M05.722
BillableRheumatoid arthritis with rheumatoid factor of left elbow 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 M05.722 an HCC code?
Yes. M05.722 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 M05.722
For M05.722to 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 M05.722 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M05.722 is the ICD-10-CM diagnosis code for rheumatoid arthritis with rheumatoid factor of left elbow without organ or systems involvement. Rheumatoid arthritis with positive rheumatoid factor affecting the left elbow only, without involvement of other organs or systems. M05.722 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, M05.722 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, M05.722 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.
Verify left elbow involvement in the medical record before assigning this code. Because M05.722 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 M05.722 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify left elbow involvement in the medical record before assigning this code
- •If bilateral elbows are affected, use appropriate bilateral or multiple site coding instead
Clinical Significance
This diagnosis represents seropositive rheumatoid arthritis affecting the left elbow without systemic involvement, indicating localized inflammatory arthritis with positive rheumatoid factor. This chronic inflammatory condition requires ongoing medical management despite the absence of systemic manifestations.
Documentation Requirements
- ✓Confirmation of rheumatoid arthritis diagnosis in left elbow joint
- ✓Positive rheumatoid factor laboratory result documented
- ✓Confirmation that no organ or system involvement exists
- ✓Clinical evidence of inflammatory arthritis in left elbow specifically
- ✓Exclusion of extra-articular manifestations
- ✓Assessment of disease activity and functional limitation
- ✓Clear documentation of left elbow laterality
Commonly Confused Codes
- •M05722 vs M05721 — Wrong laterality (right vs left elbow)
- •M05722 vs M19.022 — M19.022 is primary osteoarthritis of left elbow
- •M05722 vs M25.522 — M25.522 is pain in left elbow without inflammation
- •M05722 vs M77.12 — M77.12 is lateral epicondylitis of left elbow
- •M05722 vs M05.622 — M05.622 includes systemic organ involvement