ICD-10 Coding for History of Rheumatoid Arthritis(M05.79, Z86.59)
Complete ICD-10-CM coding and documentation guide for History of Rheumatoid Arthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to History of Rheumatoid Arthritis
M05-M06Primary Range
Rheumatoid arthritis and related conditions
These codes cover active rheumatoid arthritis conditions, both seropositive and seronegative.
Personal history of other diseases of the musculoskeletal system and connective tissue
This code is used for documenting a history of rheumatoid arthritis when the condition is resolved.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M05.79 | Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement | Use when rheumatoid arthritis is active and seropositive, affecting multiple joints. |
|
| Z86.59 | Personal history of other diseases of the musculoskeletal system and connective tissue | Use when rheumatoid arthritis is resolved and no longer active. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for history of rheumatoid arthritis
Essential facts and insights about History of Rheumatoid Arthritis
Primary ICD-10-CM Codes for history of rheumatoid arthritis
Decision Criteria
clinical Criteria
- Positive RF test and multiple joint involvement
documentation Criteria
- Detailed joint involvement and serostatus
Applicable To
- Seropositive rheumatoid arthritis
Excludes
- Rheumatoid arthritis with organ or systems involvement
Clinical Validation Requirements
- Positive rheumatoid factor (RF) test
- Clinical documentation of affected joints
Code-Specific Risks
- Incorrectly coding as seronegative when RF is positive
Coding Notes
- Ensure documentation specifies seropositive status and affected joints.
Z86.59 - Personal history of other diseases of the musculoskeletal system and connective tissue
Use when rheumatoid arthritis is resolved and no longer active.
Applicable To
- History of resolved rheumatoid arthritis
Excludes
- Active rheumatoid arthritis
Clinical Validation Requirements
- Documentation of resolved condition
- No current treatment or symptoms
Coding Notes
Only use when RA is fully resolved.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long term (current) use of other agents affecting estrogen receptors and selective estrogen receptor modulators
Z79.2Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting History of Rheumatoid Arthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M05.79.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Always include RF or anti-CCP results in documentation.
Impact
Reimbursement: May lead to incorrect reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Ensure active RA is coded with M05 or M06 series codes.
Impact
Using Z86.59 for active RA cases.
Mitigation Strategy
Ensure active RA is documented with appropriate M05 or M06 codes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for History of Rheumatoid Arthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for History of Rheumatoid Arthritis
Use these documentation templates to ensure complete and accurate documentation for History of Rheumatoid Arthritis. These templates include all required elements for proper coding and billing.
Rheumatology follow-up for RA
Specialty: RheumatologyRequired Elements
- Serostatus
- Affected joints
- Current treatment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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