M05.712
BillableRheumatoid arthritis with rheumatoid factor of left shoulder without organ or systems involvement
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M05.712 an HCC code?
Yes. M05.712 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease under the CMS-HCC V28 risk adjustment model (and Rheumatoid Arthritis and Inflammatory Connective Tissue Disease under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for M05.712
For M05.712to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed M05.712 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M05.712 is the ICD-10-CM diagnosis code for rheumatoid arthritis with rheumatoid factor of left shoulder without organ or systems involvement. Rheumatoid arthritis with positive rheumatoid factor affecting the left shoulder only, without involvement of other organs or systems. M05.712 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering inflammatory polyarthropathies (m05-m14).
Under the CMS-HCC V28 risk adjustment model, M05.712 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease (HCC 93) with a community, non-dual, aged base RAF weight of 0.175. Under the older V24 model, M05.712 mapped to the same category but with a base RAF weight of 0.307 — V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
This code applies specifically to left-sided shoulder involvement; verify laterality in the medical record. Because M05.712 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M05.712 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code applies specifically to left-sided shoulder involvement; verify laterality in the medical record
- •If both shoulders are affected, this code should not be used; instead use bilateral or multiple site codes
Clinical Significance
This code represents seropositive rheumatoid arthritis affecting the left shoulder without systemic involvement, indicating localized inflammatory arthritis with confirmed rheumatoid factor positivity. This represents chronic inflammatory disease requiring ongoing monitoring and treatment despite lack of systemic manifestations.
Documentation Requirements
- ✓Confirmation of rheumatoid arthritis diagnosis in left shoulder joint
- ✓Documented positive rheumatoid factor laboratory result
- ✓Confirmation that no organ or system involvement exists
- ✓Clinical evidence of inflammatory arthritis specifically in left shoulder
- ✓Exclusion of extra-articular manifestations
- ✓Assessment of disease activity and functional limitation
- ✓Clear documentation of left shoulder laterality
Commonly Confused Codes
- •M05712 vs M05711 — Wrong laterality (right vs left shoulder)
- •M05712 vs M19.012 — M19.012 is primary osteoarthritis of left shoulder
- •M05712 vs M75.32 — M75.32 is calcific tendinitis of left shoulder
- •M05712 vs M25.512 — M25.512 is pain in left shoulder without inflammation
- •M05712 vs M05.612 — M05.612 includes systemic organ involvement