How to Code for Systemic Lupus Erythematosus (SLE) – An Autoimmune Disorder

by | Published on May 16, 2023 | Medical Billing

Systemic Lupus Erythematosus
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Regarded as a common type of lupus, systemic lupus erythematosus (SLE), is an autoimmune disease in which the immune system attacks the body’s own tissues. Normally, the immune system fights off dangerous infections and bacteria to keep the body healthy. The condition causes widespread inflammation and tissue damage in the affected organs. SLE can affect the joints, skin, brain, lungs, kidneys, and blood vessels. There is no specific cure for lupus, but serious medical intervention and lifestyle changes can help control it in a better manner. While reporting SLE diagnosis and treatment on claims, it is crucial to ensure thorough documentation and assign the correct ICD-10 codes. Physicians can rely on professional medical billing and coding outsourcing services to accurately report the condition on the medical claims and receive maximum reimbursement.

SLE-Causes and Symptoms

According to the Lupus Foundation of America, at least 1.5 million Americans are living with diagnosed lupus. Systemic lupus erythematosus (SLE) can affect people of all age groups, including children. It is estimated that women of all age groups are affected far more than men – ranging from 4 to 12 women for every 1 man. However, women of childbearing ages – 15-44 years – are at higher risk of developing SLE. The exact causes of SLE are unknown, but several factors such as genetics, environmental triggers and sex and hormonal factors have been associated with the disease. The seriousness of SLE can range from mild to life-threatening.

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People with SLE may experience a wide variety of symptoms that range from mild to life-threatening. The severity of symptoms can vary and can change over time. In certain adults, having a period of SLE symptoms – called flares – may happen every so often. This may at times occur years apart and go away at other times – called remission. However, certain other adults may experience SLE flares more frequently throughout their life. Some of the common symptoms include –

  • A rash on the cheeks and nose, which is called a “butterfly rash”
  • Anemia
  • Arthritis
  • Blood cell and immunological abnormalities
  • Blood-clotting problems
  • Headaches
  • Joint pain and swelling
  • Oral ulcers
  • Seizures
  • Severe fatigue
  • Sun sensitivity

Other symptoms depend on the part of the body affected, such as the digestive tract, the heart, or the skin.

How Is SLE Diagnosed and Treated?

No one single test can help diagnose SLE. In fact, SLE may be difficult to diagnose as its early signs and symptoms are not specific and can mimic the symptoms of other diseases. Diagnosis of SLE will begin with a physical examination that involves analysis of typical signs and symptoms. Several screening tests such as urinalysis, chest X-ray and blood tests, such as antibody tests and a complete blood count – may be performed.

There is no specific cure for systemic lupus erythematosus (SLE). Treatment modalities can vary depending on the severity of symptoms and the specific parts of the body SLE affects. Treatment options include a combination of medications and key lifestyle changes. Medications include – anti-inflammatory medications (for joint pain and stiffness), steroid creams, corticosteroids, antimalarial drugs and disease modifying drugs or targeted immune system agents (in severe cases). Incorporating lifestyle habits such as consuming or avoiding certain foods and minimizing stress to reduce the likelihood of triggering symptoms may also be used as part of the treatment.

ICD-10 Codes for Systemic Lupus Erythematosus (SLE)

Physicians treating patients with SLE can rely on the services of professional medical billing companies for correct documentation of this condition. The ICD-10 codes for SLE are listed below –

  • M32 Systemic lupus erythematosus (SLE)
  • M32.0 Drug-induced systemic lupus erythematosus
  • M32.1 Systemic lupus erythematosus with organ or system involvement
    • M32.10 Systemic lupus erythematosus, organ or system involvement unspecified
    • M32.11 Endocarditis in systemic lupus erythematosus
    • M32.12 Pericarditis in systemic lupus erythematosus
    • M32.13 Lung involvement in systemic lupus erythematosus
    • M32.14 Glomerular disease in systemic lupus erythematosus
    • M32.15 Tubulo-interstitial nephropathy in systemic lupus erythematosus
    • M32.19 Other organ or system involvement in systemic lupus erythematosus
  • M32.8 Other forms of systemic lupus erythematosus
  • M32.9 Systemic lupus erythematosus, unspecified

If left untreated, SLE can damage or cause severe complications in systems throughout the body such as – blood clots and inflammation of blood vessels, stroke, memory and behavioral changes, stroke, seizures, kidney function/inflammation/failure and inflammation of lung tissue and the lining of the lung or pleuritis. SLE affects people differently. Treatments are most effective when initiated at an early stage as soon as symptoms develop.

Billing and coding for SLE can be complex, as there are several codes associated with the condition. By outsourcing these tasks to a medical billing and coding company that provides the services of AAPC-certified coding specialists, healthcare practices can ensure correct and timely claim submission for optimal reimbursement.

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Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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