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ICD-10 Guide
ICD-10 CodesM05.352

M05.352

Billable

Rheumatoid heart disease with rheumatoid arthritis of left hip

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

Code Description

ICD-10 M05.352 is a billable code used to indicate a diagnosis of rheumatoid heart disease with rheumatoid arthritis of left 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 left hip joint, a ball-and-socket joint formed by the acetabulum of the pelvis and the head of the femur, can become inflamed and painful due to RA. Patients may experience limited range of motion, stiffness, and functional impairment. The heart involvement may manifest as pericarditis, myocarditis, or valvular heart disease, complicating the clinical picture. Patients often present with joint swelling, tenderness, and systemic symptoms such as fatigue and fever. The interplay between joint and cardiac symptoms necessitates a comprehensive treatment approach, including disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs), and possibly surgical interventions for joint repair or replacement.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Involvement of multiple body systems (musculoskeletal and cardiovascular)
  • Need for precise documentation of joint involvement and severity
  • Potential for overlapping symptoms with other conditions
  • Complexity in treatment approaches requiring multidisciplinary care

Audit Risk Factors

  • Inadequate documentation of joint involvement and severity
  • Failure to capture systemic manifestations of rheumatoid arthritis
  • Misclassification of joint conditions due to overlapping symptoms
  • Lack of clarity in treatment plans and outcomes

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 notes on joint examination findings.

Common Clinical Scenarios

Common scenarios include surgical interventions such as hip arthroplasty for severe joint damage or joint injections for pain management.

Billing Considerations

Documentation must specify the degree of joint involvement, any deformities, and the impact on the patient's mobility.

Rheumatology

Documentation Requirements

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

Common Clinical Scenarios

Scenarios may involve adjusting DMARD therapy based on disease progression or managing cardiovascular risks associated with rheumatoid arthritis.

Billing Considerations

Documenting the systemic effects of rheumatoid arthritis is crucial, especially regarding cardiovascular health.

Physical Medicine

Documentation Requirements

Functional assessments should evaluate the patient's ability to perform daily activities, mobility limitations, and the need for assistive devices.

Common Clinical Scenarios

Rehabilitation scenarios may include physical therapy to improve joint function and mobility or occupational therapy for adaptive strategies.

Billing Considerations

Focus on documenting specific mobility limitations and the effectiveness of rehabilitation interventions.

Coding Guidelines

Inclusion Criteria

Use M05.352 When
  • Follow official coding guidelines for laterality (specifying left hip involvement), severity (acute vs
  • chronic), and encounter type (initial vs
  • follow
  • up visits)
  • Ensure that all relevant conditions are documented to support the coding

Exclusion Criteria

Do NOT use M05.352 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 left hip due to rheumatoid arthritis.

Documentation Requirements

Document the indication for the procedure, joint involved, and any complications.

Specialty Considerations

Orthopedic and rheumatologic considerations for joint management.

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, particularly those with systemic involvement like rheumatoid arthritis. This specificity aids in better tracking of disease outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, particularly those with systemic involvement like rheumatoid arthritis. This specificity aids in better tracking of disease outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, particularly those with systemic involvement like rheumatoid arthritis. This specificity aids in better tracking of disease outcomes and resource allocation.

Resources

Clinical References

  • •
    American College of Rheumatology Guidelines

Coding & Billing References

  • •
    American College of Rheumatology Guidelines

Frequently Asked Questions

What are the key documentation elements for coding rheumatoid arthritis with heart involvement?

Key documentation elements include the specific joints affected, the severity of arthritis, any systemic manifestations such as cardiovascular issues, and the treatment plan including medications and procedures.