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ICD-10 Guide
ICD-10 CodesM05.622

M05.622

Billable

Rheumatoid arthritis of left elbow with involvement of other organs and systems

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

Code Description

ICD-10 M05.622 is a billable code used to indicate a diagnosis of rheumatoid arthritis of left elbow with involvement of other organs and systems.

Key Diagnostic Point:

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder characterized by synovial inflammation and joint destruction. The left elbow, a hinge joint formed by the humerus, radius, and ulna, can be significantly affected by RA, leading to pain, swelling, and reduced range of motion. Involvement of other organs and systems may include the lungs, heart, and skin, indicating a systemic manifestation of the disease. Clinically, patients may present with morning stiffness, joint deformities, and systemic symptoms such as fatigue and malaise. The pathophysiology involves immune-mediated processes that lead to synovitis, cartilage degradation, and bone erosion, which can severely impact joint function and overall quality of life.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Involvement of multiple organ systems complicates diagnosis and treatment.
  • Need for detailed documentation of joint involvement and systemic effects.
  • Variability in clinical presentation and disease progression.
  • Potential for overlapping conditions requiring careful differentiation.

Audit Risk Factors

  • Inadequate documentation of systemic involvement.
  • Failure to specify laterality or severity.
  • Misclassification of RA as osteoarthritis or other conditions.
  • Lack of supporting evidence for the diagnosis in medical records.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Orthopedic documentation should include imaging studies (X-rays, MRIs) to assess joint damage, functional assessments to evaluate range of motion, and any surgical interventions performed.

Common Clinical Scenarios

Common scenarios include joint replacement surgeries or arthroscopic procedures for severe joint damage.

Billing Considerations

Documentation must detail the specific joint involvement and any deformities present, as well as the impact on 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 managing flares of RA, adjusting DMARD therapy, or addressing complications such as rheumatoid nodules.

Billing Considerations

Systemic involvement must be clearly documented, including any extra-articular manifestations such as lung or cardiovascular issues.

Physical Medicine

Documentation Requirements

Functional assessments should evaluate the patient's ability to perform daily activities and any rehabilitation needs, including physical therapy referrals.

Common Clinical Scenarios

Rehabilitation scenarios may focus on restoring function post-surgery or managing chronic pain.

Billing Considerations

Documentation should address mobility limitations and the need for assistive devices.

Coding Guidelines

Inclusion Criteria

Use M05.622 When
  • 10 coding guidelines require accurate documentation of laterality (left elbow), severity of the condition, and any associated systemic involvement
  • Each encounter should reflect the current status of the disease and any changes in treatment

Exclusion Criteria

Do NOT use M05.622 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 swelling management in RA patients.

Documentation Requirements

Document the joint involved, reason for the procedure, and any findings.

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 in capturing the complexity of RA and its systemic effects, which aids in better patient management and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, particularly in capturing the complexity of RA and its systemic effects, which aids in better patient management and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, particularly in capturing the complexity of RA and its systemic effects, which aids in better patient management 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 points for coding rheumatoid arthritis?

Key documentation points include specifying the affected joints, noting any systemic involvement, detailing the severity of the disease, and including results from laboratory tests and imaging studies.