M08.019
BillableUnspecified juvenile rheumatoid arthritis, unspecified shoulder
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
Juvenile rheumatoid arthritis affecting the shoulder in a child, where the specific type of juvenile arthritis has not been determined.
Coding Tips
- •This code is used when the type of juvenile rheumatoid arthritis is unspecified; if a specific type (systemic, polyarticular, pauciarticular) is documented, use a more specific M08 code.
- •The '9' in the fifth position indicates the shoulder location is unspecified (could be bilateral or not clearly documented); use M08.011 or M08.012 if laterality is known.
Clinical Significance
Unspecified juvenile rheumatoid arthritis of unspecified shoulder indicates chronic inflammatory arthritis requiring ongoing specialty care and monitoring. This diagnosis captures patients with significant healthcare resource utilization needs including immunomodulating therapies and potential for long-term disability.
Documentation Requirements
- ✓Patient age at onset documented as under 16 years
- ✓Evidence of chronic shoulder joint inflammation
- ✓Documentation that laterality cannot be determined
- ✓Confirmation that specific juvenile arthritis subtype cannot be classified
- ✓Physical examination findings of arthritis
- ✓Laboratory evidence of systemic inflammation
- ✓Current or planned disease-modifying treatment
- ✓Functional assessment documentation
Commonly Confused Codes
M08.012 — Use when left shoulder is specifically documentedM08.011 — Use when right shoulder is specifically documentedM06.9 — Adult-onset rheumatoid arthritis versus juvenile onsetM25.519 — Shoulder pain versus confirmed inflammatory arthritisM08.2 — Juvenile rheumatoid arthritis with systemic onset when systemic features present
Code Hierarchy
└M08Juvenile arthritis└M08.0Unspecified juvenile rheumatoid arthritis└M08.01Unspecified juvenile rheumatoid arthritis, shoulder└M08.019Unspecified juvenile rheumatoid arthritis, unspecified shoulder
└M08.019Unspecified juvenile rheumatoid arthritis, unspecified shoulder