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ICD-10 Guide
ICD-10 CodesM05.472

M05.472

Billable

Rheumatoid myopathy with rheumatoid arthritis of left ankle and foot

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

Code Description

ICD-10 M05.472 is a billable code used to indicate a diagnosis of rheumatoid myopathy with rheumatoid arthritis of left ankle and foot.

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. In this case, the left ankle and foot are specifically involved. Anatomically, the left ankle consists of the tibia, fibula, and talus, while the foot includes multiple bones such as the metatarsals and phalanges. The pathophysiology involves inflammation of the synovial membrane, leading to joint damage and muscle atrophy due to disuse. Clinically, patients may present with swelling, tenderness, and reduced range of motion in the affected joints, along with systemic symptoms like fatigue and malaise. The myopathy aspect indicates muscle involvement, which can lead to significant functional limitations, impacting ambulation and daily activities.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Involvement of multiple anatomical structures (ankle and foot)
  • Need for differentiation from other types of myopathy
  • Potential for systemic manifestations complicating diagnosis
  • Documentation of both joint and muscle involvement

Audit Risk Factors

  • Inadequate documentation of muscle weakness or atrophy
  • Failure to specify laterality (left ankle and foot)
  • Misclassification of rheumatoid arthritis severity
  • Lack of supporting evidence for functional limitations

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 mobility and strength.

Common Clinical Scenarios

Common scenarios include surgical interventions for joint repair or replacement, as well as conservative management strategies.

Billing Considerations

Joint-specific considerations include the degree of joint erosion and the impact on surrounding soft tissues.

Rheumatology

Documentation Requirements

Rheumatologic documentation must include lab results 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

Consideration of systemic involvement is crucial, as RA can affect multiple organ systems beyond the musculoskeletal system.

Physical Medicine

Documentation Requirements

Functional assessments should evaluate the patient's ability to perform activities of daily living and mobility assessments to determine rehabilitation needs.

Common Clinical Scenarios

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

Billing Considerations

Mobility limitations may necessitate the use of assistive devices, which should be documented.

Coding Guidelines

Inclusion Criteria

Use M05.472 When
  • Official coding guidelines require accurate documentation of laterality (left ankle and foot), severity of the condition, and the type of encounter (initial, follow
  • up, etc
  • Coders must ensure that all relevant clinical information is captured to support the diagnosis

Exclusion Criteria

Do NOT use M05.472 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97001CPT Code

Physical therapy evaluation

Clinical Scenario

Used for initial assessment of functional limitations due to myopathy.

Documentation Requirements

Requires detailed documentation of physical limitations and treatment goals.

Specialty Considerations

Physical therapy may focus on strengthening and mobility enhancement.

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 clinical decision-making and resource allocation.

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 clinical decision-making and resource allocation.

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 clinical decision-making 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 requirements for coding M05.472?

Key documentation requirements include detailed clinical notes on muscle weakness, joint involvement, inflammatory markers, and any imaging studies that support the diagnosis of rheumatoid myopathy with arthritis.