M05.359
BillableRheumatoid heart disease with rheumatoid arthritis of unspecified hip
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
A condition where rheumatoid arthritis affects the hip (side not specified) and also causes inflammation of the heart tissue (rheumatoid heart disease).
Coding Tips
- •Use only when laterality cannot be determined from available documentation
- •Attempt to clarify which hip is affected through provider query or chart review
Clinical Significance
This diagnosis represents a complex systemic manifestation of rheumatoid arthritis affecting both the cardiovascular system and hip joint when laterality is not specified. The combination of rheumatoid heart disease with large joint involvement indicates advanced inflammatory disease with significant impact on mobility and cardiovascular health, requiring comprehensive management including cardiac monitoring and aggressive disease-modifying therapy.
Documentation Requirements
- ✓Confirmed diagnosis of rheumatoid arthritis with positive serology (RF or anti-CCP)
- ✓Evidence of cardiac involvement such as pericarditis, myocarditis, or valvular disease
- ✓Documentation of hip joint involvement without laterality specification
- ✓Clinical assessment of hip pain, stiffness, and mobility limitations
- ✓Echocardiogram or other cardiac imaging showing rheumatoid heart disease
- ✓Laboratory evidence of systemic inflammation (elevated ESR, CRP)
- ✓Documentation of chronicity and ongoing disease activity
- ✓Treatment with DMARDs or biologic agents
Commonly Confused Codes
M05.351 — Same condition but specifically right hip (more specific when known)M05.352 — Same condition but specifically left hip (more specific when known)M16.9 — Osteoarthritis of hip, unspecified (different etiology, no cardiac involvement)M06.9 — Rheumatoid arthritis, unspecified (no heart involvement documented)
Code Hierarchy
└M05Rheumatoid arthritis with rheumatoid factor└M05.3Rheumatoid heart disease with rheumatoid arthritis└M05.35Rheumatoid heart disease with rheumatoid arthritis of hip└M05.359Rheumatoid heart disease with rheumatoid arthritis of unspecified hip
└M05.359Rheumatoid heart disease with rheumatoid arthritis of unspecified hip