Coding and coverage · ICD-10-CM

M35 › M35.8

M35.81 Multisystem inflammatory syndrome

BillableCMS-HCC V28: HCC 2Chapter 13
Check coverage with this diagnosis

Instructional notes

Chapter 13

Excludes2Not included here: the patient may have both; report both when both are present.
  • 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)
Notes
  • Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition

Section M30-M36

Excludes1Not coded here: never report with this code, except when the two conditions are unrelated.
  • autoimmune disease, single organ or single cell-type -code to relevant condition category
Includes
  • autoimmune disease NOS
  • collagen (vascular) disease NOS
  • systemic autoimmune disease
  • systemic collagen (vascular) disease

M35

Excludes1Not coded here: never report with this code, except when the two conditions are unrelated.
  • reactive perforating collagenosis (L87.1)

This code

Code firstSequence the underlying condition first.
  • , if applicable, COVID-19 (U07.1)
Use additional codeAdd a second code for the full picture.
  • code, if applicable, for:
  • exposure to COVID-19 or SARS-CoV-2 infection (Z20.822)
  • personal history of COVID-19 (Z86.16)
  • post COVID-19 condition (U09.9)
Code also
  • any associated complications such as:
  • acute hepatic failure (K72.0-)
  • acute kidney failure (N17.-)
  • acute myocarditis (I40.-)
  • acute respiratory distress syndrome (J80)
  • cardiac arrhythmia (I47-I49.-)
  • pneumonia due to COVID-19 (J12.82)
  • severe sepsis (R65.2-)
  • viral cardiomyopathy (B33.24)
  • viral pericarditis (B33.23)
Inclusion terms
  • MIS-A
  • MIS-C
  • Multisystem inflammatory syndrome in adults
  • Multisystem inflammatory syndrome in children
  • Pediatric inflammatory multisystem syndrome
  • PIMS

Chapter 13: Diseases of the musculoskeletal system and connective tissue · M30-M36 Systemic connective tissue disorders (M30-M36)

Source: ICD-10-CM FY 2027 code descriptions and tabular list (CMS and CDC National Center for Health Statistics), effective 2026-10-01 through 2027-09-30 · CMS ICD-10 files. HCC mapping: CMS-HCC V28, payment year 2027. As of 2026-11-04.

Coverage and payment depend on the claim details; confirm with the Medicare Administrative Contractor.