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ICD-10 Guide
ICD-10 CodesM05.40

M05.40

Billable

Rheumatoid myopathy with rheumatoid arthritis of unspecified site

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

Code Description

ICD-10 M05.40 is a billable code used to indicate a diagnosis of rheumatoid myopathy with rheumatoid arthritis of unspecified site.

Key Diagnostic Point:

Rheumatoid myopathy is a condition characterized by muscle weakness and pain associated with rheumatoid arthritis (RA), an autoimmune disorder that primarily affects the joints. The pathophysiology involves inflammation of the synovial membrane, leading to joint damage and systemic effects, including muscle involvement. Clinically, patients may present with symmetrical muscle weakness, particularly in proximal muscle groups, fatigue, and joint pain. Anatomically, the condition affects the muscles surrounding the joints, particularly the shoulders, hips, and knees, which can lead to significant functional limitations. The presence of rheumatoid arthritis complicates the clinical picture, as joint inflammation can exacerbate muscle weakness and pain, impacting mobility and quality of life. Diagnosis is often supported by serological markers such as rheumatoid factor and anti-citrullinated protein antibodies, alongside imaging studies to assess joint involvement.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Multisystem involvement complicating diagnosis and treatment
  • Need for precise documentation of muscle weakness and joint involvement
  • Variability in clinical presentation among patients
  • Potential for overlapping conditions (e.g., fibromyalgia)

Audit Risk Factors

  • Inadequate documentation of muscle weakness severity
  • Failure to specify joint involvement
  • Misclassification of myopathy as a separate condition
  • Lack of supporting lab results for rheumatoid arthritis diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Orthopedic documentation should include imaging studies (X-rays, MRIs) to assess joint damage and functional assessments to evaluate mobility and strength.

Common Clinical Scenarios

Common scenarios include surgical interventions for joint repair or replacement in patients with severe rheumatoid arthritis and myopathy.

Billing Considerations

Joint-specific considerations include documenting the severity of joint destruction and the impact on mobility.

Rheumatology

Documentation Requirements

Rheumatologic documentation must include 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 muscle weakness and systemic symptoms.

Billing Considerations

Systemic involvement should be documented, including any extra-articular manifestations of rheumatoid arthritis.

Physical Medicine

Documentation Requirements

Functional assessments should evaluate the patient's ability to perform daily activities and the need for rehabilitation services.

Common Clinical Scenarios

Rehabilitation scenarios may include physical therapy for strength training and mobility improvement.

Billing Considerations

Mobility limitations should be clearly documented, including the use of assistive devices.

Coding Guidelines

Inclusion Criteria

Use M05.40 When
  • Follow official coding guidelines that require documentation of laterality (if applicable), severity of muscle weakness, and the type of encounter (initial, follow
  • up, etc
  • Ensure that all relevant clinical information is captured to support the diagnosis

Exclusion Criteria

Do NOT use M05.40 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97110CPT Code

Therapeutic exercises

Clinical Scenario

Used for rehabilitation of muscle weakness in patients with rheumatoid myopathy.

Documentation Requirements

Document the specific exercises performed and the patient's response.

Specialty Considerations

Physical therapy documentation should focus on functional outcomes and progress.

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, enabling better tracking of disease prevalence and treatment outcomes. This specificity aids in research and improves patient care by ensuring accurate representation of conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, enabling better tracking of disease prevalence and treatment outcomes. This specificity aids in research and improves patient care by ensuring accurate representation of conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, enabling better tracking of disease prevalence and treatment outcomes. This specificity aids in research and improves patient care by ensuring accurate representation of conditions.

Resources

Clinical References

  • •
    American College of Rheumatology Guidelines

Coding & Billing References

  • •
    American College of Rheumatology Guidelines

Frequently Asked Questions

What are the common symptoms of rheumatoid myopathy?

Common symptoms include muscle weakness, particularly in proximal muscle groups, fatigue, and joint pain. Patients may also experience difficulty with daily activities due to these symptoms.