What's Your New RA Code?

Have you had an appointment with any of your doctors within the past few weeks? Did your doctor spend more time on the computer than usual? If so, your doctor may have been hit hard by the new ICD-10-CM/PCS codes which became effective on October 1, 2015.

ICD-10-CM/PCS stands for International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System a system which the World Health Organization (WHO) began designing in 1983 and completed in 1992. Adoption of ICD-10 steadily spread through most of the industrialized nations with the United States being one of the final countries to make the switch.

According to a number of sources, the new codes are designed to provide better data that can be used to evaluate and improve the quality of patient care, increase the detail and accuracy of patient symptoms and outcomes, ensure fair reimbursement to providers, and more easily identify patients in need of disease management programs.

How does ICD-10 affect rheumatology patients and their doctors?

Rheumatoid arthritis (RA) was previously represented by the ICD-9-CM code 714.0. Now RA and its many manifestations are represented by more than 300 individual codes that are grouped under two main categories: Rheumatoid arthritis with rheumatoid factor (ICD-10-CM code M05), and Other rheumatoid arthritis (ICD-10-CM code M06).

The increased number of codes allows for greater detail in documenting the specific manifestations of RA-related disease activity, such as identifying that the left shoulder joint is affected, or that a patient has rheumatoid lung involvement, or whether a patient tested positive for rheumatoid factor.

In my own case of RA, my 714.0 Rheumatoid Arthritis diagnosis has now been changed to “M06.09 Rheumatoid arthritis without rheumatoid factor of multiple sites.”

Examples of other ICD-10-CM codes related to RA disease manifestations:

  • M05.10 – Rheumatoid lung disease with rheumatoid arthritis of unspecified site
  • M05.352 – Rheumatoid heart disease with rheumatoid arthritis of left hip
  • M05.419 – Rheumatoid myopathy with rheumatoid arthritis of unspecified shoulder
  • M05.719 – Rheumatoid arthritis with rheumatoid factor of unspecified shoulder without organ or systems involvement
  • M06.071 – Rheumatoid arthritis without rheumatoid factor of right ankle and foot
  • M06.239 – Rheumatoid bursitis of unspecified wrist
  • M06.331Rheumatoid nodule of right wrist
  • M71.20 – Synovial cyst of popliteal space [Baker] of unspecified knee

I’m not sure what code would apply if you had seronegative negative RA with rheumatoid lung involvement as the code for rheumatoid lung disease with rheumatoid arthritis is M05.1 which falls under the classification of M05 which is Rheumatoid arthritis with rheumatoid factor.

With all of this in mind, no wonder my soon-to-be-retired rheumatologist said that if she had known exactly when all of this was coming, she might have retired a month sooner.

What do you think? Would having this greater amount of detail hiding in the numbers lead to improved quality of care?

Now I wonder if there could be codes created for things such as “tried Enbrel and it didn’t work,” or “developed antibodies to Remicade,” or “can’t use a specific medication,” so that insurance companies can more quickly approve the use of other medications and not require patients/doctors to repeatedly justify treatment choices when submitting pre-authorization documentation.

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