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ICD-10 Guide
ICD-10 CodesM05.35

M05.35

Billable

Rheumatoid heart disease with rheumatoid arthritis of hip

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

Code Description

ICD-10 M05.35 is a billable code used to indicate a diagnosis of rheumatoid heart disease with rheumatoid arthritis of hip.

Key Diagnostic Point:

Rheumatoid heart disease is a complication of rheumatoid arthritis (RA), an autoimmune disorder characterized by chronic inflammation of the joints. In this condition, the immune system mistakenly attacks the synovial membrane, leading to joint damage and systemic effects, including cardiovascular complications. The hip joint, a ball-and-socket joint formed by the acetabulum of the pelvis and the head of the femur, can be significantly affected by RA, resulting in pain, stiffness, and reduced mobility. Patients may experience joint swelling and deformity, which can lead to functional limitations in daily activities. The presence of rheumatoid heart disease indicates systemic involvement, where inflammation can affect the heart's structure and function, potentially leading to pericarditis, valvular heart disease, or cardiomyopathy. Clinically, patients may present with joint pain, fatigue, and cardiovascular symptoms, necessitating a multidisciplinary approach for management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Involvement of multiple body systems (musculoskeletal and cardiovascular)
  • Need for detailed documentation of joint involvement and systemic effects
  • Variability in clinical presentation and severity
  • Potential for overlapping diagnoses and complications

Audit Risk Factors

  • Inadequate documentation of joint involvement and severity
  • Failure to capture systemic manifestations of rheumatoid heart disease
  • Misclassification of the primary diagnosis versus secondary conditions
  • Lack of clarity in treatment plans and interdisciplinary communication

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Orthopedic documentation should include imaging studies (X-rays, MRIs) to assess joint damage, functional assessments to evaluate mobility, and detailed descriptions of any surgical interventions.

Common Clinical Scenarios

Common scenarios include joint replacement surgeries, arthroscopy for joint debridement, and management of joint deformities.

Billing Considerations

Joint-specific considerations include the degree of joint erosion, presence of deformities, and functional limitations impacting daily activities.

Rheumatology

Documentation Requirements

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

Common Clinical Scenarios

Scenarios often involve managing flare-ups of RA, adjusting DMARD therapy, and monitoring for cardiovascular complications.

Billing Considerations

Systemic involvement factors include monitoring for signs of heart disease, assessing for pericarditis, and evaluating the impact of RA on overall health.

Physical Medicine

Documentation Requirements

Functional assessments should document mobility limitations, pain levels, and the need for assistive devices (e.g., walkers, canes).

Common Clinical Scenarios

Rehabilitation scenarios may include post-operative recovery from hip surgery, physical therapy for joint mobility, and pain management strategies.

Billing Considerations

Mobility limitations should be clearly documented, including the impact on activities of daily living and the need for adaptive equipment.

Coding Guidelines

Inclusion Criteria

Use M05.35 When
  • Coders must ensure accurate documentation of laterality (right, left, bilateral) and severity (mild, moderate, severe) of both rheumatoid arthritis and heart disease
  • Encounter type (initial, follow
  • up, or chronic management) must also be documented appropriately

Exclusion Criteria

Do NOT use M05.35 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, hip joint

Clinical Scenario

Used for joint aspiration in cases of hip swelling due to RA.

Documentation Requirements

Document indication for aspiration, joint fluid analysis, and patient response.

Specialty Considerations

Orthopedic assessment of joint fluid and rheumatologic evaluation of inflammatory markers.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has increased specificity in coding for musculoskeletal conditions, allowing for better tracking of complications like rheumatoid heart disease, which can improve patient management and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has increased specificity in coding for musculoskeletal conditions, allowing for better tracking of complications like rheumatoid heart disease, which can improve patient management and outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has increased specificity in coding for musculoskeletal conditions, allowing for better tracking of complications like rheumatoid heart disease, which can improve patient management and outcomes.

Resources

Clinical References

  • •
    American College of Rheumatology Guidelines

Coding & Billing References

  • •
    American College of Rheumatology Guidelines

Frequently Asked Questions

What are the key documentation requirements for M05.35?

Key documentation includes detailed descriptions of joint involvement, systemic symptoms, treatment plans, and any imaging or laboratory results that support the diagnosis of rheumatoid heart disease alongside rheumatoid arthritis.