2027 ICD-10-CM Diagnosis Code M05.111Rheumatoid lung disease with rheumatoid arthritis of right shoulder
ICD-10-CM Codes›M00–M99›M05-M14›M05
- Billable — Valid for Submission
- Risk Adjusts — HCC 93
- Chronic Condition
M05.111 is a billable ICD-10-CM diagnosis code for rheumatoid lung disease with rheumatoid arthritis of right shoulder. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 196 through 198. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified and unspecified lower respiratory disease and Rheumatoid arthritis and related disease.
For Medicare Advantage risk adjustment, M05.111 maps to CMS-HCC Category 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders) under the V28 model, adding a risk factor of about 0.617 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
M05.111 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M05.111: its own notes plus those printed at M05, block M00-M25, and Chapter 13. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- Disorders affecting predominantly peripheral (limb) joints
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- arthropathic psoriasis (L40.5-)
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- compartment syndrome (traumatic) (T79.A-)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Notes
General instructions on how these codes are used.
- Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name M05.111, its category, or a range that includes it.
Excludes1 1
These codes carry an Excludes1 note naming M05.111: they are not reported together with it, unless the two conditions are unrelated.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a form of arthritis that causes pain, swelling, and stiffness in your joints. RA is an autoimmune disease. Although it is most common in the wrist and fingers, this disease can cause your immune system to attack any joint tissue. The inflammation (swelling) that comes with RA can also affect other body parts.
The full article covers:
- What is rheumatoid arthritis?
- Who is more likely to get rheumatoid arthritis?
- What causes rheumatoid arthritis?
- What are the symptoms of rheumatoid arthritis?
- How is rheumatoid arthritis diagnosed?
- What are the treatments for rheumatoid arthritis?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert M05.111 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M05.111Overview
What is the ICD-10 code for rheumatoid lung disease with rheumatoid arthritis of right shoulder?
The ICD-10-CM code for rheumatoid lung disease with rheumatoid arthritis of right shoulder is M05.111 (sometimes written as M05111). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is M05.111 a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report rheumatoid lung disease with rheumatoid arthritis of right shoulder on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does M05.111 group to?
When rheumatoid lung disease with rheumatoid arthritis of right shoulder is the principal diagnosis on an inpatient stay, it groups to MS-DRG 198, 197, 196, with relative weights from 0.7256 to 1.8335 depending on complications. Higher weights mean higher Medicare reimbursement.
Can M05.111 be reported with I00?
Not as a rule. The Excludes1 note at M05, which applies to M05.111, lists "rheumatic fever (I00)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What is the ICD-9 equivalent of M05.111?
Under the General Equivalence Mappings, rheumatoid lung disease with rheumatoid arthritis of right shoulder converts to ICD-9-CM 714.81 (rheumatoid lung). The mapping is approximate, so confirm the match fits the documentation.
What HCC is M05.111?
M05.111 (rheumatoid lung disease with rheumatoid arthritis of right shoulder) maps to CMS-HCC Category 93 (Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders), commonly written as HCC 93, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 40 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 83.
Does M05.111 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, M05.111 adds a risk adjustment factor of about 0.617 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.288 to 0.617 depending on the payment segment). HCC 93 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 93 category page.
