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ICD-10 Guide
ICD-10 CodesM05.6

M05.6

Billable

Rheumatoid arthritis with involvement of other organs and systems

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

Code Description

ICD-10 M05.6 is a billable code used to indicate a diagnosis of rheumatoid arthritis with involvement of other organs and systems.

Key Diagnostic Point:

Rheumatoid arthritis (RA) is a chronic inflammatory disorder primarily affecting the synovial joints, leading to pain, swelling, and eventual joint destruction. Involvement of other organs and systems can occur, including the skin, lungs, heart, and eyes, due to the systemic nature of the disease. Anatomically, RA is characterized by synovial membrane inflammation, which can lead to the formation of pannus, a destructive granulation tissue that invades cartilage and bone. Clinically, patients may present with symmetrical polyarthritis, morning stiffness, and systemic symptoms such as fatigue and malaise. Extra-articular manifestations may include rheumatoid nodules, interstitial lung disease, and vasculitis, complicating the clinical picture and necessitating a multidisciplinary approach to management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Multisystem involvement complicates diagnosis and treatment.
  • Requires comprehensive documentation of both musculoskeletal and systemic symptoms.
  • Differentiation from other inflammatory and autoimmune conditions is necessary.
  • Potential for overlapping conditions increases coding complexity.

Audit Risk Factors

  • Inadequate documentation of systemic involvement.
  • Failure to specify laterality or severity of joint involvement.
  • Misclassification of RA as a primary condition without acknowledging extra-articular manifestations.
  • Inconsistent coding across multiple specialties involved in patient care.

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 joint involvement.

Common Clinical Scenarios

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

Billing Considerations

Documentation must specify which joints are affected and the severity of involvement, as this impacts treatment decisions.

Rheumatology

Documentation Requirements

Rheumatologic documentation should include laboratory tests for inflammatory markers (e.g., ESR, CRP), disease activity scores (e.g., DAS28), and assessments of extra-articular manifestations.

Common Clinical Scenarios

Scenarios often involve managing systemic complications such as lung involvement or vasculitis.

Billing Considerations

Documenting the progression of systemic involvement is crucial for treatment planning and coding accuracy.

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 joint mobility and strength training.

Billing Considerations

Mobility limitations and the need for assistive devices must be documented to support coding for rehabilitation services.

Coding Guidelines

Inclusion Criteria

Use M05.6 When
  • Coders must ensure accurate documentation of laterality (e
  • , bilateral vs
  • unilateral joint involvement), severity (e
  • , mild, moderate, severe), and the type of encounter (initial vs
  • follow
  • up) to comply with official coding guidelines

Exclusion Criteria

Do NOT use M05.6 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used for follow-up visits in patients with RA and systemic involvement.

Documentation Requirements

Requires documentation of history, examination, and medical decision-making.

Specialty Considerations

Rheumatology documentation must reflect disease activity and systemic involvement.

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used for joint injections in RA patients with significant joint effusion.

Documentation Requirements

Requires documentation of joint involved and indication for the procedure.

Specialty Considerations

Orthopedic documentation should specify the joint and any prior treatments.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding RA, particularly in capturing systemic involvement, which is crucial for appropriate treatment and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding RA, particularly in capturing systemic involvement, which is crucial for appropriate treatment and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American College of Rheumatology Guidelines

Coding & Billing References

  • •
    American College of Rheumatology Guidelines

Frequently Asked Questions

What documentation is required for coding M05.6?

Documentation must include details of joint involvement, any systemic manifestations, and the patient's functional status. Laboratory results and imaging studies should also be included to support the diagnosis.