ICD-10 Coding for Inflammatory Polyarthritis(M06.4, M13.0)
Complete ICD-10-CM coding and documentation guide for Inflammatory Polyarthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Inflammatory Polyarthritis
M05-M06Primary Range
Rheumatoid arthritis and other inflammatory polyarthropathies
This range includes codes for various types of inflammatory arthritis, including rheumatoid arthritis and inflammatory polyarthropathy.
Other arthritis
This range includes codes for unspecified types of arthritis, used when inflammation is not confirmed.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M06.4 | Inflammatory polyarthropathy | Use when documentation confirms inflammatory arthritis affecting multiple joints with systemic inflammation markers. |
|
| M13.0 | Polyarthritis, unspecified | Use when documentation does not confirm inflammation or lacks specificity. |
|
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 inflammatory polyarthritis
Essential facts and insights about Inflammatory Polyarthritis
Primary ICD-10-CM Codes for inflammatory polyarthritis
Decision Criteria
clinical Criteria
- Documented evidence of systemic inflammation and joint involvement.
coding Criteria
- Use M06.4 when inflammation is specified in the documentation.
documentation Criteria
- Include CRP, ESR, and imaging findings in the documentation.
Applicable To
- Undifferentiated inflammatory polyarthritis
Excludes
- Rheumatoid arthritis (M05.-)
Clinical Validation Requirements
- CRP >10 mg/dL
- ESR elevation
- Synovitis on imaging
Code-Specific Risks
- Undercoding if inflammation is documented but not coded
- Omission of laterality or specific joint involvement
Coding Notes
- Ensure documentation specifies inflammation and affected joints to avoid unspecified codes.
M13.0 - Polyarthritis, unspecified
Use when documentation does not confirm inflammation or lacks specificity.
Excludes
- Inflammatory polyarthropathy (M06.4)
Clinical Validation Requirements
- Lack of specific inflammatory markers
Coding Notes
Ensure documentation is reviewed for any mention of inflammation before using this code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other long term (current) drug therapy
Z79.899Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Rheumatoid arthritis with rheumatoid factor
M05.xxPolyarthritis, unspecified
M13.0Inflammatory polyarthropathy
M06.4Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Inflammatory Polyarthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M06.4.
Impact
Clinical: Misrepresentation of patient's condition., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Review documentation for inflammatory markers, Ensure joint involvement is specified
Impact
Reimbursement: Potential underpayment due to incorrect DRG assignment., Compliance: Increased audit risk for incorrect coding., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Use M06.4 if documentation specifies inflammation.
Impact
Using M13.0 when M06.4 is appropriate.
Mitigation Strategy
Educate coders on documentation requirements for inflammatory conditions.
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 Inflammatory Polyarthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Inflammatory Polyarthritis
Use these documentation templates to ensure complete and accurate documentation for Inflammatory Polyarthritis. These templates include all required elements for proper coding and billing.
Rheumatology Progress Note
Specialty: RheumatologyRequired Elements
- Joint involvement
- Inflammatory markers
- Imaging findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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