ED Coding and Reimbursement Alert

Question: Encounter notes indicate that a patient suffers from “rheumatoid carditis w/RA, R shoulder.” I’m at a loss here; can you help me choose a diagnosis code for this shorthand?

Illinois Subscriber

Answer: This one is tricky, as you’ll need to grapple with alternate terms in ICD-10 as well as wading through the shorthand.

The abbreviations your physician uses translates to: rheumatoid carditis with rheumatoid arthritis of the right shoulder. Rheumatoid arthritis often accompanies rheumatoid carditis.

Choosing an ICD-10 code is where things get trickier. There is no code descriptor that explicitly states “Rheumatoid carditis.” Instead, the condition is listed as an alternate term beneath the descriptor for M05.3- (Rheumatoid heart disease with rheumatoid arthritis). From there, you can scroll through the code set until you see the most accurate diagnosis code: M05.311 (Rheumatoid heart disease with rheumatoid arthritis of right shoulder).

Other alternate terms: In addition to rheumatoid carditis, here are the other terms that ICD-10 deems codeable with M05.3- codes:

• Rheumatoid endocarditis
• Rheumatoid myocarditis
• Rheumatoid pericarditis.