M06.059
BillableRheumatoid arthritis without rheumatoid factor, unspecified hip
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 hip without rheumatoid factor, but the specific hip (left or right) is not documented.
Coding Tips
- •This is a less specific code; attempt to obtain laterality information from clinical documentation
- •Query the provider if hip involvement is documented but side is unclear
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)
- ✓Query provider for specific laterality or site to assign a more specific code when possible
- ✓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└M06.05Rheumatoid arthritis without rheumatoid factor, hip└M06.059Rheumatoid arthritis without rheumatoid factor, unspecified hip
└M06.059Rheumatoid arthritis without rheumatoid factor, unspecified hip