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ICD-10 Guide
ICD-10 CodesM05.249

M05.249

Billable

Rheumatoid vasculitis with rheumatoid arthritis of unspecified hand

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

Code Description

ICD-10 M05.249 is a billable code used to indicate a diagnosis of rheumatoid vasculitis with rheumatoid arthritis of unspecified hand.

Key Diagnostic Point:

Rheumatoid vasculitis is a serious complication of rheumatoid arthritis (RA) characterized by inflammation of blood vessels, leading to ischemia and potential necrosis of tissues. In this condition, the vasculitis is associated with the systemic effects of RA, which primarily affects the synovial joints, including the hands. The hands consist of multiple joints, including the metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints, and distal interphalangeal (DIP) joints, all of which can be involved in RA. Clinically, patients may present with joint pain, swelling, and stiffness, particularly in the morning. The presence of vasculitis can lead to additional symptoms such as skin lesions, neuropathy, and organ involvement, complicating the clinical picture. The diagnosis is often supported by serological markers such as rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA), along with imaging studies to assess joint damage and inflammation.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Involvement of multiple systems (musculoskeletal and vascular)
  • Need for detailed documentation of joint involvement and systemic symptoms
  • Variability in clinical presentation and severity
  • Potential for overlapping conditions (e.g., other forms of vasculitis)

Audit Risk Factors

  • Inadequate documentation of systemic involvement
  • Failure to capture all affected joints
  • Misclassification of the type of vasculitis
  • Lack of supporting lab results or imaging studies

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Orthopedic documentation should include imaging studies (X-rays, MRIs) to assess joint damage, functional assessments, and detailed descriptions of joint involvement.

Common Clinical Scenarios

Common scenarios include surgical interventions for joint deformities or severe pain management.

Billing Considerations

Documentation must specify which joints are affected and the severity of involvement to guide treatment decisions.

Rheumatology

Documentation Requirements

Rheumatologic documentation should include lab results for inflammatory markers (ESR, CRP), disease activity scores, and assessments of systemic involvement.

Common Clinical Scenarios

Scenarios often involve managing flares of RA and monitoring for complications of vasculitis.

Billing Considerations

Systemic involvement must be documented, including any organ damage or additional symptoms related to vasculitis.

Physical Medicine

Documentation Requirements

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

Common Clinical Scenarios

Rehabilitation scenarios may include post-operative recovery or management of chronic pain.

Billing Considerations

Focus on mobility limitations and the impact of joint involvement on daily activities.

Coding Guidelines

Inclusion Criteria

Use M05.249 When
  • 10 guidelines require specificity in documenting laterality (if applicable), severity of the condition, and the type of encounter (initial, follow
  • up, etc
  • Ensure that all relevant clinical details are captured to support the diagnosis

Exclusion Criteria

Do NOT use M05.249 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 pain management in patients with RA and vasculitis.

Documentation Requirements

Document the joint involved, indication for the procedure, and any complications.

Specialty Considerations

Orthopedic and rheumatologic considerations for joint health and systemic implications.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has increased specificity in coding for musculoskeletal conditions, allowing for better tracking of complications like vasculitis associated with RA. This specificity aids in treatment planning and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has increased specificity in coding for musculoskeletal conditions, allowing for better tracking of complications like vasculitis associated with RA. This specificity aids in treatment planning and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has increased specificity in coding for musculoskeletal conditions, allowing for better tracking of complications like vasculitis associated with RA. This specificity aids in treatment planning 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 symptoms of rheumatoid vasculitis?

Key symptoms include joint pain and swelling, skin lesions, neuropathy, and systemic symptoms such as fatigue and fever. The presence of these symptoms indicates the need for comprehensive evaluation and management.