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ICD-10 Guide
ICD-10 CodesM05.452

M05.452

Billable

Rheumatoid myopathy with rheumatoid arthritis of left hip

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

Code Description

ICD-10 M05.452 is a billable code used to indicate a diagnosis of rheumatoid myopathy with rheumatoid arthritis of left hip.

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. In this case, the left hip joint is involved, leading to inflammation, pain, and potential joint damage. Anatomically, the hip joint is a ball-and-socket joint formed by the acetabulum of the pelvis and the head of the femur. The inflammation in RA can lead to synovitis, which may cause joint effusion and erosion of cartilage and bone. Clinically, patients may present with decreased range of motion, muscle weakness, and difficulty in weight-bearing activities. The pathophysiology involves immune-mediated damage to the synovial membrane, leading to chronic inflammation and subsequent muscle atrophy due to disuse and pain. Patients may experience systemic symptoms such as fatigue and malaise, alongside localized symptoms in the hip region.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Involvement of multiple body systems (musculoskeletal and immune)
  • Need for precise documentation of laterality and severity
  • Potential for co-morbid conditions affecting treatment and coding
  • Variability in clinical presentation and response to treatment

Audit Risk Factors

  • Inadequate documentation of muscle weakness or myopathy
  • Failure to specify laterality of the hip involvement
  • Lack of evidence for the severity of the condition
  • Misclassification of rheumatoid arthritis type

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Orthopedic documentation should include imaging studies (e.g., X-rays, MRIs) to assess joint integrity, functional assessments to evaluate mobility, and detailed notes on any surgical interventions.

Common Clinical Scenarios

Common scenarios include joint replacement surgery, arthroscopy for synovitis, and management of joint deformities.

Billing Considerations

Joint-specific considerations include the degree of joint erosion, presence of osteophytes, and overall joint function.

Rheumatology

Documentation Requirements

Rheumatologic documentation must include laboratory tests for inflammation markers (e.g., ESR, CRP), disease activity scores, and patient-reported outcomes.

Common Clinical Scenarios

Scenarios often involve medication management (DMARDs, biologics) and monitoring for systemic involvement.

Billing Considerations

Consideration of systemic manifestations of RA, such as fatigue and extra-articular symptoms, is crucial.

Physical Medicine

Documentation Requirements

Functional assessments should detail the patient's mobility limitations, pain levels, and rehabilitation goals.

Common Clinical Scenarios

Rehabilitation scenarios may include physical therapy for strength training and mobility enhancement.

Billing Considerations

Assessment of assistive devices (e.g., walkers, canes) and home modifications may be necessary.

Coding Guidelines

Inclusion Criteria

Use M05.452 When
  • Official coding guidelines require accurate documentation of laterality (left hip), severity of the condition, and the type of encounter (initial, follow
  • up, etc
  • Coders must ensure that all relevant clinical information is captured to support the diagnosis

Exclusion Criteria

Do NOT use M05.452 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 effusion management in the left hip.

Documentation Requirements

Documentation must include indication for the procedure and joint involved.

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, enabling better tracking of disease prevalence and treatment outcomes. This specificity aids in appropriate reimbursement and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, enabling better tracking of disease prevalence and treatment outcomes. This specificity aids in appropriate reimbursement and resource allocation.

Reimbursement & Billing Impact

reimbursement 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 documentation requirements for coding M05.452?

Key documentation requirements include detailed clinical notes on muscle weakness, joint involvement, laterality, and any imaging or lab results that support the diagnosis of rheumatoid myopathy with left hip involvement.