The ICD-10-CM code for arthritis represents a group of diagnosis codes used to document and report various types of joint inflammation in clinical practice. These codes are essential for accurate medical billing, insurance reimbursement, clinical documentation, and data reporting. Because arthritis includes multiple conditions with different causes, severities, and affected joints, ICD-10-CM offers a high level of specificity to ensure correct coding.
Understanding how arthritis is classified and coded helps providers, coders, and billers reduce claim denials and maintain compliance.
ICD Code Description: Arthritis in ICD-10-CM
Arthritis is not represented by a single ICD-10 code. Instead, it is classified under multiple codes depending on:
- Type of arthritis (e.g., osteoarthritis, rheumatoid arthritis)
- Joint(s) affected
- Laterality (right, left, bilateral)
- Severity and clinical features
Common ICD-10-CM Code Ranges for Arthritis
- M05–M06: Rheumatoid arthritis
- M15–M19: Osteoarthritis
- M10: Gout
- M08: Juvenile arthritis
- M11: Crystal arthropathies
- M12: Other specific arthropathies
Category & Code Type
ICD-10-CM Chapter
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Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00–M99)
Example Codes
| Condition | ICD-10-CM Code |
|---|---|
| Primary osteoarthritis, right knee | M17.11 |
| Primary osteoarthritis, left knee | M17.12 |
| Rheumatoid arthritis with positive rheumatoid factor | M05.9 |
| Rheumatoid arthritis without rheumatoid factor | M06.9 |
| Gout, unspecified | M10.9 |
Billable Status
- Most arthritis codes are billable and specific
- Unspecified codes may be accepted but can increase denial risk
Includes / Excludes Notes
- Includes: Degenerative joint disease, inflammatory arthritis
- Excludes: Traumatic joint disorders (coded elsewhere)
Always review Excludes1 and Excludes2 notes to avoid incorrect code selection.
ICD-10-CM Coding Guidelines for Arthritis
Key coding rules include:
- Code to the highest level of specificity
- Document laterality when available
- Identify the type of arthritis, not just “arthritis”
- Use combination codes when systemic involvement exists
- Do not code “rule out” diagnoses for outpatient encounters
Billing Considerations
Reimbursement Impact
- Specific arthritis codes support medical necessity
- Payers may deny claims for vague or unspecified diagnoses
- Chronic arthritis often supports long-term treatment plans and imaging
Payer Considerations
-
Medicare and commercial payers expect:
-
Clear diagnosis type
-
Joint-specific documentation
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Consistency between diagnosis and treatment
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Documentation Tips for Accurate Coding
To support correct ICD-10 arthritis coding:
- Specify the type of arthritis
- Document affected joints
- Indicate laterality (right, left, bilateral)
- Note disease severity or stage, if applicable
- Include lab findings (e.g., rheumatoid factor, uric acid levels)
Clear documentation directly improves coding accuracy and claim approval.
Common Clinical Examples
- A 68-year-old patient with chronic right knee pain and imaging confirming degeneration → M17.11
- A patient with symmetrical joint swelling and positive rheumatoid factor → M05.9
- Acute flare of gout in the left toe → M10.072
Common Errors & Claim Denials (Optional)
Frequent coding mistakes include:
- Using unspecified arthritis codes when details are documented
- Missing laterality for joint-specific arthritis
- Coding symptoms (joint pain) instead of confirmed arthritis
- Incorrectly coding traumatic joint conditions as arthritis
Key Takeaways
- There is no single ICD-10 code for arthritis
- Codes vary by type, joint, and clinical detail
- Accurate documentation supports correct coding and reimbursement
- Specific codes reduce denials and audits
- Always follow ICD-10-CM guidelines and payer rules
FAQ:
What is the ICD-10 code for arthritis?
There is no single code. Arthritis is coded using multiple ICD-10-CM codes, primarily in the M05–M19 range, depending on the type and joint involved.
What is the ICD-10 code for osteoarthritis?
Osteoarthritis codes fall under M15–M19, such as M17.11 for primary osteoarthritis of the right knee.
Is arthritis considered a chronic condition?
Yes, most forms of arthritis are chronic and may require ongoing treatment and long-term management.
Can unspecified arthritis codes be used?
Yes, but they should be avoided when more detailed documentation is available, as they may lead to claim denials.
Why is laterality important in arthritis coding?
Laterality improves diagnostic accuracy and is required for many joint-specific ICD-10-CM codes.
