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ICD-10 Guide
ICD-10 CodesM05.251

M05.251

Billable

Rheumatoid vasculitis with rheumatoid arthritis of right hip

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

Code Description

ICD-10 M05.251 is a billable code used to indicate a diagnosis of rheumatoid vasculitis with rheumatoid arthritis of right hip.

Key Diagnostic Point:

Rheumatoid vasculitis is a serious complication of rheumatoid arthritis (RA), characterized by inflammation of blood vessels that can lead to ischemia and tissue damage. In this case, the condition is specifically affecting the right hip joint, which is anatomically significant as it is a major weight-bearing joint composed of the femur and the acetabulum of the pelvis. The pathophysiology involves immune-mediated damage to the vascular endothelium, leading to systemic manifestations such as skin lesions, neuropathy, and joint pain. Clinically, patients may present with severe pain, swelling, and limited range of motion in the right hip, alongside systemic symptoms like fatigue and malaise. The diagnosis is often supported by imaging studies, laboratory tests for rheumatoid factor, anti-CCP antibodies, and inflammatory markers such as ESR and CRP. Early recognition and management are crucial to prevent further joint damage and systemic complications.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Involvement of multiple systems (musculoskeletal and vascular)
  • Need for precise documentation of laterality and joint involvement
  • Potential for systemic manifestations complicating treatment
  • Variability in clinical presentation and severity

Audit Risk Factors

  • Inadequate documentation of systemic involvement
  • Failure to specify laterality of joint involvement
  • Misclassification of the severity of the condition
  • Lack of supporting diagnostic tests in the medical record

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 notes if procedures are performed.

Common Clinical Scenarios

Common scenarios include joint replacement surgery or arthroscopy for severe joint damage due to RA.

Billing Considerations

Documentation must detail the extent of joint damage and any surgical interventions, as well as the patient's functional status.

Rheumatology

Documentation Requirements

Rheumatologic documentation should include lab results for inflammatory markers, disease activity scores, and notes on systemic involvement.

Common Clinical Scenarios

Patients may present with exacerbations of RA requiring adjustments in DMARD therapy or biologics.

Billing Considerations

Systemic involvement must be documented, including any extra-articular manifestations of rheumatoid vasculitis.

Physical Medicine

Documentation Requirements

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

Common Clinical Scenarios

Rehabilitation scenarios may involve physical therapy to improve joint function and mobility post-surgery or during flare-ups.

Billing Considerations

Documentation should focus on mobility limitations and the impact on daily activities.

Coding Guidelines

Inclusion Criteria

Use M05.251 When
  • 10 coding guidelines require specificity in documenting laterality (right hip), severity of the condition, and the encounter type (initial, subsequent, or sequela)
  • Accurate coding is essential for reimbursement and tracking disease progression

Exclusion Criteria

Do NOT use M05.251 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 aspiration in cases of swelling and pain due to RA and vasculitis.

Documentation Requirements

Documentation must include indication for the procedure, joint involved, and any findings from the aspiration.

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 those with systemic involvement like rheumatoid vasculitis, improving the accuracy of patient records and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, particularly those with systemic involvement like rheumatoid vasculitis, improving the accuracy of patient records and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American College of Rheumatology Guidelines

Coding & Billing References

  • •
    American College of Rheumatology Guidelines

Frequently Asked Questions

What are the common complications of rheumatoid vasculitis?

Common complications include ischemic changes in tissues, skin lesions, neuropathy, and exacerbation of joint symptoms. Early recognition and management are crucial to prevent long-term damage.