Medically appropriate counseling approaches are currently available and can help individuals in this pre-RA state gain awareness of RA, its symptoms, the importance of medical follow-up to watch for the development of treatable inflammatory arthritis, and lifestyle changes (e.g., smoking cessation) that may lower their risk for developing RA. In addition, the predictive ability of RF and anti-CCP for future clinical RA has underpinned multiple clinical observational studies and prevention trials in RA, and it is expected that there soon will be approved pharmacologic therapies for RA prevention.
Importantly, although existing ICD-10 codes can be used to designate clinical RA as well as RF and anti-CCP positivity, there is not currently a clear way in the existing ICD-10 system to designate individuals who may exhibit RA-related biomarkers but do not have clinically apparent inflammatory arthritis. As such, the introduction of a new code to accurately designate an individual who has abnormal RA-related immunologic tests will facilitate clinical designation and care of these individuals, as well as facilitate clinical research.
Next Steps
The ACR presented the case for this new code to the CDC and received some initial feedback that included shortening the term, as well as including the specific laboratory tests that would qualify this code. A suggested revision is: “Anti-cyclic citrullinated peptide antibody (anti-CCP) and/or rheumatoid factor (RF) positivity without a current or prior diagnosis of rheumatoid arthritis.”
Final decisions on code revisions are made through a clearance process within the Department of Health & Human Services. The ACR expects to receive formal feedback around mid-November, after which we will address any comments and plan to move forward with finalizing this new code.
Questions on ICD-10 or the code change proposal can be sent to Antanya Chung at [email protected] or [email protected].
