Orthopedic Coding Alert

You Be the Coder:

Use Single ICD-10 Code for RA With Heart Disease

Question: An established patient with rheumatoid heart disease and rheumatoid arthritis (RA) of the wrist reported to the orthopedist for a checkup of the condition. The provider performed a level-three evaluation and management (E/M) service. I know to report 99213, but what is the best ICD-10 code(s) to capture this condition? My colleague says M05.30- along with M06.82-, but I’m not so sure. Any thoughts?

Mississippi Subscriber

Answer: You were right to pause at this decision. The best ICD-10 code for your 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity …) claim is one of the following, depending on encounter specifics:

  • M05.331 (Rheumatoid heart disease with rheumatoid arthritis of right wrist)
  • M05.332 (Rheumatoid heart disease with rheumatoid arthritis of left wrist)
  • M05.339 (Rheumatoid heart disease with rheumatoid arthritis of unspecified wrist).

Explanation: It is redundant to report M05.30- (Rheumatoid heart disease with rheumatoid arthritis of unspecified site) and M06.82 (Other specified rheumatoid arthritis, elbow) for this patient, as there is a single diagnosis that provides a better snapshot of the patient’s condition.