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v1.0.0
ICD-10 Guide
ICD-10 CodesM05.012

M05.012

Billable

Felty's syndrome, left shoulder

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

Code Description

ICD-10 M05.012 is a billable code used to indicate a diagnosis of felty's syndrome, left shoulder.

Key Diagnostic Point:

Felty's syndrome is a rare complication of rheumatoid arthritis characterized by the triad of rheumatoid arthritis, splenomegaly, and neutropenia. In the context of the left shoulder, patients may experience significant joint inflammation, pain, and functional limitations due to the autoimmune process affecting the synovial tissue. Anatomically, the left shoulder comprises the glenohumeral joint, acromioclavicular joint, and scapulothoracic articulation, all of which can be affected by the inflammatory processes associated with Felty's syndrome. Clinically, patients may present with swelling, tenderness, and decreased range of motion in the left shoulder, impacting daily activities and quality of life. The pathophysiology involves immune-mediated damage to the joint structures, leading to chronic inflammation and potential joint destruction if not managed appropriately.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Involvement of multiple anatomical structures in the shoulder region
  • Need for precise documentation of laterality and severity
  • Complexity of differentiating from other inflammatory joint diseases
  • Potential for systemic manifestations affecting coding

Audit Risk Factors

  • Inadequate documentation of the autoimmune nature of the condition
  • Failure to specify laterality and joint involvement
  • Misclassification of the condition as a primary diagnosis without supporting evidence
  • Lack of comprehensive functional assessments

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients may present with severe shoulder pain requiring surgical intervention, such as arthroscopy or joint replacement, due to joint destruction.

Billing Considerations

Documenting the severity of joint involvement and any surgical interventions is crucial for accurate coding.

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

Patients may experience exacerbations of rheumatoid arthritis leading to increased shoulder pain and functional limitations.

Billing Considerations

Systemic involvement, such as splenomegaly and neutropenia, should be documented to support the diagnosis of Felty's syndrome.

Physical Medicine

Documentation Requirements

Functional assessments should evaluate mobility, strength, and the need for assistive devices to aid rehabilitation.

Common Clinical Scenarios

Patients may require physical therapy to improve shoulder function and manage pain.

Billing Considerations

Documenting mobility limitations and the impact on daily activities is essential for rehabilitation coding.

Coding Guidelines

Inclusion Criteria

Use M05.012 When
  • Official coding guidelines require precise documentation of laterality (left shoulder), 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 M05.012 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 effusion management in the left shoulder.

Documentation Requirements

Document the indication for the procedure, including joint involvement and any prior treatments.

Specialty Considerations

Orthopedic and rheumatologic considerations for joint aspiration.

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.

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.

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.

Resources

Clinical References

  • •
    American College of Rheumatology Guidelines

Coding & Billing References

  • •
    American College of Rheumatology Guidelines

Frequently Asked Questions

What are the key features of Felty's syndrome?

Felty's syndrome is characterized by rheumatoid arthritis, splenomegaly, and neutropenia. Patients may experience joint pain, particularly in the shoulders, and increased susceptibility to infections due to low neutrophil counts.