M05.019
BillableFelty's syndrome, unspecified 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 shoulder area, but the specific side (right or left) is not documented or specified.
Coding Tips
- •Use this code when shoulder involvement is documented but laterality cannot be determined from the record
- •Query the provider if possible to obtain laterality information for more specific coding
Clinical Significance
Felty's syndrome with unspecified shoulder involvement indicates the presence of the complete triad (rheumatoid arthritis, splenomegaly, neutropenia) but lacks specific laterality documentation. This rare condition requires comprehensive monitoring and aggressive treatment due to high morbidity and mortality risks from opportunistic infections.
Documentation Requirements
- ✓Documentation of rheumatoid arthritis affecting shoulder joint without side specification
- ✓Clinical or imaging evidence of splenomegaly
- ✓Laboratory confirmation of neutropenia with quantitative values
- ✓Shoulder joint involvement documented but laterality unspecified
- ✓Evidence of systemic inflammatory response
- ✓Assessment of functional impairment and pain levels
- ✓Treatment history and current medication regimen
- ✓Monitoring for infection complications and immune status
Commonly Confused Codes
M05.9 — Rheumatoid arthritis seropositive without the complete Felty's triadM05.011 or M05.012 — When laterality is actually documented in the recordD70.9 — Neutropenia without the rheumatoid arthritis and spleen componentsM06.9 — Rheumatoid arthritis unspecified without hematologic involvementR16.1 — Splenomegaly as isolated finding without RA context
Code Hierarchy
└M05Rheumatoid arthritis with rheumatoid factor└M05.0Felty's syndrome└M05.01Felty's syndrome, shoulder└M05.019Felty's syndrome, unspecified shoulder
└M05.019Felty's syndrome, unspecified shoulder