M08.419

Billable

Pauciarticular juvenile 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 type of arthritis in children that affects only a few joints, involving the shoulder when the specific side (left or right) is not documented or is bilateral.

Coding Tips

•Use this code only when laterality cannot be determined from the medical record
•Query the provider if documentation indicates bilateral shoulder involvement to determine if separate codes for each side should be used

Clinical Significance

Pauciarticular juvenile rheumatoid arthritis affecting unspecified 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 shoulder joint involvement without laterality specification or bilateral involvement
✓Absence of systemic symptoms (fever, rash, organomegaly)
✓Duration of symptoms (minimum 6 weeks for JRA diagnosis)
✓Physical examination findings of shoulder joint inflammation
✓Laboratory studies excluding other causes of arthritis
✓Assessment of functional impact on upper extremity activities

Commonly Confused Codes

M08.411 — Use when right shoulder specifically documented M08.412 — Use when left shoulder specifically documented M08.3 — Juvenile rheumatoid polyarthritis seronegative (affects 5 or more joints)M25.519 — Pain in unspecified shoulder (symptom code, not diagnostic)M75.30 — Calcific tendinitis of unspecified shoulder (different pathophysiology)

Code Hierarchy

└M08Juvenile arthritis └M08.4Pauciarticular juvenile rheumatoid arthritis └M08.41Pauciarticular juvenile rheumatoid arthritis, shoulder └M08.419Pauciarticular juvenile rheumatoid arthritis, unspecified shoulder

└M08.419Pauciarticular juvenile rheumatoid arthritis, unspecified shoulder