M05.011
BillableFelty's syndrome, right shoulder
HCC Category Mapping
V28HCC 93 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.175V24HCC 40 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.307ESRDHCC 40 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.000RxHCCHCC 83 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.000What This Code Means
Felty's syndrome affecting the right shoulder, characterized by rheumatoid arthritis, enlarged spleen, and low white blood cell count.
Coding Tips
- •This code is site-specific; ensure documentation clearly indicates right shoulder involvement
- •Verify that Felty's syndrome diagnosis is documented, not just rheumatoid arthritis alone
Clinical Significance
Felty's syndrome is a rare, severe manifestation of rheumatoid arthritis that combines joint inflammation with splenomegaly and neutropenia, significantly increasing infection risk and mortality. This triad requires aggressive management and frequent monitoring due to the immunocompromised state and potential for serious complications.
Documentation Requirements
- ✓Documentation of rheumatoid arthritis affecting the right shoulder joint
- ✓Evidence of splenomegaly through physical examination or imaging
- ✓Laboratory confirmation of neutropenia (low white blood cell count)
- ✓Right shoulder joint involvement specifically documented
- ✓Clinical symptoms of joint inflammation and functional impairment
- ✓History of recurrent infections if present
- ✓Treatment response or medication management documentation
- ✓Exclusion of other causes of neutropenia and splenomegaly
Commonly Confused Codes
M05.9 — Seropositive rheumatoid arthritis without the specific triad of Felty's syndromeM06.9 — Rheumatoid arthritis unspecified, lacks the hematologic componentsD70.9 — Neutropenia without the rheumatoid arthritis and splenomegaly componentsR16.1 — Splenomegaly without associated rheumatoid arthritisM05.019 — Same condition but unspecified shoulder location
Code Hierarchy
└M05Rheumatoid arthritis with rheumatoid factor└M05.0Felty's syndrome└M05.01Felty's syndrome, shoulder└M05.011Felty's syndrome, right shoulder
└M05.011Felty's syndrome, right shoulder