As of October 1, 2015, the new International Classification of Diseases, Tenth Revision (ICD-10) was implemented as the required diagnosis code set to be used for billing all claims to insurers.

Coding Compliance

CMS and commercial payers require a valid code to be reported for reimbursement, and it is important to follow the ICD-10 guidelines to complete the code set. For example, while M05 is a correct category to identify rheumatoid arthritis with positive rheumatoid factor, ICD-10 coding guidelines indicate that at least five characters are necessary for this to be a valid/billable code. A sample of a valid code for RA with rheumatoid factor is M05.79 – rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement.

Along with choosing a correct ICD-10 code, the documentation in the medical chart must support the level of the ICD-10 code. For instance, if a patient present with a diagnosis for gout the following must be documented:

  • Is it chronic or acute
  • What is the etiology of the disease (i.e. idiopathic, drug induce, lead induced, or due to renal failure)
  • What anatomical site is effected
  • Which side of the body is affected
  • Is it with or without tophi

ICD-10 Resources

Download the top 50 rheumatology ICD-10 codes and rheumatology specific superbill to use as quick guides for coding and billing. (Note: these should not take the place of the official ICD-10 coding manual as there are key guidelines and conventions that may not be included in the crosswalk due to space.)

If there are any questions or concerns about coding ICD-10 or other coding topics, members can contact us at practice@rheumatology.org.

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