Earlier this summer, the National Center for Health Statistics’ Coordination and Maintenance Committee (CMC) for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) approved a new code for non-radiographic axial spondyloarthritis (nr-axSpA), effective Oct. 1. The ICD-10-CM is a morbidity classification published by the U.S. for classifying diagnoses and reason for visits in all healthcare settings. It’s based on the ICD-10, the statistical classification of disease published by the World Health Organization.
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The new diagnostic code should make it easier for rheumatologists to bill for treatment of nr-axSpA, a form of arthritis that causes inflammation in the spine and sacroiliac joints and may lead to severe, chronic pain and impairment of spinal mobility. The code can also be used to track and mine its incidence in electronic health records, enabling new research strategies for improving treatment.
The ACR’s Committee on Rheumatologic Care supported the proposal through the approval process alongside global biopharmaceutical company UCB, Brussels, and patient advocacy groups. UCB manufactures the biologic treatment certolizumab pegol (Cimzia), a tumor necrosis factor blocker approved by the U.S. Food & Drug Administration on March 29, 2019, as the first treatment for nr-axSpA.1 UCB has been pursuing the new ICD-10-CM code for two years, says Jeffrey Stark, MD, an Atlanta-based rheumatologist and UCB’s head of medical immunology. Two other drugs have subsequently been approved for the condition, secukinumab (Cosentyx, Novartis) and ixekizumab (Taltz, Lilly). Clinicaltrials.gov currently lists 20 studies of treatments in the pipeline for nr-axSpA.2
The existence of three approved drugs for this condition highlights the divide between ICD-10 and current clinical practice, Dr. Stark says. European countries are already moving toward implementing the 11th revision of ICD, which includes recognition of nr-axSpA.
“We submitted our application to the CMC several times over the past two years, but we weren’t always included on the agenda for [its] twice-yearly meetings,” Dr. Stark explains.
After being asked to resubmit the application with more justification, UCB approached the ACR, says Colin Edgerton, MD, a rheumatologist in North Charleston, S.C., and chair of the ACR’s Committee on Rheumatologic Care (CORC). CORC supported the proposal along with patient advocacy groups. Drs. Edgerton and Stark both describe the process as a great example of aligned groups working together to support patients’ best interests.
The latest submission, made last September with a support letter from the ACR and alignment with the patient community, was approved in June and announced through the release of CMC’s larger document of ICD-10 updates.3 The threshold for making a change to ICD-10 is high, Dr. Stark says. “They don’t take modifications lightly, and they really require a demonstrable clinical need, articulated by the provider community.” And that’s where the ACR came in.