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ICD-10 Guide
ICD-10 CodesM05.43

M05.43

Billable

Rheumatoid myopathy with rheumatoid arthritis of wrist

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

Code Description

ICD-10 M05.43 is a billable code used to indicate a diagnosis of rheumatoid myopathy with rheumatoid arthritis of wrist.

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 wrist, being a complex joint composed of multiple bones, ligaments, and tendons, is often involved in RA. In this condition, inflammation from RA can lead to muscle atrophy and weakness due to disuse and systemic inflammation. Clinically, patients may present with difficulty in wrist movements, reduced grip strength, and overall functional impairment. The pathophysiology involves immune-mediated damage to both the synovial joints and the surrounding musculature, leading to pain, swelling, and eventual joint deformities. The anatomical considerations include the distal radius and ulna, carpal bones, and the surrounding soft tissues, which are crucial for wrist function. Early diagnosis and management are essential to prevent long-term disability.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Involvement of multiple anatomical structures (muscles, tendons, joints)
  • Need for precise documentation of joint involvement and severity
  • Differentiation from other myopathies and arthropathies
  • Potential for systemic manifestations affecting coding

Audit Risk Factors

  • Inadequate documentation of muscle weakness and functional limitations
  • Failure to specify laterality of wrist involvement
  • Misclassification of rheumatoid myopathy as a primary condition
  • Lack of evidence for systemic involvement in documentation

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Common scenarios include surgical interventions for joint deformities or tendon repairs due to RA-related damage.

Billing Considerations

Joint-specific considerations include documenting the severity of joint erosion and any surgical history.

Rheumatology

Documentation Requirements

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

Common Clinical Scenarios

Scenarios often involve managing systemic symptoms and adjusting DMARD therapy based on disease progression.

Billing Considerations

Considerations include monitoring for extra-articular manifestations and the impact of comorbidities.

Physical Medicine

Documentation Requirements

Functional assessments should document mobility limitations, pain levels, and rehabilitation goals.

Common Clinical Scenarios

Rehabilitation scenarios may include physical therapy for strength restoration and functional training.

Billing Considerations

Considerations include the need for assistive devices and home modifications to improve patient mobility.

Coding Guidelines

Inclusion Criteria

Use M05.43 When
  • Official coding guidelines require specificity in laterality (right, left, bilateral) and severity of the condition
  • Encounter type (initial, subsequent, sequela) must also be documented accurately to ensure proper coding

Exclusion Criteria

Do NOT use M05.43 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 joint injections in patients with RA to relieve inflammation.

Documentation Requirements

Document joint involved, procedure details, and patient response.

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, enabling better tracking of disease progression and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, enabling better tracking of disease progression and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, enabling better tracking of disease progression and treatment 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 coding M05.43?

Key documentation requirements include detailed descriptions of muscle weakness, joint involvement, functional limitations, and any relevant imaging or laboratory results that support the diagnosis of rheumatoid myopathy with wrist involvement.