M08.412

HCC Category Mapping

What This Code Means

A type of arthritis in children that affects only a few joints, specifically involving the left shoulder. It causes inflammation and stiffness in the shoulder joint.

Coding Tips

• •Confirm the laterality is documented as left shoulder in the clinical documentation
• •Do not use this code if the shoulder involvement is bilateral; instead use the appropriate bilateral code if available

Clinical Significance

Pauciarticular juvenile rheumatoid arthritis affecting the left 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 left 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