus Notes ↗
M32.13 Lung involvement in systemic lupus erythematosus Notes ↗
M32.14 Glomerular disease in systemic lupus erythematosus Notes ↗
M32.15 Tubulo-interstitial nephropathy in systemic lupus erythematosus Notes ↗
M32.19 Other organ or system involvement in systemic lupus erythematosus Notes ↗
M32.8 Other forms of systemic lupus erythematosus Notes ↗
M32.9 Systemic lupus erythematosus, unspecified Notes ↗
M35.2 Behcet's disease Notes ↗
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