ICD-10 Coding for Polyarthritis(M06.4, M13.0)
Complete ICD-10-CM coding and documentation guide for Polyarthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to 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 arthritis, which can be used when specific types are not documented.
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 the diagnosis is confirmed as inflammatory polyarthropathy with specific clinical indicators. |
|
| M13.0 | Polyarthritis, unspecified | Use when documentation does not specify the type of arthritis. |
|
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 polyarthritis
Essential facts and insights about Polyarthritis
Primary ICD-10-CM Codes for polyarthritis
Decision Criteria
clinical Criteria
- Symmetric joint involvement with elevated inflammatory markers
Applicable To
- Symmetric small joint involvement
- Elevated CRP/ESR
- Morning stiffness >1hr
Excludes
- Rheumatoid arthritis with positive rheumatoid factor (M05.79)
Clinical Validation Requirements
- Symmetric joint swelling
- Elevated inflammatory markers (CRP/ESR)
- Morning stiffness >1 hour
Code-Specific Risks
- Misclassification if specific type is not documented
Coding Notes
- Ensure documentation specifies inflammatory nature and affected joints.
M13.0 - Polyarthritis, unspecified
Use when documentation does not specify the type of arthritis.
Applicable To
- Non-specific joint pain
Excludes
- Specific types of arthritis (e.g., rheumatoid arthritis)
Clinical Validation Requirements
- Documentation lacks specificity for a more precise code
Coding Notes
Avoid using this code if specific arthritis type can be determined.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fever, unspecified
R50.9Differential 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 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: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Use templates to ensure comprehensive documentation, Regular training on documentation standards
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Could result in non-compliance with coding guidelines., Data Quality: Impacts the accuracy of clinical data.
Mitigation Strategy
Ensure documentation includes specific clinical indicators for inflammatory polyarthropathy.
Impact
Inaccurate documentation of joint involvement and inflammatory markers.
Mitigation Strategy
Implement regular audits and training sessions.
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 Polyarthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Polyarthritis
Use these documentation templates to ensure complete and accurate documentation for Polyarthritis. These templates include all required elements for proper coding and billing.
Rheumatology Progress Note
Specialty: RheumatologyRequired Elements
- Joint Inventory
- Lab Correlation
- Imaging Results
- Assessment
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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