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ICD-10 Guide
ICD-10 CodesM05.319

M05.319

Billable

Rheumatoid heart disease with rheumatoid arthritis of unspecified shoulder

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

Code Description

ICD-10 M05.319 is a billable code used to indicate a diagnosis of rheumatoid heart disease with rheumatoid arthritis of unspecified shoulder.

Key Diagnostic Point:

Rheumatoid heart disease is a complication of rheumatoid arthritis (RA), an autoimmune disorder characterized by chronic inflammation of the joints. In this condition, the immune system mistakenly attacks the synovial membrane, leading to joint damage and systemic effects, including cardiovascular complications. The heart can be affected by inflammation of the pericardium (pericarditis), myocardium (myocarditis), or valvular disease. The unspecified shoulder involvement indicates that the specific shoulder joint (right or left) is not documented, which can complicate treatment and rehabilitation strategies. Clinically, patients may present with joint pain, swelling, and stiffness, particularly in the morning or after periods of inactivity. Movement limitations in the shoulder can significantly impact daily activities and quality of life. The anatomical considerations include the glenohumeral joint, acromioclavicular joint, and surrounding musculature, which may be affected by both RA and associated heart disease.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Inadequate documentation of joint involvement and laterality
  • Failure to document the relationship between rheumatoid arthritis and heart disease
  • Lack of evidence for the severity of symptoms and functional limitations
  • Inconsistent coding of related conditions or complications

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 details of any surgical interventions.

Common Clinical Scenarios

Patients may require joint injections, arthroscopy, or joint replacement surgery due to severe damage from rheumatoid arthritis.

Billing Considerations

Documentation must specify the severity of joint involvement and any functional limitations affecting 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

Patients may present with exacerbations of RA, requiring adjustments in medication or treatment plans.

Billing Considerations

Systemic involvement, such as cardiovascular effects, must be documented to support the diagnosis of rheumatoid heart disease.

Physical Medicine

Documentation Requirements

Functional assessments should evaluate the patient's ability to perform activities of daily living and any rehabilitation needs.

Common Clinical Scenarios

Patients may require physical therapy to improve shoulder mobility and strength following joint damage.

Billing Considerations

Mobility limitations and the need for assistive devices should be documented to support rehabilitation efforts.

Coding Guidelines

Inclusion Criteria

Use M05.319 When
  • Official coding guidelines require accurate documentation of laterality (if applicable), severity of the condition, and the type of encounter (initial, follow
  • up, etc
  • It is essential to document the relationship between rheumatoid arthritis and any cardiovascular complications

Exclusion Criteria

Do NOT use M05.319 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 patients with rheumatoid arthritis experiencing joint effusion in the shoulder.

Documentation Requirements

Document the joint involved, the procedure performed, and the patient's response.

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 complexities of systemic diseases like rheumatoid arthritis and its complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, particularly in capturing the complexities of systemic diseases like rheumatoid arthritis and its complications.

Reimbursement & Billing Impact

reimbursement.

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 arthritis?

Common complications include joint damage, cardiovascular disease, lung disease, and increased risk of infections due to immunosuppressive therapies.