M06.042
BillableRheumatoid arthritis without rheumatoid factor, left hand
HCC Category Mapping
V28HCC 93 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.175V24HCC 40 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.307ESRDHCC 40 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.000RxHCCHCC 83 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease
0.000What This Code Means
Rheumatoid arthritis affecting the left hand without rheumatoid factor antibodies.
Coding Tips
- •Distinguish between hand and wrist involvement; hand codes refer to finger joints
- •Document whether multiple joints in the hand are involved
Clinical Significance
Seronegative rheumatoid arthritis represents autoimmune inflammatory arthritis with a negative rheumatoid factor blood test, which occurs in approximately 20-30% of rheumatoid arthritis patients. Despite the negative serology, the disease carries similar risks of joint destruction and disability. This code is significant for risk adjustment as it captures a chronic condition requiring ongoing disease-modifying therapy.
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)
- ✓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) — Use M05.7xx when rheumatoid factor test is positiveM05.8xx (Other rheumatoid arthritis with rheumatoid factor) — Use M05.8xx for other seropositive presentationsM06.9 (Rheumatoid arthritis, unspecified) — Avoid when rheumatoid factor status and site are documented; code to highest specificityM13.x (Other arthritis) — Use for non-rheumatoid inflammatory arthritis; rheumatoid arthritis has its own specific categoryM19.x (Osteoarthritis) — Osteoarthritis is a degenerative, non-autoimmune condition; do not confuse with rheumatoid arthritis which is inflammatory and autoimmune
Code Hierarchy
└M06Other rheumatoid arthritis└M06.0Rheumatoid arthritis without rheumatoid factor└M06.04Rheumatoid arthritis without rheumatoid factor, hand└M06.042Rheumatoid arthritis without rheumatoid factor, left hand
└M06.042Rheumatoid arthritis without rheumatoid factor, left hand