ICD-10 Primer for Orthopedics - Rheumatoid Arthritis ICD 10 Codes 2 - 116

rheumatoid arthritis: icd 10 code for rheumatoid arthritis (RA)Continuing our series on ICD-10 basics we are going to use the next few blog posts to give primers on specific documentation requirements for various specialties.  We will also give some samples of how ICD-9-CM codes common for those specialties compare to ICD-10-CM codes.  Again, much of the material in these speciality-specific blog posts will be based on guidelines and material published by CMS in their Road to 10 Series.  There is a lot of questionable data and advice out there and we want to help improve the consistency and reduce the uncertainty by going to the source of regulations.  We will summarize and consolidate to enhance readability and brevity. The application of ICD-10 documentation requirements and the common codes for Orthopedics is the focus of this post. In ICD-10-CM, there are three main categories of changes:

  1. Definition Changes
  2. Terminology differences
  3. Increased specificity

For orthopedics the focus of ICD-10 is generally on increased specificity over ICD-9-CM. More than one third of the expansion of ICD-10 codes is due to the addition of laterality (left, right, or bilateral). Physicians and other clinicians likely already note laterality when evaluating the clinically pertinent anatomical site(s). ICD-10 Code Examples for Orthopedics Illustrating Laterality:

M21.722 Unequal limb length (acquired), left humerus
M25.561 Pain in right knee
M25.562 Pain in left knee
S72.344A Nondisplaced spiral fracture of shaft of right femur, initial encounter for closed fracture

Documentation for Fractures: When documenting fractures, include the following parameters:

  • Type - Open, closed, pathological, neoplastic disease, stress
  • Pattern - Comminuted, oblique, segmental, spiral, transverse
  • Etiology to document in the external cause codes encounter of care - Initial, subsequent, sequelae
  • Healing status, if subsequent encounter - Normal healing, delayed healing, nonunion, malunion
  • Localization - Shaft, head, neck, distal, proximal, styloid
  • Displacement - Displaced, non displaced
  • Classification - Gustilo-Anderson, Salter-Harris
  • Any complications, whether acute or delayed - Direct result of trauma sustained

In addition, depending on the circumstances, it may be necessary to document intra-articular or extra-articular involvement. For certain conditions, the bone may be affected at the proximal or distal end. Though the portion of the bone affected may be at the joint at either end, the site designation will be the bone, not the joint. ICD-10 Code Examples for Fractures:

S52.521A Torus fracture of lower end of right radius, initial encounter for closed fracture
S52.521D Torus fracture of lower end of right radius, subsequent encounter for fracture with routine healing
S42.021K Displaced fracture of the shaft of right clavicle, subsequent for fracture with nonunion

Documentation for Arthritis: In ICD-10-CM, there are specific codes for primary and secondary arthritis. Within the secondary arthritis codes there are specific codes for post-traumatic osteoarthritis and other secondary osteoarthritis. For secondary osteoarthritis of the hip there is also a code for dysplastic osteoarthritis. Arthritis codes in ICD-10-CM is both similar and different than ICD-9-CM. For example, currently, in ICD-9, osteoarthritis can be described as degenerative, hypertrophic, or secondary to other factors, and the type as generalized or localized. ICD-10 provides more options for the coding osteoarthritis related encounters, including:

  • Generalized forms of osteoarthritis or arthritis where multiple joints are involved.
  • Localized forms of osteoarthritis with more specificity that includes primary versus secondary types, subtypes, laterality, and joint involvement.

Indicate the type, location, and specific bones and joints (multiple sites if applicable) involved in the disease. In addition, describe any related underlying diseases or conditions. Comparison of ICD-9-CM Codes to ICD-10-CM Codes for Osteoarthristis: ICD-9 Codes:

714.0    Rheumatoid Arthritis
714.2 Rheumatoid arthritis with visceral or systemic involvement

Common ICD-10 Codes for Rheumatoid Arthritis in Both Hands:

M05.611 Rheumatoid arthritis of right shoulder with involvement of other organs and systems
M05.612 Rheumatoid arthritis of left shoulder with involvement of other organs and systems
M05.619* Rheumatoid arthritis of unspecified shoulder with involvement of other organs and systems
M05.621 Rheumatoid arthritis of right elbow with involvement of other organs and systems
M05.622 Rheumatoid arthritis of left elbow with involvement of other organs and systems
M05.629* Rheumatoid arthritis of unspecified elbow with involvement of other organs and systems
M05.631 Rheumatoid arthritis of right wrist with involvement of other organs and systems
M05.632 Rheumatoid arthritis of left wrist with involvement of other organs and systems
M05.639* Rheumatoid arthritis of unspecified wrist with involvement of other organs and systems
M05.641 Rheumatoid arthritis of right hand with involvement of other organs and systems
M05.642 Rheumatoid arthritis of left hand with involvement of other organs and systems
M05.649* Rheumatoid arthritis of unspecified hand with involvement of other organs and systems
M05.651 Rheumatoid arthritis of right hip with involvement of other organs and systems
M05.652 Rheumatoid arthritis of left hip with involvement of other organs and systems
M05.659* Rheumatoid arthritis of unspecified hip with involvement of other organs and systems
M05.661 Rheumatoid arthritis of right knee with involvement of other organs and systems
M05.662 Rheumatoid arthritis of left knee with involvement of other organs and systems
M05.669* Rheumatoid arthritis of unspecified knee with involvement of other organs and systems
M05.671 Rheumatoid arthritis of right ankle and foot with involvement of other organs and systems
M05.672 Rheumatoid arthritis of left ankle and foot with involvement of other organs and systems
M05.679* Rheumatoid arthritis of unspecified ankle and foot with involvement of other organs and systems
M05.69 Rheumatoid arthritis of multiple sites with involvement of other organs and systems
M05.711 Rheumatoid arthritis with rheumatoid factor of right shoulder without organ or systems involvement
M05.712 Rheumatoid arthritis with rheumatoid factor of left shoulder without organ or systems involvement
M05.719* Rheumatoid arthritis with rheumatoid factor of unspecified shoulder without organ or systems involvement
M05.721 Rheumatoid arthritis with rheumatoid factor of right elbow without organ or systems involvement
M05.722 Rheumatoid arthritis with rheumatoid factor of left elbow without organ or systems involvement
M05.729* Rheumatoid arthritis with rheumatoid factor of unspecified elbow without organ or systems involvement
M05.731 Rheumatoid arthritis with rheumatoid factor of right wrist without organ or systems involvement
M05.732 Rheumatoid arthritis with rheumatoid factor of left wrist without organ or systems involvement
M05.739* Rheumatoid arthritis with rheumatoid factor of unspecified wrist without organ or systems involvement
M05.741 Rheumatoid arthritis with rheumatoid factor of right hand without organ or systems involvement
M05.742 Rheumatoid arthritis with rheumatoid factor of left hand without organ or systems involvement
M05.749* Rheumatoid arthritis with rheumatoid factor of unspecified hand without organ or systems involvement
M05.751 Rheumatoid arthritis with rheumatoid factor of right hip without organ or systems involvement
M05.752 Rheumatoid arthritis with rheumatoid factor of left hip without organ or systems involvement
M05.759* Rheumatoid arthritis with rheumatoid factor of unspecified hip without organ or systems involvement
M05.761 Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement
M05.762 Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement
M05.769* Rheumatoid arthritis with rheumatoid factor of unspecified knee without organ or systems involvement
M05.771 Rheumatoid arthritis with rheumatoid factor of right ankle and foot without organ or systems involvement
M05.772 Rheumatoid arthritis with rheumatoid factor of left ankle and foot without organ or systems involvement
M05.779* Rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot without organ or systems involvement
M05.79 Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement
M05.811 Other rheumatoid arthritis with rheumatoid factor of right shoulder
M05.812 Other rheumatoid arthritis with rheumatoid factor of left shoulder
M05.819* Other rheumatoid arthritis with rheumatoid factor of unspecified shoulder
M05.821 Other rheumatoid arthritis with rheumatoid factor of right elbow
M05.822 Other rheumatoid arthritis with rheumatoid factor of left elbow
M05.829* Other rheumatoid arthritis with rheumatoid factor of unspecified elbow
M05.831 Other rheumatoid arthritis with rheumatoid factor of right wrist
M05.832 Other rheumatoid arthritis with rheumatoid factor of left wrist
M05.839* Other rheumatoid arthritis with rheumatoid factor of unspecified wrist
M05.841 Other rheumatoid arthritis with rheumatoid factor of right hand
M05.842 Other rheumatoid arthritis with rheumatoid factor of left hand
M05.849* Other rheumatoid arthritis with rheumatoid factor of unspecified hand
M05.851 Other rheumatoid arthritis with rheumatoid factor of right hip
M05.852 Other rheumatoid arthritis with rheumatoid factor of left hip
M05.859* Other rheumatoid arthritis with rheumatoid factor of unspecified hip
M05.861 Other rheumatoid arthritis with rheumatoid factor of right knee
M05.862 Other rheumatoid arthritis with rheumatoid factor of left knee
M05.869* Other rheumatoid arthritis with rheumatoid factor of unspecified knee
M05.871 Other rheumatoid arthritis with rheumatoid factor of right ankle and foot
M05.872 Other rheumatoid arthritis with rheumatoid factor of left ankle and foot
M05.879* Other rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot
M05.89 Other rheumatoid arthritis with rheumatoid factor of multiple sites
M05.9* Rheumatoid arthritis with rheumatoid factor, unspecified
M06.00* Rheumatoid arthritis without rheumatoid factor, unspecified site
M06.011 Rheumatoid arthritis without rheumatoid factor, right shoulder
M06.012 Rheumatoid arthritis without rheumatoid factor, left shoulder
M06.019* Rheumatoid arthritis without rheumatoid factor, unspecified shoulder
M06.021 Rheumatoid arthritis without rheumatoid factor, right elbow
M06.022 Rheumatoid arthritis without rheumatoid factor, left elbow
M06.029* Rheumatoid arthritis without rheumatoid factor, unspecified elbow
M06.031 Rheumatoid arthritis without rheumatoid factor, right wrist
M06.032 Rheumatoid arthritis without rheumatoid factor, left wrist
M06.039* Rheumatoid arthritis without rheumatoid factor, unspecified wrist
M06.041 Rheumatoid arthritis without rheumatoid factor, right hand
M06.042 Rheumatoid arthritis without rheumatoid factor, left hand
M06.049* Rheumatoid arthritis without rheumatoid factor, unspecified hand
M06.051 Rheumatoid arthritis without rheumatoid factor, right hip
M06.052 Rheumatoid arthritis without rheumatoid factor, left hip
M06.059* Rheumatoid arthritis without rheumatoid factor, unspecified hip
M06.061 Rheumatoid arthritis without rheumatoid factor, right knee
M06.062 Rheumatoid arthritis without rheumatoid factor, left knee
M06.069* Rheumatoid arthritis without rheumatoid factor, unspecified knee
M06.071 Rheumatoid arthritis without rheumatoid factor, right ankle and foot
M06.072 Rheumatoid arthritis without rheumatoid factor, left ankle and foot
M06.079* Rheumatoid arthritis without rheumatoid factor, unspecified ankle and foot
M06.08 Rheumatoid arthritis without rheumatoid factor, vertebrae
M06.09 Rheumatoid arthritis without rheumatoid factor, multiple sites
M06.80* Other specified rheumatoid arthritis, unspecified site
M06.811 Other specified rheumatoid arthritis, right shoulder
M06.812 Other specified rheumatoid arthritis, left shoulder
M06.819* Other specified rheumatoid arthritis, unspecified shoulder
M06.821 Other specified rheumatoid arthritis, right elbow
M06.822 Other specified rheumatoid arthritis, left elbow
M06.829* Other specified rheumatoid arthritis, unspecified elbow
M06.831 Other specified rheumatoid arthritis, right wrist
M06.832 Other specified rheumatoid arthritis, left wrist
M06.839* Other specified rheumatoid arthritis, unspecified wrist
M06.841 Other specified rheumatoid arthritis, right hand
M06.842 Other specified rheumatoid arthritis, left hand
M06.849* Other specified rheumatoid arthritis, unspecified hand
M06.851 Other specified rheumatoid arthritis, right hip
M06.852 Other specified rheumatoid arthritis, left hip
M06.859* Other specified rheumatoid arthritis, unspecified hip
M06.861 Other specified rheumatoid arthritis, right knee
M06.862 Other specified rheumatoid arthritis, left knee
M06.869* Other specified rheumatoid arthritis, unspecified knee
M06.871 Other specified rheumatoid arthritis, right ankle and foot
M06.872 Other specified rheumatoid arthritis, left ankle and foot
M06.879* Other specified rheumatoid arthritis, unspecified ankle and foot
M06.88 Other specified rheumatoid arthritis, vertebrae
M06.89 Other specified rheumatoid arthritis, multiple sites
M06.9* Rheumatoid arthritis, unspecified

*Codes with a greater degree of specificity should be considered first.

Please bear in mind these are only the most common icd 10 codes for rheumatoid arthritis in both hands. Should you need more, please feel free to visit our comprehensive ICD-10 database.

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