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FY2027 ICD-10-CM reference

M05.511: Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder

By the HCC Buddy Coding Team

The official ICD-10-CM descriptor is Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Billable code. Verified against the official FY2027 order file.

CMS-HCC V28

  • HCC 93: Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders · RAF 0.617, Community Non-Dual Aged (CNA)

Payment year 2027, 2026 dates of service. HCC from the CMS 2027 Initial ICD-10-CM Mappings; RAF from the CMS-HCC V28 relative factors. For 2027 dates of service, CMS has not yet published the payment year 2028 mappings.

CMS-HCC V24

Not used for payment year 2027 Medicare Advantage payment

ESRD

  • HCC 40: Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
  • HCC 75: Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy

Coefficient pending: payment year 2027 coefficients for this model are not yet verified, so no RAF is shown. Mapping: PY2026 CMS mapping; CMS 2027 initial file unchanged.

PACE

Source verification pending

RxHCC

  • HCC 83: Rheumatoid Arthritis and Other Inflammatory Polyarthropathy
  • HCC 158: Inflammatory and Toxic Neuropathy

Coefficient pending: payment year 2027 coefficients for this model are not yet verified, so no RAF is shown. Mapping: PY2026 CMS mapping; CMS 2027 initial file unchanged.

HHS-HCC

Source verification pending

FY2027 Tabular instructions

Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.

Instructional note

Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition

Source: M00-M99 (chapter, inherited).

Excludes2

arthropathic psoriasis (L40.5-)

Source: M00-M99 (chapter, inherited).

Excludes2

certain conditions originating in the perinatal period (P04-P96)

Source: M00-M99 (chapter, inherited).

Excludes2

certain infectious and parasitic diseases (A00-B99)

Source: M00-M99 (chapter, inherited).

Excludes2

compartment syndrome (traumatic) (T79.A-)

Source: M00-M99 (chapter, inherited).

Excludes2

complications of pregnancy, childbirth and the puerperium (O00-O9A)

Source: M00-M99 (chapter, inherited).

Excludes2

congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)

Source: M00-M99 (chapter, inherited).

Excludes2

endocrine, nutritional and metabolic diseases (E00-E88)

Source: M00-M99 (chapter, inherited).

Excludes2

injury, poisoning and certain other consequences of external causes (S00-T88)

Source: M00-M99 (chapter, inherited).

Excludes2

neoplasms (C00-D49)

Source: M00-M99 (chapter, inherited).

Excludes2

symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

Source: M00-M99 (chapter, inherited).

Excludes1

rheumatic fever (I00)

Source: M05 (category, inherited).

Excludes1

juvenile rheumatoid arthritis (M08.-)

Source: M05 (category, inherited).

Excludes1

rheumatoid arthritis of spine (M45.-)

Source: M05 (category, inherited).

Source: CMS FY2027 Tabular List and Alphabetic Index.

Open Tabular instructions and code details

Compare the FY2027 additions, removals and billable-status changes

What does M05.511 mean in FY2027?

The official ICD-10-CM descriptor is Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Is M05.511 billable in FY2027?

The FY2027 order file marks M05.511 as billable. Check the complete Tabular instructions and documentation before assigning it.

Does M05.511 map to an HCC?

In the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service), M05.511 maps to CMS-HCC V28 HCC 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders). For 2027 dates of service, CMS has not yet published the payment year 2028 mappings. Under the PY2026 CMS mapping; CMS 2027 initial file unchanged: ESRD HCC 40 and HCC 75; RxHCC HCC 83 and HCC 158. Coefficients for these models are pending verification for payment year 2027. CMS-HCC V24, PACE and HHS-HCC mappings are still pending verification for FY2027.

Source: CMS FY2027 ICD-10-CM order file. Read the FY2027 Official Guidelines.

Review the FY2026 April edition