New Diagnostic Code R76.81 Can Be Used to Identify Those at Risk of Developing RA

Rheumatologists are increasingly aware that some patients they see are in an at-risk stage of rheumatoid arthritis (RA).

Until now, codes in the International Classification of Diseases 10th Revision (ICD-10-CM) have not offered a good way to specifically identify these at-risk individuals. In particular, there was no code to identify patients who are anti-CCP or rheumatoid factor positive with specification that they do not have a clinical diagnosis of RA.

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.