ICD-10 Changes for Rheumatology: Important Diagnoses to Consider

Like most specialties, rheumatology will see changes and expansions in ICD-10.

 

It’s important to review these changes and ensure that any templates in the electronic record (or paper encounter forms) are updated accordingly. Betty Hovey, CPC, COC, CPB, CPMA, CPC-I, CPCD, director of ICD-10 development and training at the American Academy of Professional Coders (AAPC) provides an overview of some of ICD-10 changes for several conditions relevant in this specialty.

1. Systemic lupus erythematosus. In ICD-10, there are 10 different codes that denote this condition. These codes distinguish between drug-induced lupus (specify the drug) vs. lupus with organ or system involvement (i.e., endocarditis, pericarditis, lung involvement, glomerular disease, tubular-interstitial nephropathy, or other organ involvement).

2. Gout. Codes for gout have greatly expanded in ICD-10. Document the type of gout (i.e., idiopathic, lead-induced, drug-induced, due to renal impairment, or secondary), then specific anatomical location, and laterality. For lead-induced gout, specify the toxic effect of lead and its compounds. For drug-induced gout, specify the drug that caused the gout. For gout due to renal impairment, document the associated renal disease. For secondary gout, specify the associated condition. If the gout is chronic, document whether it is with or without tophus.

3. Rheumatoid arthritis. Many of the ICD-10 codes for rheumatoid arthritis are combination codes, meaning they include an associated diagnosis. These codes also include a specific anatomical location as well as laterality. For example, ICD-10 code M05.111 denotes rheumatoid lung disease with rheumatoid arthritis of the right shoulder.

4. Psoriatic arthropathy. In ICD-9, one code (696.0) denoted this condition. However, in ICD-10, there are six codes in category L40.5-. Physicians must document whether the condition is distal interphalangeal psoriatic arthropathy, psoriatic arthritis mutilans, psoriatic spondylitis, psoriatic juvenile arthropathy, or other psoriatic arthropathy.

4. Ankylosing spondylitis. In ICD-9, one code (720.0) denotes this condition. However, in ICD-10, codes are greatly expanded to include details about the specific anatomical site (i.e., region of the spine). For example, ICD-10 code M45.3 denotes ankylosing spondylitis of the cervicothoracic region.

Preparing for ICD-10
Many of the diagnoses relevant to rheumatology include laterality, anatomical specificity, and causation. When possible, rheumatologists should document the relationship between two conditions using language such as ‘due to,’ ‘exacerbated by,’ ‘with,’ or ‘in.’ This helps demonstrate patient severity, and it also allows coders to assign the most specific code. Payers may automatically deny codes that are unspecified.

As with all specialties, rheumatology practices should ensure that any encounter forms are updated to include details necessary for ICD-10. With rheumatology, it’s not possible to include all code options on an encounter form. For instance, there are five pages of codes for gout alone. Instead, consider including the conditions with which patients are most frequently diagnosed. If the practice diagnoses gout frequently, is there a specific type or anatomical location that is diagnosed more often than another? Can you omit unspecified codes from the encounter form to leave more space for additional diagnoses? Can you include documentation prompts to encourage physicians to document laterality rather than include separate codes for this information? The potential complexity of doing this all on paper is a good reason to consider upgrading to an EHR if you have not already, and more specifically an integrated EHR and billing system that enables you to send a complete electronic superbill.

Whether using paper or EHR, you may want to keep a code cheat sheet handy. For example, Janssen Biotech, Inc. provides a quick reference crosswalk for rheumatology.  You can use a third party tool like this, or run your own top codes report using your practice management software or EHR and do a code mapping from ICD-9 to ICD-10 the reflect exactly the top codes for your practice. Either way, just be sure to get prepared and have resources handy to help make the transition a little easier.

For more ICD-10 news, updates, and tools, visit the Kareo ICD-10 Resource Center.