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v1.0.0
ICD-10 Guide
ICD-10 CodesM05.1

M05.1

Billable

Rheumatoid lung disease with rheumatoid arthritis

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

Code Description

ICD-10 M05.1 is a billable code used to indicate a diagnosis of rheumatoid lung disease with rheumatoid arthritis.

Key Diagnostic Point:

Rheumatoid lung disease is a serious complication of rheumatoid arthritis (RA), characterized by interstitial lung disease, pleural effusions, and pulmonary nodules. The pathophysiology involves autoimmune-mediated inflammation leading to lung tissue damage, which can manifest as dyspnea, cough, and reduced exercise tolerance. Anatomically, the lungs are affected primarily in the interstitial spaces, leading to fibrosis and impaired gas exchange. Clinically, patients may present with joint pain and swelling, particularly in the hands and feet, alongside respiratory symptoms. The presence of rheumatoid lung disease indicates a more severe form of RA, often correlating with increased morbidity and necessitating a multidisciplinary approach to management, including rheumatology and pulmonary specialists.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Multisystem involvement complicates diagnosis and treatment.
  • Requires detailed documentation of both joint and lung symptoms.
  • Differentiation from other lung diseases is necessary.
  • Potential for overlapping conditions increases coding complexity.

Audit Risk Factors

  • Inadequate documentation of lung involvement.
  • Failure to specify the severity of rheumatoid arthritis.
  • Misclassification of lung disease as primary rather than secondary to RA.
  • Lack of evidence for joint involvement in documentation.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Orthopedic documentation should include imaging studies (X-rays, MRIs) to assess joint damage and functional assessments to evaluate mobility.

Common Clinical Scenarios

Patients may require joint replacement surgery or arthroscopy due to severe joint damage.

Billing Considerations

Documenting the severity of joint involvement is crucial for treatment planning and coding.

Rheumatology

Documentation Requirements

Rheumatologic documentation must include laboratory tests for inflammatory markers (e.g., RF, anti-CCP) and assessments of disease activity (e.g., DAS28 score).

Common Clinical Scenarios

Management of RA with lung involvement may include DMARDs or biologics.

Billing Considerations

Systemic involvement must be documented to justify the complexity of care.

Physical Medicine

Documentation Requirements

Functional assessments should evaluate mobility limitations and the need for assistive devices.

Common Clinical Scenarios

Rehabilitation may focus on improving respiratory function and joint mobility.

Billing Considerations

Documenting the impact of lung disease on physical function is essential.

Coding Guidelines

Inclusion Criteria

Use M05.1 When
  • Follow official coding guidelines for laterality (if applicable), severity of RA, and type of encounter (initial, follow
  • up, etc
  • Ensure that documentation supports the diagnosis of both RA and lung disease

Exclusion Criteria

Do NOT use M05.1 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 for RA management with lung disease.

Documentation Requirements

Document history, examination findings, and management plan.

Specialty Considerations

Rheumatology documentation must reflect the complexity of care.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 allows for greater specificity in coding, particularly for conditions like rheumatoid lung disease, which require detailed documentation of both joint and lung involvement.

ICD-9 vs ICD-10

The transition to ICD-10 allows for greater specificity in coding, particularly for conditions like rheumatoid lung disease, which require detailed documentation of both joint and lung involvement.

Reimbursement & Billing Impact

The transition to ICD-10 allows for greater specificity in coding, particularly for conditions like rheumatoid lung disease, which require detailed documentation of both joint and lung involvement.

Resources

Clinical References

  • •
    American College of Rheumatology Guidelines

Coding & Billing References

  • •
    American College of Rheumatology Guidelines

Frequently Asked Questions

What are the common symptoms of rheumatoid lung disease?

Common symptoms include persistent cough, dyspnea, pleuritic chest pain, and fatigue, often accompanied by joint pain and swelling typical of rheumatoid arthritis.