M05.411

Billable

Rheumatoid myopathy with rheumatoid arthritis of right shoulder

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

Muscle weakness and inflammation caused by rheumatoid arthritis affecting the right shoulder.

Coding Tips

•Ensure documentation specifies the right shoulder as the affected site
•Verify that myopathy (muscle involvement) is documented as part of the rheumatoid arthritis manifestation

Clinical Significance

This diagnosis represents rheumatoid arthritis complicated by muscle weakness and inflammation affecting the right shoulder region. Rheumatoid myopathy with shoulder involvement indicates systemic disease progression affecting both joint and muscle tissue, requiring aggressive disease-modifying therapy and physical therapy to maintain shoulder function and prevent disability.

Documentation Requirements

✓Confirmed diagnosis of rheumatoid arthritis with positive serology (RF or anti-CCP)
✓Specific documentation of right shoulder joint involvement with inflammatory changes
✓Clinical evidence of muscle weakness, atrophy, or inflammatory myopathy in shoulder region
✓Documentation of muscle enzyme elevation (CK, aldolase) or muscle biopsy findings
✓Assessment of shoulder range of motion and functional limitations
✓Laboratory evidence of systemic inflammation (elevated ESR, CRP)
✓Documentation of chronicity and ongoing disease activity
✓Treatment with DMARDs or biologic agents

Commonly Confused Codes

M05.412 — Same condition but affecting left shoulder instead of right M05.419 — Same condition but shoulder laterality unspecified M75.31 — Calcific tendinitis of right shoulder (different etiology, no myopathy)M60.9 — Myositis, unspecified (not related to rheumatoid arthritis)

Code Hierarchy

└M05Rheumatoid arthritis with rheumatoid factor └M05.4Rheumatoid myopathy with rheumatoid arthritis └M05.41Rheumatoid myopathy with rheumatoid arthritis of shoulder └M05.411Rheumatoid myopathy with rheumatoid arthritis of right shoulder

└M05.411Rheumatoid myopathy with rheumatoid arthritis of right shoulder