Pediatric rheumatology or juvenile arthritis is commonly found in children under the age of 16. The common form of juvenile arthritis is juvenile idiopathic arthritis (JIA). According to the National Library of Science, about 4-16 in 10,000 children in the United States are affected by juvenile arthritis. That is, approximately 294,000 children in the US get affected every year. Among these, more than half of the cases are reported as juvenile idiopathic arthritis. Even though the cause of this auto-immune disease is unknown, it can last lifelong in rare cases. As with any medical condition, timely and accurate medical documentation is vital for effective treatment and patient care. A medical coding outsourcing company that provides rheumatology medical coding can ensure error-free clinical documentation and reimbursement for physicians.
For an effective documenting claim, ICD-10 coding is necessary. The ICD codes for pediatric arthritis are as follows.
❖ M08 Juvenile arthritis
- ➣ M08.0 Unspecified juvenile rheumatoid arthritis
- M08.00 Unspecified juvenile rheumatoid arthritis, of unspecified site
- M08.01 Unspecified juvenile rheumatoid arthritis, shoulder
- M08.011 Unspecified juvenile rheumatoid arthritis, right shoulder
- M08.012 Unspecified juvenile rheumatoid arthritis, left shoulder
- M08.019 Unspecified juvenile rheumatoid arthritis, unspecified shoulder
➣ M08.02 Unspecified juvenile rheumatoid arthritis of elbow
- M08.021 Unspecified juvenile rheumatoid arthritis, right elbow
- M08.022 Unspecified juvenile rheumatoid arthritis, left elbow
- M08.029 Unspecified juvenile rheumatoid arthritis, unspecified elbow
➣ M08.03 Unspecified juvenile rheumatoid arthritis, wrist
- M08.031 Unspecified juvenile rheumatoid arthritis, right wrist
- M08.032 Unspecified juvenile rheumatoid arthritis, left wrist
- M08.039 Unspecified juvenile rheumatoid arthritis, unspecified wrist
➣ M08.04 Unspecified juvenile rheumatoid arthritis, hand
- M08.041 Unspecified juvenile rheumatoid arthritis, right hand
- M08.042 Unspecified juvenile rheumatoid arthritis, left hand
- M08.049 Unspecified juvenile rheumatoid arthritis, unspecified hand
➣ M08.05 Unspecified juvenile rheumatoid arthritis, hip
- M08.051 Unspecified juvenile rheumatoid arthritis, right hip
- M08.052 Unspecified juvenile rheumatoid arthritis, left hip
- M08.059 Unspecified juvenile rheumatoid arthritis, unspecified hip
➣ M08.06 Unspecified juvenile rheumatoid arthritis, knee
- M08.061 Unspecified juvenile rheumatoid arthritis, right knee
- M08.062 Unspecified juvenile rheumatoid arthritis, left knee
- M08.069 Unspecified juvenile rheumatoid arthritis, unspecified knee
➣ M08.07 Unspecified juvenile rheumatoid arthritis, ankle and foot
- M08.071 Unspecified juvenile rheumatoid arthritis, right ankle and foot
- M08.072 Unspecified juvenile rheumatoid arthritis, left ankle and foot
- M08.079 Unspecified juvenile rheumatoid arthritis, unspecified ankle and foot
➣ M08.08 Unspecified juvenile rheumatoid arthritis, vertebrae
➣ M08.09 Unspecified juvenile rheumatoid arthritis, multiple site
For effective reimbursement, equal participation of physician and medical coder is necessary. The physician should enter all the details of the patient while preparing clinical documentation. These details include treatment information, clinical tests, medications and so on. The medical records should be appropriate and accurate. In case of pediatric rheumatic or juvenile arthritis, symptoms such as the following need to be documented clearly:
- Stiffness
- Limping
- Difficulty in moving arms and legs
- Decrease in level of physical activity
- Fever
- Swelling in joints
- Clumsiness
Along with the symptoms, you should also mention the child’s family history, physical examination results, blood test and scan results as well as the type of arthritis the child has. The blood test and scanning would help you to identify the type of arthritis. The different types of juvenile arthritis include:
- Oligoarthritis
- Polyarthritis
- Systemic
- Enthesitis-related
- Juvenile psoriatic arthritis
- Undifferentiated
As the treatment is finalized based on the type of the arthritis, you should mention the variant of arthritis while documenting. The treatments for juvenile arthritis include:
- Medication
- Therapies
- Surgeries
- Exercise
The clinical documentation is translated into coding data by medical coders. So, physicians should enter data accurately in the medical records. Even a small mistake can prove very costly. The documentation should include the following details:
- Site of disease or disorder
- Encounter status of treatment
- Associated conditions
- Manifestations
- Associated complications
- Supporting information such as lab values, ICD-10 documentation
The medical coding industry witnesses changes frequently. Therefore, medical coders should stay informed regarding the changes, modifications, and deletions of medical codes.
To ease the medical billing process and ensure optimum reimbursement, physicians can rely on medical billing outsourcing companies that provide rheumatology medical coding. When outsourcing, you get to work with a team of knowledgeable and experienced medical coders who provide dedicated medical billing solutions.
| Also read: Juvenile Idiopathic Arthritis (JIA) – Essentials of Diagnosis and Coding |
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.