Before dawn, with the aroma of fresh espresso throughout my apartment, the house is dark and quiet. I sit at my desk and write with the intention of helping myself and other coders understand and perform the complex work we do. This has become my favorite part of the day, allowing both my creative and analytical traits to cross paths in creating something useful. With a passion for Risk Adjustment coding and a growing passion for CPT coding, I wanted to focus on a chronic condition that would allow research across both challenging areas of coding.
Today my focus is on Rheumatoid Arthritis (RA) with and without rheumatoid factor, without organ involvement. RA is a painful, chronic autoimmune disease that requires treatment to help patients manage symptoms and reduce the risk of serious complications. Because of its systemic nature, RA can also affect the heart, lungs, and other organs. Within the Alphabetical Index of ICD-10-CM lies a long list of conditions related to RA using the “with” convention as well as etiology-based connections. For this article, I chose to walk through RA with or without rheumatoid factor, without organ involvement. These codes fall under category blocks M05.7- and M06.- and map to CMS-HCC V24 (40), CMS-HCC V28 (93), and CMS-RxHCC V08 (83).
In this article I breakdown:
- Rheumatoid Arthritis manifestations, and forms of treatment
- Indexing RA in the ICD-10-CM Alphabetical Index and tips for arriving at the correct code
- CPT codes for procedures such as Arthrotomy and Synovectomy and laboratory testing in relationship to RA
- HCPCS J codes for the management of pain associated with RA
- Coding scenarios with indexing paths to provide visual to Rheumatoid Arthritis ICD-10 and CPT coding
- ICD-10-CM Mappings to CMS-V24, CMS-V28, and RX-HCC V08 HCC Risk Adjustment Models
Rheumatoid Arthritis
Rheumatoid Arthritis (RA) is a chronic, systemic autoimmune disease in which the immune system mistakenly attacks the body’s own tissues. It primarily targets the synovial lining of joints, causing inflammation, pain, and swelling that can destroy cartilage and erode bone, often leading to deformity and loss of joint function. Unlike osteoarthritis, RA is usually symmetric, starting in the small peripheral joints and progressing to larger, proximal joints if untreated. Because RA is systemic, its effects are not limited to joints, it can also damage the skin, eyes, lungs, heart, and blood vessels. The disease develops through a combination of genetic and environmental factors, with tobacco being a well-known trigger. RA is defined as early when symptoms have lasted fewer than six months and established when they persist beyond six months. Left untreated, it is progressive, associated with significant morbidity and increased mortality. Proper evaluation and management, supported by an interprofessional healthcare team, are essential to control inflammation, prevent complications, and improve quality of life for patients. The damage from RA can cause long-lasting pain, swelling, balance problems, and joint deformities. It can also limit physical activity, make certain types of work difficult, and reduce participation in social activities, sometimes leading to isolation.
Symptoms
The most common early symptoms of rheumatoid arthritis (RA) are joint pain and swelling, which often develop gradually over weeks to months. It typically begins in the small joints of the hands and feet before progressing to larger joints. A hallmark feature is morning stiffness that lasts for a prolonged period. RA primarily affects the small peripheral joints, especially in the hands, but it can also involve the cervical spine due to the presence of synovial joints in that region. The lumbar spine, however, is not affected. Although polyarticular involvement is most common, some patients may initially present with a single joint (monoarticular) or extra-articular involvement, such as lung disease.
Common symptoms of RA include:
- Pain, stiffness, or aching in more than one joint
- Tenderness, redness, warmth, and swelling in joints
- Fatigue or tiredness
- Weakness
- Weight loss
- Fever
Flares and Remission
RA often comes and goes. People may have flares when symptoms suddenly worsen, followed by periods of remission, when symptoms improve or disappear.
Rheumatoid Factor
- Rheumatoid Factor (RF) is a protein within the blood that can often (but not always) indicate that an autoimmune disease is present. Rheumatoid Arthritis with Rheumatoid Factor is also referred to as seropositive RA, whereas RA without RF is called seronegative.
- The presence of RF is not a determining factor in the diagnosis of RA
Treatment
There is no cure for RA, but it can be managed. Treatment includes self-care and medications that help reduce pain, control inflammation, and prevent complications.
- Disease-Modifying Antirheumatic Drugs (DMARDs)
(not an exhaustive list, but common examples)
o Methotrexate
o Leflunomide
o Hydroxychloroquine
o Sulfasalazine
The use of biologic agents has transformed the treatment of rheumatoid arthritis (RA) over the past two decades. These medications target specific molecules and immune cells that drive inflammation in RA. Biologics have been shown to improve outcomes and even lead to remission, especially for patients who do not respond well to traditional disease-modifying antirheumatic drugs (DMARDs).
Examples of biologic agents approved for RA treatment include:
- TNF inhibitors: infliximab, etanercept, adalimumab, golimumab, certolizumab pegol
- IL-6 receptor antagonist: tocilizumab
- IL-1 receptor antagonist: anakinra
- B cell depleting agent: rituximab
- T cell co-stimulation inhibitor: abatacept
With growing knowledge of RA disease pathways and advances in biotechnology, new biologic therapies are continuing to be developed.
CPT Coding and Rheumatoid Arthritis
In CPT coding, an arthrotomy refers to a surgical incision into a joint. When performed with a synovectomy, the code reflects both the opening of the joint and the removal of inflamed synovial tissue. These procedures are commonly used in cases of rheumatoid arthritis (RA) to help manage symptoms and slow progression of joint damage.
A synovectomy is surgery to remove part or all of the synovium, the thin layer of tissue that lines and protects the inside of joints. Normally, the synovium produces fluid that nourishes and lubricates the joint, allowing smooth movement. In rheumatoid arthritis, however, the synovium becomes inflamed (a condition called synovitis), producing excess fluid that wears away cartilage and leads to painful bone-on-bone contact. Removing this diseased tissue does not cure RA, but it can reduce inflammation, relieve pain, and slow further damage.
The wrist is the joint most often affected early in RA, and its rapid involvement can cause severe disability if not addressed. Arthroscopic synovectomy is often recommended in the earlier stages of RA for pain relief and improved function, though it can also provide benefits for some patients with more advanced disease. While synovectomy does not restore grip strength or joint motion, it can significantly lessen pain, improve daily function, and delay the need for more invasive surgeries such as wrist fusion or total wrist replacement.
Below are sample tables listing CPT, HCPCS, and quality measure codes commonly associated with rheumatoid arthritis. This list is not exhaustive but is intended to provide a useful reference of examples for surgical procedures, diagnostic testing, quality reporting, and drug administration that may be encountered in coding and billing.
These examples illustrate how multiple code sets CPT, HCPCS, and Category II/III quality measures intersect in the documentation and management of rheumatoid arthritis for both clinical and reimbursement purposes.
| CPT Code | Description |
| 24100 | Arthrotomy, elbow with synovial biopsy only |
| 24102 | Arthrotomy, elbow with synovectomy |
| 25105 | Arthrotomy, wrist joint with synovectomy |
| 26135 | Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction, each digit |
| 26140 | Synovectomy, proximal interphalangeal joint, including extensor reconstruction, each interphalangeal joint |
| 26510 | Cross intrinsic transfer, each tendon |
| 27334 | Arthrotomy, with synovectomy, knee anterior OR posterior |
| 27335 | Arthrotomy, with synovectomy, knee anterior AND posterior including popliteal area |
| 27625 | Arthrotomy, with synovectomy, ankle |
| 27626 | Arthrotomy, with synovectomy, ankle including tenosynovectomy |
| 81490 | Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported |
| 84433 | Thiopurine S-methyltransferase (TPMT) |
| 86200 | Cyclic citrullinated peptide (CCP), antibody |
Rheumatoid Arthritis Quality Measures & Testing Codes
| 0521U | Rheumatoid factor IgA and IgM, cyclic citrullinated peptide (CCP) antibodies, and scavenger receptor A (SR-A) by immunoassay |
| 0540F | Glucocorticoid Management Plan Documented (RA) |
| 1170F | Functional status assessed (COA) (RA) |
| 3455F | TB screening performed and results interpreted within six months prior to initiation of first-time biologic disease modifying anti-rheumatic drug therapy |
| 3470F | Rheumatoid arthritis (RA) disease activity, low (RA) |
| 3471F | Rheumatoid arthritis (RA) disease activity, moderate (RA) |
| 3472F | Rheumatoid arthritis (RA) disease activity, high (RA) |
| 3475F | Disease prognosis for rheumatoid arthritis assessed, poor prognosis documented (RA) |
| 3476F | Disease prognosis for rheumatoid arthritis assessed, good prognosis documented (RA) |
| 4187F | Disease modifying anti-rheumatic drug therapy prescribed or dispensed (RA) |
| 4192F | Patient not receiving glucocorticoid therapy (RA) |
| 4195F | Patient receiving first-time biologic disease modifying anti-rheumatic drug therapy for rheumatoid arthritis (RA) |
| 4196F | Patient not receiving first-time biologic disease modifying anti-rheumatic drug therapy for rheumatoid arthritis (RA) |
HCPCS J Codes and Descriptions Table
| Code | Description |
| J0129 | Injection, abatacept, 10 mg (code may be used for Medicare when drug administered under the direct supervision of a physician) |
| 0J0139 | Injection, adalimumab, 1 mg |
| J0717 | Injection, certolizumab pegol, 1 mg (code may be used for Medicare when drug administered under the direct supervision of a physician) |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg |
| J1130 | Injection, diclofenac sodium, 0.5 mg |
| J1438 | Injection, etanercept, 25 mg (code may be used for Medicare when drug administered under the direct supervision of a physician) |
| J1600 | Injection, gold sodium thiomalate, up to 50 mg |
| J1602 | Injection, golimumab, 1 mg, for intravenous use |
| J1720 | Injection, hydrocortisone sodium succinate, up to 100 mg |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg |
| J2910 | Injection, aurothioglucose, up to 50 mg |
| J3262 | Injection, tocilizumab, 1 mg |
| J3302 | Injection, triamcinolone diacetate, per 5 mg |
| J7500 | Azathioprine, oral, 50 mg |
| J7501 | Azathioprine, parenteral, 100 mg |
| J7502 | Cyclosporine, oral, 100 mg |
| J7514 | Mycophenolate mofetil (myhibbin), oral suspension, 100 mg |
| J7515 | Cyclosporine, oral, 25 mg |
| J7516 | Injection, cyclosporine, 250 mg |
| J8610 | Methotrexate oral, 2.5 mg |
| J8611 | Methotrexate (jylamvo), oral, 2.5 mg |
| J9076 | Injection, cyclophosphamide (baxter), 5 mg |
| J9260 | Injection, methotrexate sodium, 50 mg |
ICD-10-CM Coding and Rheumatoid Arthritis
When indexing the modifier “Rheumatoid” is essential in the proper code selection, as when you index arthritis it takes you to the default code for Osteoarthritis (M19.90) It should not be assumed that the diagnosis is RA and must be explicitly documented by the provider. In risk adjustment coding do not abstract RA from a problem list that also contains documentation of Osteoarthritis, additional support would need to be visualized such as the use of DMARDs for RA to be abstracted and coded. When the diagnosis is bilateral joints affected the coding guidelines instruct us to code two separate codes for each side affected, being no bilateral code exists. In the scenario that multiple joints are affected utilize the code for “multiple sites”
In this article, my focus is on Rheumatoid Arthritis (RA) with or without rheumatoid factor and without organ involvement. However, it’s important to remember that the Index includes a long list of assumed relationships linked to RA through the “with” convention. These help coders capture the full scope and clinical nature of the disease
Let’s look at the indexing path for Rheumatoid Arthritis:
→ Arthritis → Rheumatoid
We begin at Arthritis, arthritic (acute) (chronic) (nonpyogenic) (subacute) and scrolling further we see Rheumatic, which directs us to (see also Arthritis, Rheumatoid). When we arrive at Rheumatoid, we are led to the default code M06.9 (Arthritis, Rheumatoid, unspecified).
Take note of the “with” convention in the ICD-10-CM Index, which allows further indexing of related terms such as Rheumatoid factor (see: Arthritis, Rheumatoid, seropositive).
→ Arthritis → Rheumatoid → with → Rheumatoid factor (see Arthritis, Rheumatoid, seropositive)
This leads us to site-specific codes, and when unspecified, the default is M05.9 (Rheumatoid arthritis with rheumatoid factor, unspecified).
→ With seronegative → M06.00
→ Without organ involvement → M05.70
Below is a table of CMS-HCC V24, V28 and RX-HCC V08 with those ICD-10-CM RA codes with and without Rheumatoid Factor, without organ involvement
| ICD | Code Description | V24 | V28 | Rx-V08 |
| M05.70 | Rheumatoid arthritis with rheumatoid factor of unspecified site without organ or systems involvement | 40 | 93 | 83 |
| M05.711 | Rheumatoid arthritis with rheumatoid factor of right shoulder without organ or systems involvement | 40 | 93 | 83 |
| M05.712 | Rheumatoid arthritis with rheumatoid factor of left shoulder without organ or systems involvement | 40 | 93 | 83 |
| M05.719 | Rheumatoid arthritis with rheumatoid factor of unspecified shoulder without organ or systems involvement | 40 | 93 | 83 |
| M05.721 | Rheumatoid arthritis with rheumatoid factor of right elbow without organ or systems involvement | 40 | 93 | 83 |
| M05.722 | Rheumatoid arthritis with rheumatoid factor of left elbow without organ or systems involvement | 40 | 93 | 83 |
| M05.729 | Rheumatoid arthritis with rheumatoid factor of unspecified elbow without organ or systems involvement | 40 | 93 | 83 |
| M05.731 | Rheumatoid arthritis with rheumatoid factor of right wrist without organ or systems involvement | 40 | 93 | 83 |
| M05.732 | Rheumatoid arthritis with rheumatoid factor of left wrist without organ or systems involvement | 40 | 93 | 83 |
| M05.739 | Rheumatoid arthritis with rheumatoid factor of unspecified wrist without organ or systems involvement | 40 | 93 | 83 |
| M05.741 | Rheumatoid arthritis with rheumatoid factor of right hand without organ or systems involvement | 40 | 93 | 83 |
| M05.742 | Rheumatoid arthritis with rheumatoid factor of left hand without organ or systems involvement | 40 | 93 | 83 |
| M05.749 | Rheumatoid arthritis with rheumatoid factor of unspecified hand without organ or systems involvement | 40 | 93 | 83 |
| M05.751 | Rheumatoid arthritis with rheumatoid factor of right hip without organ or systems involvement | 40 | 93 | 83 |
| M05.759 | Rheumatoid arthritis with rheumatoid factor of unspecified hip without organ or systems involvement | 40 | 93 | 83 |
| M05.761 | Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement | 40 | 93 | 83 |
| M05.762 | Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement | 40 | 93 | 83 |
| M05.769 | Rheumatoid arthritis with rheumatoid factor of unspecified knee without organ or systems involvement | 40 | 93 | 83 |
| M05.771 | Rheumatoid arthritis with rheumatoid factor of right ankle and foot without organ or systems involvement | 40 | 93 | 83 |
| M05.772 | Rheumatoid arthritis with rheumatoid factor of left ankle and foot without organ or systems involvement | 40 | 93 | 83 |
| M05.779 | Rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot without organ or systems involvement | 40 | 93 | 83 |
| M05.79 | Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement | 40 | 93 | 83 |
| M05.7A | Rheumatoid arthritis with rheumatoid factor of other specified site without organ or systems involvement | 40 | 93 | 83 |
| M05.80 | Other rheumatoid arthritis with rheumatoid factor of unspecified site | 40 | 93 | 83 |
| M05.811 | Other rheumatoid arthritis with rheumatoid factor of right shoulder | 40 | 93 | 83 |
| M05.812 | Other rheumatoid arthritis with rheumatoid factor of left shoulder | 40 | 93 | 83 |
| M05.819 | Other rheumatoid arthritis with rheumatoid factor of unspecified shoulder | 40 | 93 | 83 |
| M05.821 | Other rheumatoid arthritis with rheumatoid factor of right elbow | 40 | 93 | 83 |
| M05.822 | Other rheumatoid arthritis with rheumatoid factor of left elbow | 40 | 93 | 83 |
| M05.829 | Other rheumatoid arthritis with rheumatoid factor of unspecified elbow | 40 | 93 | 83 |
| M05.831 | Other rheumatoid arthritis with rheumatoid factor of right wrist | 40 | 93 | 83 |
| M05.832 | Other rheumatoid arthritis with rheumatoid factor of left wrist | 40 | 93 | 83 |
| M05.839 | Other rheumatoid arthritis with rheumatoid factor of unspecified wrist | 40 | 93 | 83 |
| M05.841 | Other rheumatoid arthritis with rheumatoid factor of right hand | 40 | 93 | 83 |
| M05.842 | Other rheumatoid arthritis with rheumatoid factor of left hand | 40 | 93 | 83 |
| M05.849 | Other rheumatoid arthritis with rheumatoid factor of unspecified hand | 40 | 93 | 83 |
| M05.851 | Other rheumatoid arthritis with rheumatoid factor of right hip | 40 | 93 | 83 |
| M05.852 | Other rheumatoid arthritis with rheumatoid factor of left hip 0 | 40 | 93 | 83 |
| M05.859 | Other rheumatoid arthritis with rheumatoid factor of unspecified hip | 40 | 93 | 83 |
| M05.861 | Other rheumatoid arthritis with rheumatoid factor of right knee | 40 | 93 | 83 |
| M05.862 | Other rheumatoid arthritis with rheumatoid factor of left knee | 40 | 93 | 83 |
| M05.869 | Other rheumatoid arthritis with rheumatoid factor of unspecified knee | 40 | 93 | 83 |
| M05.871 | Other rheumatoid arthritis with rheumatoid factor of right ankle and foot | 40 | 93 | 83 |
| M05.872 | Other rheumatoid arthritis with rheumatoid factor of left ankle and foot | 40 | 93 | 83 |
| M05.879 | Other rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot | 40 | 93 | 83 |
| M05.89 | Other rheumatoid arthritis with rheumatoid factor of multiple sites | 40 | 93 | 83 |
| M05.8A | Other rheumatoid arthritis with rheumatoid factor of other specified site | 40 | 93 | 83 |
| M05.9 | Rheumatoid arthritis with rheumatoid factor, unspecified | 40 | 93 | 83 |
| M06.00 | Rheumatoid arthritis without rheumatoid factor, unspecified site | 40 | 93 | 83 |
| M06.011 | Rheumatoid arthritis without rheumatoid factor, right shoulder | 40 | 93 | 83 |
| M06.012 | Rheumatoid arthritis without rheumatoid factor, left shoulder | 40 | 93 | 83 |
| M06.019 | Rheumatoid arthritis without rheumatoid factor, unspecified shoulder | 40 | 93 | 83 |
| M06.021 | Rheumatoid arthritis without rheumatoid factor, right elbow | 40 | 93 | 83 |
| M06.022 | Rheumatoid arthritis without rheumatoid factor, left elbow | 40 | 93 | 83 |
| M06.029 | Rheumatoid arthritis without rheumatoid factor, unspecified elbow | 40 | 93 | 83 |
| M06.031 | Rheumatoid arthritis without rheumatoid factor, right wrist | 40 | 93 | 83 |
| M06.032 | Rheumatoid arthritis without rheumatoid factor, left wrist | 40 | 93 | 83 |
| M06.039 | Rheumatoid arthritis without rheumatoid factor, unspecified wrist | 40 | 93 | 83 |
| M06.041 | Rheumatoid arthritis without rheumatoid factor, right hand | 40 | 93 | 83 |
| M06.042 | Rheumatoid arthritis without rheumatoid factor, left hand | 40 | 93 | 83 |
| M06.049 | Rheumatoid arthritis without rheumatoid factor, unspecified hand | 40 | 93 | 83 |
| M06.051 | Rheumatoid arthritis without rheumatoid factor, right hip | 40 | 93 | 83 |
| M06.052 | Rheumatoid arthritis without rheumatoid factor, left hip | 40 | 93 | 83 |
| M06.059 | Rheumatoid arthritis without rheumatoid factor, unspecified hip | 40 | 93 | 83 |
| M06.061 | Rheumatoid arthritis without rheumatoid factor, right knee | 40 | 93 | 83 |
| M06.062 | Rheumatoid arthritis without rheumatoid factor, left knee | 40 | 93 | 83 |
| M06.069 | Rheumatoid arthritis without rheumatoid factor, unspecified knee | 40 | 93 | 83 |
| M06.071 | Rheumatoid arthritis without rheumatoid factor, right ankle and foot | 40 | 93 | 83 |
| M06.072 | Rheumatoid arthritis without rheumatoid factor, left ankle and foot | 40 | 93 | 83 |
| M06.079 | Rheumatoid arthritis without rheumatoid factor, unspecified ankle and foot | 40 | 93 | 83 |
| M06.08 | Rheumatoid arthritis without rheumatoid factor, vertebrae | 40 | 93 | 83 |
| M06.09 | Rheumatoid arthritis without rheumatoid factor, multiple sites | 40 | 93 | 83 | ||||
| M06.0A | Rheumatoid arthritis without rheumatoid factor, other specified site | 40 | 93 | 83 | ||||
| M06.80 | Other specified rheumatoid arthritis, unspecified site | 40 | 93 | 83 | ||||
| M06.811 | Other specified rheumatoid arthritis, right shoulder | 40 | 93 | 83 | ||||
| M06.812 | Other specified rheumatoid arthritis, left shoulder | 40 | 93 | 83 | ||||
| M06.819 | Other specified rheumatoid arthritis, unspecified shoulder | 40 | 93 | 83 | ||||
| M06.821 | Other specified rheumatoid arthritis, right elbow | 40 | 93 | 83 | ||||
| M06.822 | Other specified rheumatoid arthritis, left elbow | 40 | 93 | 83 | ||||
| M06.829 | Other specified rheumatoid arthritis, unspecified elbow | 40 | 93 | 83 | ||||
| M06.831 | Other specified rheumatoid arthritis, right wrist | 40 | 93 | 83 | ||||
| M06.832 | Other specified rheumatoid arthritis, left wrist | 40 | 93 | 83 | ||||
| M06.839 | Other specified rheumatoid arthritis, unspecified wrist | 40 | 93 | 83 | ||||
| M06.841 | Other specified rheumatoid arthritis, right hand | 40 | 93 | 83 | ||||
| M06.842 | Other specified rheumatoid arthritis, left hand | 40 | 93 | 83 |
| M06.849 | Other specified rheumatoid arthritis, unspecified hand | 40 | 93 | 83 |
| M06.851 | Other specified rheumatoid arthritis, right hip | 40 | 93 | 83 |
| M06.852 | Other specified rheumatoid arthritis, left hip | 40 | 93 | 83 |
| M06.859 | Other specified rheumatoid arthritis, unspecified hip | 40 | 93 | 83 |
| M06.861 | Other specified rheumatoid arthritis, right knee | 40 | 93 | 83 |
| M06.862 | Other specified rheumatoid arthritis, left knee | 40 | 93 | 83 |
| M06.869 | Other specified rheumatoid arthritis, unspecified knee | 40 | 93 | 83 |
| M06.871 | Other specified rheumatoid arthritis, right ankle and foot | 40 | 93 | 83 |
| M06.872 | Other specified rheumatoid arthritis, left ankle and foot | 40 | 93 | 83 |
| M06.879 | Other specified rheumatoid arthritis, unspecified ankle and foot | 40 | 93 | 83 |
| M06.88 | Other specified rheumatoid arthritis, vertebrae | 40 | 93 | 83 |
| M06.89 | Other specified rheumatoid arthritis, multiple sites | 40 | 93 | 83 |
| M06.8A | Other specified rheumatoid arthritis, other specified site | 40 | 93 | 83 |
| M06.9 | Rheumatoid arthritis, unspecified | 40 | 93 | 83 |
Coding Scenarios
Scenario 1:
Patient Name: Sarah Thompson
DOB: 03/15/1972
HPI:
Patient presents with ongoing pain and swelling in the right knee. She has a known history of rheumatoid arthritis with rheumatoid factor. Despite treatment with methotrexate, she reports worsening joint stiffness in the mornings and increasing difficulty with mobility. Physical exam reveals swelling and tenderness of the right knee joint. Due to persistent synovitis, the patient is scheduled for arthrotomy with synovectomy of the right knee.
Index Path (ICD-10-CM):
→ Arthritis → Rheumatoid → with → rheumatoid factor → knee → right → M05.861
Code Assignment:
- ICD-10-CM: M05.861 – Other rheumatoid arthritis with rheumatoid factor of right knee
- CPT®: 27334 – Arthrotomy, with synovectomy, knee; anterior OR posterior
Scenario 2:
Patient Name: David Rodriguez
DOB: 07/08/1965
HPI:
Patient presents with pain, swelling, and reduced mobility in the right wrist. He carries a diagnosis of rheumatoid arthritis with rheumatoid factor without organ or systemic involvement. Despite treatment with hydroxychloroquine, he continues to have flares of wrist synovitis. On exam, synovial thickening and tenderness of the right wrist are noted. Patient is scheduled for arthrotomy with synovectomy of the right wrist to help control symptoms and preserve function.
Index Path (ICD-10-CM):
→ Arthritis → Rheumatoid → with → rheumatoid factor → wrist → right → without organ involvement → M05.731
Code Assignment:
- ICD-10-CM: M05.731 – Rheumatoid arthritis with rheumatoid factor of right wrist without organ or systems involvement
- CPT®: 25105 – Arthrotomy, wrist joint, with synovectomy
Scenario 3:
Patient Name: Linda Carter
DOB: 11/22/1978
HPI:
Patient presents with ongoing pain, stiffness, and swelling in the left elbow. She has a diagnosis of other specified rheumatoid arthritis. Recent laboratory testing with Autoimmune (RA) biomarker analysis, 12 markers, algorithm reported confirmed continued disease activity. Despite being on sulfasalazine, she continues to experience elbow synovitis with limited range of motion. On exam, there is tenderness and synovial thickening. The patient is scheduled for arthrotomy with synovectomy of the left elbow to relieve pain and slow further joint damage.
Index Path (ICD-10-CM):
→ Arthritis → Rheumatoid → specified type NEC → elbow → left → M06.822
Code Assignment:
- ICD-10-CM: M06.822 – Other specified rheumatoid arthritis, left elbow
- CPT®: 24102-LT – Arthrotomy, elbow, with synovectomy; left side
- CPT®/PLA: 81490 – Autoimmune (RA), analysis of 12 biomarkers, serum, prognostic algorithm reported
Closing Thoughts
Rheumatoid arthritis is a complex autoimmune disease that requires careful attention in both clinical care and coding. Whether coding for RA with or without rheumatoid factor, without organ involvement, it is important to follow the correct indexing path beginning with “Rheumatoid” to ensure accurate ICD-10-CM code assignment.
Treatment options such as arthrotomy with synovectomy are captured through CPT coding, and while the examples presented here are not exhaustive, they highlight how procedures are linked to the underlying diagnosis. The coding scenarios for the knee, wrist, and elbow demonstrate how proper documentation, indexing, and code selection work together to reflect the true clinical picture.
In summary, coders should always anchor their work in precise index navigation, recognize the differences in RA coding with or without RF, and apply CPT and HCPCS codes appropriately for treatment and management. This not only supports compliance but also ensures accurate reporting that impacts both patient care and reimbursement.
Works Cited
• “Rheumatoid Arthritis.” StatPearls, NCBI Bookshelf, 2025.
• ICD-10-CM Coding Expert 2025. AAPC, 2025.
• Codify. AAPC, www.aapc.com/codify.
• CPT® 2025 Professional Edition. American Medical Association, 2025.
• “Rheumatoid Arthritis.” Centers for Disease Control and Prevention, www.cdc.gov/arthritis/rheumatoid-arthritis.
• “What Is Synovectomy for RA?” Arthritis Foundation, www.arthritis.org.
• “Arthroscopic Synovectomy in Rheumatoid Arthritis of Wrist.” PubMed Central (PMC), U.S. National Library of Medicine, 2025.
• Wang, Dashan, et al. “The Use of Biologic Therapies in the Treatment of Rheumatoid Arthritis.” Current Pharmaceutical Biotechnology, vol. 15, no. 6