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ICD-10 Guide
ICD-10 CodesM05.429

M05.429

Billable

Rheumatoid myopathy with rheumatoid arthritis of unspecified elbow

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

Code Description

ICD-10 M05.429 is a billable code used to indicate a diagnosis of rheumatoid myopathy with rheumatoid arthritis of unspecified elbow.

Key Diagnostic Point:

Rheumatoid myopathy is a condition characterized by muscle weakness and pain associated with rheumatoid arthritis (RA), an autoimmune disorder that primarily affects the joints. The elbow, a hinge joint formed by the humerus, radius, and ulna, can be involved in RA, leading to inflammation, pain, and functional impairment. Patients may present with symptoms such as joint swelling, stiffness, and reduced range of motion, which can significantly impact daily activities. The pathophysiology involves the immune system mistakenly attacking the synovial membrane, leading to chronic inflammation and subsequent muscle involvement. Clinically, patients may experience muscle weakness, particularly in the proximal muscles, and may have difficulty with tasks requiring arm strength. The unspecified nature of the elbow involvement indicates that the specific joint affected is not documented, which can complicate treatment and management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified joint involvement complicates treatment planning.
  • Differentiating between myopathy and other muscle disorders.
  • Need for comprehensive documentation of joint and muscle symptoms.
  • Potential for systemic involvement requiring multidisciplinary care.

Audit Risk Factors

  • Inadequate documentation of joint involvement.
  • Failure to specify laterality when applicable.
  • Lack of evidence for muscle weakness or myopathy.
  • Misclassification of rheumatoid arthritis severity.

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 range of motion and strength.

Common Clinical Scenarios

Patients may require surgical intervention for joint repair or replacement due to severe RA damage.

Billing Considerations

Documentation should specify the degree of joint involvement and any surgical history.

Rheumatology

Documentation Requirements

Rheumatologic documentation must include laboratory tests for inflammation markers (e.g., ESR, CRP) and assessments of disease activity (e.g., DAS28 score).

Common Clinical Scenarios

Management of RA flares and adjustments in disease-modifying antirheumatic drugs (DMARDs) are common.

Billing Considerations

Systemic involvement should be documented, including any extra-articular manifestations.

Physical Medicine

Documentation Requirements

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

Common Clinical Scenarios

Rehabilitation programs focusing on strength training and mobility enhancement are typical.

Billing Considerations

Documentation should address specific mobility limitations and the impact on daily living activities.

Coding Guidelines

Inclusion Criteria

Use M05.429 When
  • Follow official coding guidelines that require specificity in laterality (if applicable), severity of the condition, and the type of encounter (initial, follow
  • up, etc
  • Ensure that documentation supports the diagnosis and any associated conditions

Exclusion Criteria

Do NOT use M05.429 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97001CPT Code

Physical therapy evaluation

Clinical Scenario

Used for initial assessment of functional limitations due to myopathy.

Documentation Requirements

Must document specific functional deficits and treatment goals.

Specialty Considerations

Physical medicine specialists should focus on mobility and strength assessments.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has increased specificity in coding musculoskeletal conditions, allowing for better tracking of disease prevalence and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has increased specificity in coding musculoskeletal conditions, allowing for better tracking of disease prevalence and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has increased specificity in coding musculoskeletal conditions, allowing for 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 documentation requirements for coding M05.429?

Key documentation includes specific details about joint involvement, muscle weakness, inflammatory markers, and any functional limitations experienced by the patient.