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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (5)
  • gsehealth
    1 year ago

    Yes. Thanks. Codes help to treat the disease well.

  • Janet Lemay
    3 years ago

    Hi Lisa,
    I enjoy the joint truth & sarcasm in your blog. My concern is this…. The codes don’t determine how they will treat you, but it may have a profound effect on how your other Dr,s treat you. For instance, I have pain med Drs that can see certain items & they may classify me as not worthy of treating, I just don’t know..????
    My Rheumy already spends most his time head down typing, but maybe he’s a great listener!!!
    Thx for the true funnies!
    Janet

  • Leslie Rott moderator
    3 years ago

    I understand the need for greater specificity, but in a disease like RA that is systemic, I have a problem seeing the utility in this. Would someone get a different code at each doctors’ visit? For example, if my hip is bothering me one month and my neck is bothering me the next. Or what if your RA affects your entire body?

  • Lisa Emrich author
    3 years ago

    Hi Leslie,

    I’m glad you pointed that out. I believe that’s when the catch-all ‘multiple sites’ comes into play and all specificity is lost.

    Or perhaps if you are lucky enough to only have a few select areas of concern, then maybe the doctor might use the increased number of coding slots to detail the current problem areas in addition to the ‘multiple sites’ category. I don’t know how most rheumatologists will choose to use these options in real world practice.

    I can see how this type of detail could be very useful for ‘Big Data’ research, but only if the system were used consistently.

    I’d be interested to learn if patients notice any change at all in how their appointments are conducted as a result of this new coding system or in what their records look like.

  • SydneyH
    3 years ago

    I work in a doctor’s office. Procedure codes and diagnosis codes are a fact of life but I can’t imagine any doctor relying on them for patient care. They may rely on them in terms of what insurance will pay for, but not patient care. No doctor is going to call up another doctor and say “She’s a M06.09.” They are going to rely on the office notes and labs before the diagnosis codes. In my opinion it’s mostly for the benefit of insurance companies, CDC, and statistic trackers. Although I suppose you could make the argument that it could ultimately lead to better quality of care.

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