ICD-10 M05.511
Billable / Specific HCC v28: 75Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder
About ICD-10-CM M05.511
ICD-10-CM code M05.511 represents Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M05). The 2026 edition of ICD-10-CM M05.511 became effective on October 1, 2025.
Coding Tips for M05.511
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
M05.511 is a CMS-HCC v28 risk-adjustment code (category 75). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for M05.511
Local Coverage Determinations (LCDs) from CMS MACs that list M05.511 as a covered diagnosis.
Showing top 10 of 613 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing M05.511.
2 Cigna
5 Medicare
CPT Codes Commonly Billed with M05.511
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert M05.511 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| M05.511 | 3571 | 10112 |
| M05.511 | 7140 | 10111 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To M05.511
Other codes in section M05-M14 (Inflammatory polyarthropathies).
ICD-10 M05.511, Billing FAQ
Is ICD-10 code M05.511 billable? +
Yes, M05.511 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does M05.511 affect Medicare Advantage HCC risk adjustment? +
Yes. M05.511 maps to CMS-HCC v28 category 75. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does M05.511 map to? +
Per CMS GEMs, M05.511 maps to ICD-9 codes: 3571, 7140. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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