M05.361

Billable

Rheumatoid heart disease with rheumatoid arthritis of right knee

HCC Category Mapping

V28HCC 93 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease

0.175

V24HCC 40 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease

0.307

ESRDHCC 40 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease

0.000

RxHCCHCC 83 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease

0.000

What This Code Means

A condition where rheumatoid arthritis affects the right knee and also causes inflammation of the heart tissue (rheumatoid heart disease).

Coding Tips

•Ensure documentation supports both knee involvement and cardiac manifestations of rheumatoid disease
•This represents systemic disease with multiple organ involvement

Clinical Significance

This diagnosis represents a complex systemic manifestation of rheumatoid arthritis affecting both the cardiovascular system and right knee joint. The combination of rheumatoid heart disease with large weight-bearing joint involvement indicates advanced inflammatory disease with significant impact on mobility, function, and cardiovascular health, requiring comprehensive management including cardiac monitoring and aggressive immunosuppression.

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
✓Specific documentation of right knee joint involvement with inflammatory changes
✓Clinical assessment of knee pain, swelling, 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

M05.362 — Same condition but affecting left knee instead of right M05.369 — Same condition but knee laterality unspecified M17.11 — Primary osteoarthritis of right knee (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 └M05.36Rheumatoid heart disease with rheumatoid arthritis of knee └M05.361Rheumatoid heart disease with rheumatoid arthritis of right knee

└M05.361Rheumatoid heart disease with rheumatoid arthritis of right knee