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v1.0.0
ICD-10 Guide
ICD-10 CodesM05.01

M05.01

Billable

Felty's syndrome, shoulder

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 M05.01 is a billable code used to indicate a diagnosis of felty's syndrome, shoulder.

Key Diagnostic Point:

Felty's syndrome is a rare complication of rheumatoid arthritis characterized by the triad of rheumatoid arthritis, splenomegaly, and neutropenia. In the context of the shoulder, patients may experience significant joint involvement leading to pain, swelling, and limited range of motion. Anatomically, the shoulder consists of the humerus, scapula, and clavicle, with the glenohumeral joint being the primary site of movement. Pathophysiologically, Felty's syndrome can exacerbate joint inflammation and damage due to the autoimmune nature of rheumatoid arthritis, leading to increased joint erosion and functional impairment. Clinically, patients may present with shoulder pain, stiffness, and decreased ability to perform overhead activities, which can significantly impact daily living and quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Involvement of multiple anatomical structures in the shoulder region
  • Need for comprehensive documentation of autoimmune disease progression
  • Variability in clinical presentation and severity among patients
  • Potential for co-morbid conditions affecting treatment and coding

Audit Risk Factors

  • Inadequate documentation of the autoimmune nature of the condition
  • Failure to document joint involvement and functional limitations
  • Misclassification of the severity of the disease
  • Inconsistent coding of related conditions or complications

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Orthopedic documentation should include imaging studies (e.g., X-rays, MRIs) to assess joint damage, as well as functional assessments to evaluate range of motion and strength.

Common Clinical Scenarios

Common scenarios include surgical interventions such as shoulder arthroscopy or joint replacement due to severe joint erosion.

Billing Considerations

Joint-specific considerations include the assessment of rotator cuff integrity and the presence of any associated impingement syndromes.

Rheumatology

Documentation Requirements

Rheumatologic documentation must include laboratory tests for inflammation markers (e.g., ESR, CRP) and assessments of disease activity (e.g., DAS28 score).

Common Clinical Scenarios

Patients may present with exacerbations of rheumatoid arthritis leading to increased shoulder pain and functional decline.

Billing Considerations

Systemic involvement, such as splenomegaly and neutropenia, should be documented to provide a complete picture of the patient's health status.

Physical Medicine

Documentation Requirements

Functional assessments should evaluate mobility, strength, and the need for assistive devices to aid in rehabilitation.

Common Clinical Scenarios

Rehabilitation scenarios may include physical therapy focused on restoring range of motion and strength in the shoulder.

Billing Considerations

Documentation should address any mobility limitations and the impact on activities of daily living.

Coding Guidelines

Inclusion Criteria

Use M05.01 When
  • Official coding guidelines require documentation of laterality (e
  • , right or left shoulder), severity of the condition, and the type of encounter (initial, follow
  • up, etc
  • Accurate coding also necessitates a clear link between the diagnosis and the treatment provided

Exclusion Criteria

Do NOT use M05.01 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used for managing joint effusion in the shoulder due to Felty's syndrome.

Documentation Requirements

Documentation must include the indication for the procedure, joint involved, and any therapeutic agents used.

Specialty Considerations

Orthopedic considerations include assessing joint stability and the need for further intervention.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, including Felty's syndrome, which can lead to improved patient management and more accurate reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, including Felty's syndrome, which can lead to improved patient management and more accurate reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American College of Rheumatology Guidelines

Coding & Billing References

  • •
    American College of Rheumatology Guidelines

Frequently Asked Questions

What are the key features of Felty's syndrome?

Felty's syndrome is characterized by rheumatoid arthritis, splenomegaly, and neutropenia. Clinically, it presents with joint pain, particularly in the shoulders, and can lead to significant functional impairment.