2027 ICD-10-CM Diagnosis Code A69.23Arthritis due to Lyme disease
ICD-10-CM Codes›A00–B99›A65-A69›A69
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 92
- Not Chronic
A69.23 is a billable ICD-10-CM diagnosis code for arthritis due to Lyme disease. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 867 through 869. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 56 closely related codes. Coders also document this condition as arthritis caused by Spirochaetales. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Infective arthritis; and Parasitic, other specified and unspecified infections.
For Medicare Advantage risk adjustment, A69.23 maps to CMS-HCC Category 92 (Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis) under the V28 model, adding a risk factor of about 0.479 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
A69.23 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Arthritis caused by Spirochaetales
- Lyme arthritis
- Lyme arthritis of knee joint
- Skeletal Lyme disease
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to A69.23: its own notes plus those printed at block A65-A69 and Chapter 1. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- diseases generally recognized as communicable or transmissible
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- carrier or suspected carrier of infectious disease (Z22.-)
- certain localized infections - see body system-related chapters
- infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium (O98.-)
- infectious and parasitic diseases specific to the perinatal period (P35-P39)
- influenza and other acute respiratory infections (J00-J22)
Use Additional Code
Add a second code, after this one, to fully describe the condition.
- code to identify resistance to antimicrobial drugs (Z16.-)
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name A69.23, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming A69.23: they are not reported together with it, unless the two conditions are unrelated.
- M01 Direct infections of joint in infectious and parasitic diseases classified elsewherearthropathy in Lyme disease (A69.23)
- Block L49-L54 Urticaria and erythemaLyme disease (A69.2-) names A69.2-, which includes this code
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Lyme Disease
an infectious disease caused by a spirochete, borrelia burgdorferi, which is transmitted chiefly by ixodes dammini (see ixodes) and pacificus ticks in the united states and ixodes ricinis (see ixodes) in europe. it is a disease with early and late cutaneous manifestations plus involvement of the nervous system, heart, eye, and joints in variable combinations. the disease was formerly known as lyme arthritis and first discovered at old lyme, connecticut.
Patient EducationClinical
Infectious Arthritis
Most kinds of arthritis cause pain and swelling in your joints. Joints are places where two bones meet, such as your elbow or knee. Infectious arthritis is an infection in the joint. The infection comes from a bacterial, viral, or fungal infection that spreads from another part of the body. Symptoms of infectious arthritis include:
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert A69.23 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About A69.23Overview
What is the ICD-10 code for arthritis due to Lyme disease?
The ICD-10-CM code for arthritis due to Lyme disease is A69.23 (sometimes written as A6923). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is A69.23 (Lyme disease) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report arthritis due to Lyme disease on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does A69.23 group to?
When arthritis due to Lyme disease is the principal diagnosis on an inpatient stay, it groups to MS-DRG 867, 869, 868, with relative weights from 0.6784 to 2.1855 depending on complications. Higher weights mean higher Medicare reimbursement.
Is A69.23 a CC or MCC?
CMS lists A69.23 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 56 closely related codes in its exclusion list.
What is the ICD-9 equivalent of A69.23?
Under the General Equivalence Mappings, arthritis due to Lyme disease converts to ICD-9-CM 088.81 (Lyme disease). The mapping is approximate, so confirm the match fits the documentation.
What HCC is A69.23?
A69.23 (arthritis due to Lyme disease) maps to CMS-HCC Category 92 (Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis), commonly written as HCC 92, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 39 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does A69.23 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, A69.23 adds a risk adjustment factor of about 0.479 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.471 to 0.632 depending on the payment segment). HCC 92 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 92 category page.
