M08.411

Billable

Pauciarticular juvenile rheumatoid arthritis, right 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 type of arthritis in children that affects only a few joints, specifically involving the right shoulder. It causes inflammation and stiffness in the shoulder joint.

Coding Tips

•Verify the laterality is documented as right shoulder in the medical record before assigning this code
•This is a form of juvenile idiopathic arthritis (JIA); ensure the diagnosis specifies pauciarticular type to distinguish from other JIA subtypes

Clinical Significance

Pauciarticular juvenile rheumatoid arthritis affecting the right shoulder represents a chronic inflammatory condition requiring ongoing management to prevent joint destruction and functional impairment. This diagnosis is significant for risk adjustment as shoulder involvement can significantly impact activities of daily living and may require physical therapy, occupational therapy, and potential surgical intervention.

Documentation Requirements

✓Patient age at onset (must be under 16 years)
✓Involvement of 4 or fewer joints throughout disease course
✓Documentation of right shoulder joint involvement with inflammation
✓Absence of systemic symptoms (fever, rash, organomegaly)
✓Duration of symptoms (minimum 6 weeks for JRA diagnosis)
✓Physical examination findings of shoulder joint swelling, warmth, or limited motion
✓Laboratory studies excluding other causes of arthritis
✓Assessment of functional impact on upper extremity activities

Commonly Confused Codes

M08.3 — Juvenile rheumatoid polyarthritis seronegative (affects 5 or more joints)M08.2x — Juvenile rheumatoid arthritis with systemic onset (has systemic symptoms)M25.511 — Pain in right shoulder (symptom code, not diagnostic)M75.30 — Calcific tendinitis of unspecified shoulder (different pathophysiology)S43.001A — Unspecified dislocation of right shoulder joint, initial encounter (traumatic injury)

Code Hierarchy

└M08Juvenile arthritis └M08.4Pauciarticular juvenile rheumatoid arthritis └M08.41Pauciarticular juvenile rheumatoid arthritis, shoulder └M08.411Pauciarticular juvenile rheumatoid arthritis, right shoulder

└M08.411Pauciarticular juvenile rheumatoid arthritis, right shoulder