M05.419

Billable

Rheumatoid myopathy with rheumatoid arthritis of unspecified 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 an unspecified shoulder.

Coding Tips

•Use this code when the shoulder is affected but laterality (left vs right) is not documented
•Query the provider if possible to determine which shoulder is involved for more specific coding

Clinical Significance

This diagnosis represents rheumatoid arthritis complicated by muscle weakness and inflammation affecting the shoulder region when laterality is not specified. 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)
✓Documentation of shoulder joint involvement without laterality specification
✓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

M05.411 — Same condition but specifically right shoulder (more specific when known)M05.412 — Same condition but specifically left shoulder (more specific when known)M75.3 — Calcific tendinitis of shoulder, unspecified (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 └M05.419Rheumatoid myopathy with rheumatoid arthritis of unspecified shoulder

└M05.419Rheumatoid myopathy with rheumatoid arthritis of unspecified shoulder