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M05.831 ICD-10-CM Code: Other rheumatoid arthritis with rheumatoid factor of right wrist

M05.831 maps to CMS-HCC V28 93 (RAF 0.617). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Inflammatory polyarthropathies (M05-M14)

M05.831

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other rheumatoid arthritis with rheumatoid factor of right wrist

A type of rheumatoid arthritis affecting the right wrist in patients who test positive for rheumatoid factor, an antibody associated with this autoimmune joint disease.

Buddy the Bee presenting code insight

Buddy Insight

This code captures other specified manifestations of seropositive rheumatoid arthritis with positive rheumatoid factor, representing a systemic autoimmune condition with potential for progressive joint destruction and disability.

CMS-HCC V28

HCC 93

RAF 0.617

CMS-HCC V24

HCC 40

RAF 0.421

ACA/HHS

HCC 56

Varies by metal level

ESRD/PACE

HCC 40

RAF 0.058

RXHCC

HCC 83

RAF 0.222

Code Book Path

Official
M05.8Other rheumatoid arthritis with rheumatoid factor
M05.83Other rheumatoid arthritis with rheumatoid factor of wrist
M05.831Other rheumatoid arthritis with rheumatoid factor of right wrist

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M05.831 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M05.831 in this effective period.

Related Child Codes

Official
M05.832Other rheumatoid arthritis with rheumatoid factor of left wrist
M05.839Other rheumatoid arthritis with rheumatoid factor of unspecified wrist

Includes

Official

ICD-10-CM does not list Includes notes for M05.831 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M05.831 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M05.831 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M05.831 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M05.831 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Clinical diagnosis of rheumatoid arthritis clearly documented by the treating provider
Rheumatoid factor lab result status (positive or negative) consistent with the code selected
Affected joint(s) specified with laterality (right, left, or bilateral)
Current disease status: active, in remission, or chronic stable

MEAT Support

HCC Buddy guidance
Clinical diagnosis of rheumatoid arthritis clearly documented by the treating provider
Rheumatoid factor lab result status (positive or negative) consistent with the code selected
Affected joint(s) specified with laterality (right, left, or bilateral)
Current disease status: active, in remission, or chronic stable

Audit Caution

HCC Buddy guidance
Failing to verify rheumatoid factor status before selecting between M05 (seropositive) and M06 (seronegative) categories — lab results must support code selection
Coding rheumatoid arthritis based solely on a positive rheumatoid factor lab result without a clinical diagnosis from the provider — a positive rheumatoid factor alone is not sufficient to code rheumatoid arthritis
Reporting rheumatoid arthritis from past medical history without confirmation that the condition is still active, being treated, or being monitored during the current encounter
Not linking rheumatoid arthritis to all associated manifestations that may warrant additional codes, such as anemia of chronic disease or interstitial lung disease

Common Mistakes

HCC Buddy guidance
M05.7xx (Rheumatoid arthritis with rheumatoid factor without organ involvement, same site) — Use M05.7xx for the standard seropositive presentation without organ or systems involvement
M06.0xx (Rheumatoid arthritis without rheumatoid factor, same site) — Use M06.0xx when rheumatoid factor is negative
M06.9 (Rheumatoid arthritis, unspecified) — A nonspecific code that does not indicate rheumatoid factor status; avoid when rheumatoid factor status is known
M05.0x-M05.6x (Rheumatoid arthritis with organ involvement such as Felty syndrome, rheumatoid lung, vasculitis) — Use these when extra-articular manifestations are documented

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is M05.831 an HCC code?

Yes. M05.831 (Other rheumatoid arthritis with rheumatoid factor of right wrist) maps to Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders under the CMS-HCC V28 risk adjustment model (and Rheumatoid Arthritis and Inflammatory Connective Tissue Disease under V24), with a community non-dual aged RAF of 0.617. It is billable for payment year 2026.

Coder answer: M05.831 is billable and maps to V28 HCC 93, Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
M05.831
Description
Other rheumatoid arthritis with rheumatoid factor of right wrist
HCC (V28)
HCC 93 — Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders
RAF
0.617
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 93, Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders
0.617
V24HCC 40, Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.421
ESRDHCC 40, Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.058
RxHCCHCC 83, Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.222

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work M05.831 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for M05.831

For M05.831 to 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 M05.831 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

M05.831 is the ICD-10-CM diagnosis code for other rheumatoid arthritis with rheumatoid factor of right wrist. A type of rheumatoid arthritis affecting the right wrist in patients who test positive for rheumatoid factor, an antibody associated with this autoimmune joint disease. M05.831 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, M05.831 maps to Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders (HCC 93) with a community, non-dual, aged base RAF weight of 0.617. Under the older CMS-HCC V24 model, M05.831 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease (HCC 40) with a community, non-dual, aged base RAF weight of 0.421. 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.

Confirm right wrist involvement is documented; wrist arthritis is a common manifestation of rheumatoid arthritis. Because M05.831 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 M05.831 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Confirm right wrist involvement is documented; wrist arthritis is a common manifestation of rheumatoid arthritis
  • •Verify rheumatoid factor positivity in laboratory results before code assignment

Clinical Significance

This code captures other specified manifestations of seropositive rheumatoid arthritis with positive rheumatoid factor, representing a systemic autoimmune condition with potential for progressive joint destruction and disability. Accurate capture is essential for risk adjustment as it reflects significant ongoing treatment burden including disease-modifying antirheumatic drugs, biologics, and regular laboratory monitoring.

Documentation Requirements

  • ✓Clinical diagnosis of rheumatoid arthritis clearly documented by the treating provider
  • ✓Rheumatoid factor lab result status (positive or negative) consistent with the code selected
  • ✓Affected joint(s) specified with laterality (right, left, or bilateral)
  • ✓Current disease status: active, in remission, or chronic stable
  • ✓Current treatment plan including medications (disease-modifying antirheumatic drugs, biologics, nonsteroidal anti-inflammatory drugs)
  • ✓Specification of the 'other' rheumatoid arthritis manifestation or feature that distinguishes it from standard presentations
  • ✓Assessment and plan addressing rheumatoid arthritis at each encounter where it impacts care or treatment

Commonly Confused Codes

  • •M05.7xx (Rheumatoid arthritis with rheumatoid factor without organ involvement, same site): Use M05.7xx for the standard seropositive presentation without organ or systems involvement
  • •M06.0xx (Rheumatoid arthritis without rheumatoid factor, same site): Use M06.0xx when rheumatoid factor is negative
  • •M06.9 (Rheumatoid arthritis, unspecified): A nonspecific code that does not indicate rheumatoid factor status; avoid when rheumatoid factor status is known
  • •M05.0x-M05.6x (Rheumatoid arthritis with organ involvement such as Felty syndrome, rheumatoid lung, vasculitis): Use these when extra-articular manifestations are documented
  • •M19.x (Osteoarthritis): Osteoarthritis is a degenerative, non-autoimmune condition; do not confuse with rheumatoid arthritis which is inflammatory and autoimmune

Child Codes

M05.831Other rheumatoid arthritis with rheumatoid factor of right wrist
HCC 93
M05.832Other rheumatoid arthritis with rheumatoid factor of left wrist
HCC 93
M05.839Other rheumatoid arthritis with rheumatoid factor of unspecified wrist
HCC 93

Code Hierarchy

└M05Rheumatoid arthritis with rheumatoid factor└M05.8Other rheumatoid arthritis with rheumatoid factor└M05.83Other rheumatoid arthritis with rheumatoid factor of wrist└M05.831Other rheumatoid arthritis with rheumatoid factor of right wrist
└M05.831Other rheumatoid arthritis with rheumatoid factor of right wrist

Because M05.831 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

M05.831 maps to CMS-HCC V28 category 93, Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because M05.831 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

More on M05.831

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