ACR Proposes New ICD-10 Code to Capture ‘Pre-RA’

On Sept. 13, the ACR and Kevin D. Deane, MD, PhD, rheumatologist at the University of Colorado, Aurora, presented a proposal to create a new clinical code to recognize “pre-rheumatoid arthritis” to the International Classification of Diseases Coordination & Maintenance Committee (ICD-10 C&M) at the Centers for Medicare & Medicaid Services (CMS).

The International Classification of Diseases 10th Revision, or ICD-10-CM, is the Health Insurance Portability & Accountability Act (HIPAA) code set standard for reporting diagnoses in all healthcare settings. ICD-10-CM is a U.S. clinical modification of the World Health Organization’s ICD-10. These codes help ensure the accuracy, protection and accessibility of health information.

Twice each year, organizations have the opportunity to present diagnosis code proposals to the ICD-10 C&M for consideration. This federal committee, which includes the CMS and the Centers for Disease Control & Prevention’s (CDC) National Center for Health Statistics (NCHS), focuses on the clinical issues for a condition, procedure or technology and is responsible for approving ICD code changes, diagnosis errata, addenda and modifications.

The ACR’s code change request proposes a new code and definition for pre-rheumatoid arthritis (pre-RA), a condition in which an individual may exhibit RA-related autoantibodies without the clinical condition (i.e., inflammatory arthritis) of RA. The proposed new code and definition is: R76.81 “Abnormal rheumatoid arthritis-related immunologic findings without current or prior diagnosis of clinically apparent inflammatory arthritis.”

Rationale

The code proposal included a rationale for why a pre-RA code is needed.

RA is a well-known autoimmune condition that is characterized by the presence of inflammatory arthritis. Up to 80% of individuals with RA may also have abnormalities in circulating biomarkers, including but not limited to the autoantibodies rheumatoid factor (RF) and antibodies to cyclic citrullinated proteins (CCP).

The current paradigm for the diagnosis and treatment of RA is for a clinician to identify joint findings that are determined to be clinically apparent IA, diagnose the condition as RA and initiate treatment. This is the typical clinical situation in which the existing ICD-10 codes for RA (e.g., M60.XXX, M50.XXX) are applied.

However, it is now well-established that RA-related immunologic tests such as RF and CCP can be present in individuals in the absence of and prior to the appearance of inflammatory arthritis and are predictive of future onset of clinical RA—a period that can be termed “pre-RA.” Further, individuals who have abnormal RA-related immunologic tests without inflammatory arthritis are being identified in growing numbers in clinical care.