M06.819

Billable

Other specified rheumatoid arthritis, unspecified shoulder

HCC Category Mapping

V28HCC 93 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease

0.175

V24HCC 40 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease

0.307

ESRDHCC 40 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease

0.000

RxHCCHCC 83 — Rheumatoid Arthritis and Inflammatory Connective Tissue Disease

0.000

What This Code Means

A form of rheumatoid arthritis affecting the shoulder joint that doesn't fit into other specific categories, with the affected shoulder not specified as left or right.

Coding Tips

•Use this code when the documentation indicates rheumatoid arthritis of the shoulder but doesn't clearly specify laterality; consider querying the provider if laterality can be determined
•Verify that the condition is truly 'other specified' rather than seronegative or another more specific rheumatoid arthritis subtype

Clinical Significance

Other specified rheumatoid arthritis affecting an unspecified shoulder indicates atypical RA variant in a functionally critical joint when laterality is not documented or bilateral involvement exists. Shoulder arthritis significantly impacts upper extremity function and quality of life.

Documentation Requirements

✓Confirmed rheumatoid arthritis diagnosis with specific atypical characteristics
✓Documentation of shoulder involvement without laterality specification
✓Clinical features that distinguish this as 'other specified' RA type
✓Assessment of shoulder function and range of motion limitations
✓Laboratory support for active rheumatoid inflammatory process
✓Evidence that laterality is truly unspecified or bilateral involvement
✓Treatment approach and response to anti-rheumatic therapy
✓Functional impact on activities requiring shoulder mobility

Commonly Confused Codes

M06.811 — Other specified rheumatoid arthritis, right shoulder (when laterality is documented)M06.812 — Other specified rheumatoid arthritis, left shoulder (when laterality is documented)M06.80 — Other specified rheumatoid arthritis, unspecified site (when shoulder location documented)M05.819 — Other rheumatoid arthritis with rheumatoid factor of unspecified shoulder (different RA classification)M25.519 — Pain in unspecified shoulder (symptom without inflammatory disease)

Code Hierarchy

└M06Other rheumatoid arthritis └M06.8Other specified rheumatoid arthritis └M06.81Other specified rheumatoid arthritis, shoulder └M06.819Other specified rheumatoid arthritis, unspecified shoulder

└M06.819Other specified rheumatoid arthritis, unspecified shoulder