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

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.’”