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 ACR crosswalk with the top commonly used rheumatology codes and the rheumatology specific superbill to be used as a quick guide for coding and billing. (Note: these should not take the place of the official ICD-10 coding manual as there are key guidelines and convention 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.