Just-released diagnosis code R76.81 eases this challenge—representing a major triumph after a three-year effort led by Kevin D. Deane, MD, PhD, rheumatologist at the University of Colorado, Aurora and the ACR’s Senior Director of Practice Antanya Chung-Gardiner, MBA, CPC, CPC-I, CRHC, CCP.
Dr. Deane
Clinicians can benefit from this new code because R76.81 will facilitate more accurate determination of the at-risk state in medical records. Researchers, too, can benefit because the new code can be tracked to identify at-risk individuals in electronic medical records as well as other medical databases, supporting the ability to study the at-risk RA period, Dr. Deane explains. In his research, he is excited for this new investigative opportunity and what it can do. “When we have approved preventive interventions for RA, having this code in place will help us identify the individuals who we can approach to implement prevention,” he says.
New Code at a Glance
Rheumatologists can now use code R76.81 with accompanying term abnormal rheumatoid factor and anti-citrullinated protein antibody without rheumatoid arthritis in routine clinical care. It specifically applies when a patient presents with the strongest risk factor for future RA—elevations of antibodies to citrullinated proteins, most commonly tested with the anti-CCP antibody, or rheumatoid factor (RF). “Now we can identify individuals who are at at-risk for future RA because of anti-CCP or RF positivity and avoid just saying that they have RA,” Dr. Deane acknowledges.
The new code should also help raise awareness of the at-risk state for RA among rheumatologists and other clinicians.
“Right now, this code can help signal when individuals may need close follow up to monitor their joint health and the possible development of RA,” Dr. Deane says. Although there are not yet approved drugs for RA prevention, he hopes the new code can fuel conversations between patients and providers about commonsense approaches an individual who is at-risk for RA can take to potentially prevent the disease from developing, including tobacco cessation and a shift toward a healthier diet and exercise.
How the Code Came to Be
Any new diagnosis code must be proposed to the Centers for Disease Control & Prevention (CDC) Coordination and Maintenance Committee, which meets twice a year. In 2022, Dr. Deane and Ms. Chung-Gardiner, through the ACR’s Committee on Rheumatologic Care (CORC), began the conversation to propose the need for an at-risk RA diagnostic code. Through various presentations, they outlined the rationale for the code and shared its clinical relevance to meet classification criteria. The CDC committee approved the creation of the new code in 2024.
Ms. Chung-Gardiner
“Getting this new code in place was a team effort, and we had terrific support to implement this new code from the ACR’s CORC, Antanya Chung-Gardiner and the ICD team at the CDC,” Dr. Deane adds. He also acknowledges the work of researchers across the global community who have helped study the at-risk state of RA and, in particular, helped identify anti-CCP and RF as risk factors for RA.
Code Limitations & Opportunities
The R76.81 code has some limitations in that it doesn’t address RA risk factors other than anti-CCP or RF positivity.
Dr. Deane and the team considered this when proposing the code. However, he says, “since positivity for those autoantibodies—especially anti-CCP—is one of the strongest risk factors for RA, at this point we thought it made sense to include those autoantibodies in this code.”
He also notes that in ICD coding, the word “and” can mean “and/or.” “As such,” he says, “this code can be applied in individuals who have abnormal anti-citrullinated protein antibodies, rheumatoid factor or both.”
In the future, he hopes the rheumatology community can propose additional codes that can identify other risks for RA, including other autoantibodies, symptoms and even imaging abnormalities.
Two other codes are somewhat related but don’t specifically identify an at-risk RA state. These include:
- Code M25.50 for “anti-CCP positive arthralgia” that can be considered as an at-risk state for RA. However, this code doesn’t include the absence of RA.
- Code Z82.61 for a family history of RA. Although this is a risk factor for RA, it does not identify a specific health state for an individual.
Another clarification: The new code R76.81 does not represent what some may call “pre-RA,” Dr. Deane cautions. “While ‘pre-RA’ is a simple term that has been used to describe an at-risk state for RA, not all individuals who are anti-CCP or RF positive will develop RA. As such, we should use this new code to specifically define a certain at-risk state for RA because of autoantibodies, but not blanketly describe ‘pre-RA.’”
How to Use the New Code
Now that code R76.81 has been officially released, Ms. Chung-Gardiner says it can be used by providers and defined by coders through medical record review without any difficulties in documentation. Stay tuned for a series of new coding-related scenarios from the ACR practice department that will help members understand what needs to be documented in the patient records for coding accuracy.
In the meantime, if ACR members have any questions about code R76.81 or need additional information to apply the new ICD-10 code, they should contact the ACR coding department at [email protected].
Carina Stanton is a freelance science journalist based in Denver.
