2027 ICD-10-CM Diagnosis Code M34.81Systemic sclerosis with lung involvement
ICD-10-CM Codes›M00–M99›M30-M36›M34
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 93
- Chronic Condition
M34.81 is a billable ICD-10-CM diagnosis code for systemic sclerosis with lung involvement. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 196 through 198. 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 1 closely related codes. Coders also document this condition as lung disease with systemic sclerosis. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Systemic lupus erythematosus and connective tissue disorders.
For Medicare Advantage risk adjustment, M34.81 maps to CMS-HCC Category 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders) under the V28 model, adding a risk factor of about 0.617 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
M34.81 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.
- Lung disease with systemic sclerosis
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M34.81: its own notes plus those printed at M34, block M30-M36, and Chapter 13. 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.
- autoimmune disease NOS
- collagen (vascular) disease NOS
- systemic autoimmune disease
- systemic collagen (vascular) disease
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- autoimmune disease, single organ or single cell-type -code to relevant condition category
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.
- arthropathic psoriasis (L40.5-)
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- compartment syndrome (traumatic) (T79.A-)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Code Also
A second code may be needed to fully describe the condition; the note gives no sequencing direction.
Notes
General instructions on how these codes are used.
- Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name M34.81, its category, or a range that includes it.
Excludes1 4
These codes carry an Excludes1 note naming M34.81: they are not reported together with it, unless the two conditions are unrelated.
- J99 Respiratory disorders in diseases classified elsewheresystemic sclerosis (M34.81)
- L93 Lupus erythematosusscleroderma (M34.-) names M34.-, which includes this code
- Block M60-M63 Disorders of musclesmyopathy in scleroderma (M34.-) names M34.-, which includes this code
- L94 Other localized connective tissue disorders
Excludes2 4
These codes carry an Excludes2 note naming M34.81: its condition is not part of those codes, and both may be reported when the patient has both.
- Chapter 9 (I00-I99) Diseases of the circulatory system
- I77 Other disorders of arteries and arterioles
- J82 Pulmonary eosinophilia, not elsewhere classified
- Chapter 12 (L00-L99) Diseases of the skin and subcutaneous tissue
Code First 2
These codes say to code first a condition named in the note, and M34.81 is one of the conditions named.
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.
Patient EducationClinical
Lung Diseases
When you breathe, your lungs take in oxygen from the air and deliver it to the bloodstream. The cells in your body need oxygen to work and grow. During a normal day, you breathe nearly 25,000 times. People with lung disease have difficulty breathing. Millions of people in the U.S. have lung disease.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert M34.81 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M34.81Overview
What is the ICD-10 code for systemic sclerosis with lung involvement?
The ICD-10-CM code for systemic sclerosis with lung involvement is M34.81 (sometimes written as M3481). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is M34.81 (Other forms of systemic sclerosis) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report systemic sclerosis with lung involvement on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does M34.81 group to?
When systemic sclerosis with lung involvement is the principal diagnosis on an inpatient stay, it groups to MS-DRG 198, 197, 196, with relative weights from 0.7256 to 1.8335 depending on complications. Higher weights mean higher Medicare reimbursement.
Is M34.81 a CC or MCC?
CMS lists M34.81 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 1 closely related codes in its exclusion list.
Can M34.81 be reported with L94.0?
Not as a rule. The Excludes1 note at M34, which applies to M34.81, lists "circumscribed scleroderma (L94.0)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is M34.81?
M34.81 (systemic sclerosis with lung involvement) maps to CMS-HCC Category 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders), commonly written as HCC 93, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 40 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 226.
Does M34.81 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, M34.81 adds a risk adjustment factor of about 0.617 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.288 to 0.617 depending on the payment segment). HCC 93 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 93 category page.
