Not all joint pains are related to arthritis, but arthritis is one of the most widespread health conditions in the United States. According to the CDC, the condition affects about one in four adults overall. That’s over 58 million men and women. Each year, the month of May is observed as National Arthritis Awareness Month. Organized by the Arthritis Foundation, Arthritis Awareness Month aims at creating awareness about arthritis and the issues involved. Rheumatologists diagnose and treat all types of arthritis, mainly those requiring complex treatment. Being a medical billing and coding company with years of experience in providing services for many specialities, we understand that rheumatology medical billing and coding poses many challenges.

Some major forms of arthritis are – Osteoarthritis, Rheumatoid arthritis, Psoriatic arthritis, Gout, Fibromyalgia, and Juvenile idiopathic arthritis. To get due reimbursement for all services provided, it is important to submit cleans medical claims with accurate codes. Coding arthritis in ICD 10 requires good knowledge of the codes, terminologies and related vocabulary. Like other medical specialties, rheumatology has its own set of coding and billing challenges.

Check out some of the applicable ICD-10 codes for the arthritis types –

Osteoarthritis (M15-M19)

  • M15 Polyosteoarthritis
    • 15.0 Primary generalized (osteo)arthritis
    • 15.1 Heberden’s nodes (with arthropathy)
    • 15.2 Bouchard’s nodes (with arthropathy)
  • M16 Osteoarthritis of hip
    • 0 Bilateral primary osteoarthritis of hip
    • 1 Unilateral primary osteoarthritis of hip
    • 2 Bilateral osteoarthritis resulting from hip d…
  • M17 Osteoarthritis of knee
    • M17.0 Bilateral primary osteoarthritis of knee
    • M17.1 Unilateral primary osteoarthritis of knee
    • M17.2 Bilateral post-traumatic osteoarthritis of kn…
  • M18 Osteoarthritis of first carpometacarpal joint…
    • M18.0 Bilateral primary osteoarthritis of first car…
    • M18.1 Unilateral primary osteoarthritis of first ca…
    • M18.2 Bilateral post-traumatic osteoarthritis of fi…
  • M19 Other and unspecified osteoarthritis
    • M19.0 Primary osteoarthritis of other joints
    • M19.1 Post-traumatic osteoarthritis of other joints…

Rheumatoid arthritis

  • M05 Rheumatoid arthritis with rheumatoid factor
    • M05.0 Felty’s syndrome
    • M05.02 Felty’s syndrome, elbow
    • M05.03 Felty’s syndrome, wrist
    • M05.04 Felty’s syndrome, hand
    • M05.05 Felty’s syndrome, hip
    • M05.06 Felty’s syndrome, knee
    • M05.07 Felty’s syndrome, ankle and foot
    • M05.09 …… multiple sites
  • M06 Other rheumatoid arthritis
    • M06.0 Rheumatoid arthritis without rheumatoid facto…
    • M06.02 Rheumatoid arthritis without rheumatoid facto…
    • M06.03 Rheumatoid arthritis without rheumatoid facto…
    • M06.04 Rheumatoid arthritis without rheumatoid facto…
    • M06.05 Rheumatoid arthritis without rheumatoid facto…
    • M06.06 Rheumatoid arthritis without rheumatoid facto…
    • M06.07 Rheumatoid arthritis without rheumatoid facto…
    • M06.08 Rheumatoid arthritis without rheumatoid facto…
    • M06.09 Rheumatoid arthritis without rheumatoid facto…
    • M06.0A Rheumatoid arthritis without rheumatoid facto…

Gout

  • M10 Gout
    • M10.0 Idiopathic gout
    • M10.1 Lead-induced gout
    • M10.2 Drug-induced gout
    • M10.3 Gout due to renal impairment
    • M10.4 Other secondary gout
    • M10.9 Gout, unspecified

Juvenile arthritis

  • M08 Juvenile arthritis
    • M08.0 Unspecified juvenile rheumatoid arthritis
    • M08.1 Juvenile ankylosing spondylitis
    • M08.2 Juvenile rheumatoid arthritis with systemic o…
    • M08.3 Juvenile rheumatoid polyarthritis (seronegati…
    • M08.4 Pauciarticular juvenile rheumatoid arthritis
    • M08.8 Other juvenile arthritis
    • M08.9 Juvenile arthritis, unspecified

Psoriatic arthritis

  • L40 Psoriasis
    • L40.0 Psoriasis vulgaris
    • L40.1 Generalized pustular psoriasis
    • L40.2 Acrodermatitis continua
    • L40.3 Pustulosis palmaris et plantaris
    • L40.4 Guttate psoriasis
    • L40.5 Arthropathic psoriasis
      • L40.50 …… unspecified
      • L40.51 Distal interphalangeal psoriatic arthropathy
      • L40.52 Psoriatic arthritis mutilans
      • L40.53 Psoriatic spondylitis
      • L40.54 Psoriatic juvenile arthropathy
      • L40.59 Other psoriatic arthropathy
    • L40.8 Other psoriasis
    • L40.9 Psoriasis, unspecified

Medicare coverage for arthritis

In an article, Medical News Today has discussed the Medicare coverage criteria for arthritis. Medicare helps cover multiple aspects of arthritis treatments although copayments, deductibles, and coinsurances still apply.

Medicare is comprised of several parts and each part may cover different care options for arthritis.

Medicare Part A

Part A covers the costs involved with inpatient hospital stays and skilled nursing care. This may also apply to a person who requires surgical intervention to treat arthritis, such as a total joint replacement.

Medicare Part B

Part B covers outpatient medical costs such as doctors’ visits and durable medical equipment (DME). Medicare will usually cover doctor’s visits related to arthritis, physical therapy, and some DME, such as splints, braces, walkers, or canes.

A person is often required to obtain prior authorization from Medicare before purchasing equipment or pursuing therapy services.

Medicare Advantage (Part C)

Part C or Medicare Advantage plans are provided mainly by private insurance companies.

Medicare Part D (Prescription Drug Plan)

Part D or prescription drug plans (PDPs) provide coverage for prescribed medications. A person with original Medicare must enroll in a PDP separately, as private insurance companies administer the plans.

Often, Medicare Advantage plans will include coverage for prescribed drugs, so a person will not need to purchase a separate PDP.

Medigap

Medigap plans cover some out-of-pocket costs, including copayments, deductibles, coinsurance, and excess charges.

Being a reliable rheumatology medical coding company, our team is also up to date with the coverage guidelines for arthritis with diverse insurers. Many arthritis medications and surgical approaches require prior authorization from Medicare to ensure their costs will be covered. At OSI, our team can also support in obtaining pre-authorization for various drugs, radiologic examinations and other services as specified by the insurers.

Also Read

Rheumatic Diseases in Pregnancy and their ICD-10 Codes

ICD-10 Coding for Pediatric Rheumatic Diseases

Rheumatoid Arthritis Diagnosis and Coding – Importance