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In today’s podcast, Natalie Tornese, one of our Senior Group Managers, discusses about Rheumatic Disease and its awareness month which is observed in September.

Hello everyone and welcome to our podcast series. My name is Natalie Tornese and I’m a Senior Group Manager at Outsource Strategies.

00:08 Introduction of Rheumatic Disease Awareness Month

September is Rheumatic Disease Awareness Month. It is designated as Rheumatic Disease Awareness Month by the American College of Rheumatology to draw attention to these painful autoimmune and inflammatory diseases that affect about 54 million or 1 in 4 American adults. Rheumatic diseases are considered the leading cause of disability in the United States. Awareness about symptoms and risk factors, early diagnosis and specialized treatment can help people better manage their condition and improve their quality of life.

00:42 Common Types and Prevalence of Rheumatic Disorders

Rheumatic diseases cause the immune system to attack the joints, bones, cartilage, tendons, ligaments, and muscles. They can also damage the vital organs, including the lungs, heart, nervous system, kidneys, skin and eyes. There are hundreds of different rheumatic diseases. The most commonly known types are rheumatoid arthritis, osteoarthritis, lupus, psoriatic arthritis, Sjogren’s syndrome, gout, and scleroderma.

While the risk of gout, osteoarthritis, and rheumatoid arthritis increases with the age, these conditions can also affect people ages 20-40. Pediatric rheumatic diseases affect nearly 300,000 children in the United States, and for many, symptoms may persist even in adulthood. Affordability is a major concern for individuals with rheumatic diseases. Sadly, nearly 60 percent of patients being treated for a rheumatic disease reported that they had difficulty affording their medications or treatments in the past year.

01:47 Importance of Early Diagnosis and Treatment

Lack of awareness about rheumatic disease increases the risk of longer-term pain and damage of not only the joints but also various organs and body systems. Autoimmune rheumatic diseases causes the immune system to attack the body’s healthy tissues.

It is crucial that people learn to recognize the symptoms of rheumatic disease and get timely treatment. Recent studies suggest that patients with autoimmune rheumatic disease may be at higher risk for severe COVID-19 disease than the general population.

The Rheumatic Disease Awareness Month is a national campaign dedicated to drawing attention to the more than 100 conditions that come within the sphere of rheumatic disease. Rheumatic disease symptoms can be difficult to recognize and may be just considered as aches and pains usually associated with aging.  Unfortunately, many people live with their condition for years before they get a correct diagnosis and treatment.

02:51 Goal of Rheumatic Disease Awareness Month

The goal of Rheumatic Disease Awareness Month is to educate people about the risk factors, treatment options, economic impact, and lifestyle or healthcare challenges associated with it, and importantly, what symptoms to look for and when to consult a rheumatology specialist.

03:10 Causes and Symptoms of Rheumatic Conditions

Rheumatic diseases are believed to be triggered by a combination of hereditary and environmental factors, though it is difficult to determine the cause of the condition in a particular individual. Many of these conditions occur when the immune system gets “confused” and attacks your own joints, muscles, bones and organs. Examples of autoimmune diseases include rheumatoid arthritis , lupus, and vasculitis. Factors that increase risk of developing rheumatic disease include:

  • Your sex, as women are more likely than men to develop rheumatic diseases such as Rheumatoid Arthritis, Scleroderma, Fibromyalgia, and Lupus.
  • Age: Rheumatic diseases can occur at any age, but it most commonly begins in middle age.
  • Family history is associated if a member of your family has rheumatic disease, you may have an increased risk.
  • Smoking:Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing disease. It also appears to be associated with greater disease severity.
  • Environmental exposures: Although poorly understood, some exposures such as asbestos or silica may increase the risk of developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
  • Higher levels of estrogen may contribute to the development of the disease.
  • And high levels of stress may also cause symptoms to flare up.

04:46 Signs and Symptoms of Rheumatic disorders

Rheumatic diseases are generally chronic, and symptoms can worsen over time and lead to severe complications. Common signs and symptoms of rheumatic disease include:

  • Chronic and debilitating joint pain
  • Inflammation indicated by joint swelling, tenderness, warmth and redness
  • Morning stiffness
  • Muscle pain
  • Pain in the neck, spine, or back
  • Numbness and tingling in the hands and feet
  • Swelling
  • Difficulty moving the joints
  • Joint deformity
  • Fatigue
  • Eye inflammation, infections, or dryness
  • And rashes and sores

05:24 Importance of Early and Timely Diagnosis of Rheumatic Disease

 Timely diagnosis can prevent the condition from becoming more serious or causing more severe symptoms. Also, having one rheumatic disease can put a person at a risk of developing others. Initiating treatment early can slow the progression of rheumatic disorders and prevent irreversible joint or organ damage, and improve chances of remission. This all depends on early diagnosis.

The sooner a person is diagnosed and referred to the correct specialist to receive proper treatment, the better a patient’s chances are of managing their disease and enjoying a fuller, healthier life.

06:01 Types of Rheumatic Disease

The types of rheumatic diseases are as follows:

 06:06 Ankylosing Spondylitis: This is a chronic inflammatory disease that can cause some small bones of the spine to fuse, affecting movement and leading to stiffness, pain and hunching. Other complications include breathing difficulties, eye inflammation, compression fractures, and heart problems.  Men are at greater risk of developing ankylosing spondylitis than women.

06:33 Bursitis: This painful condition affects the bursae, the small fluid-filled sacs that serve as a cushion for the bones, tendons and muscles near the joints. The bursa become inflamed when there is too much friction. The most common areas where inflammation occurs are the shoulder, elbow, hip and knee.  In addition to pain, symptoms can also include stiffness of the affected joint, swelling, warmth and redness at the site, along with tenderness, and fever.

07:07 Crohn’s Disease is a chronic, inflammatory bowel disease that appears early in life, typically at age 15. Different people experience inflammation caused by Crohn's disease in different areas of the digestive tract, and the disease can progress deep into the layers of affected tissue. Symptoms include pain, abdominal cramps, diarrhea, mouth sores, fever, weight loss, and anemia. Crohn's disease can also lead to complications such as colitic arthritis, inflammation of the tissues around the bile ducts, kidney stones, fistulas and urinary tract problems.

07:42 Gout is a form of inflammatory arthritis that results in painful, swollen joints. It is caused by monosodium urate crystal deposits in the joints which result from excessive uric acid in the body. Gout mostly affects the joint at the base of the big toe. Common symptoms include severe sudden pain, chills, fever, and general malaise.

08:06 Juvenile Idiopathic Arthritis, JIA is a group of conditions that causes joint inflammation in children. Though children often outgrow this autoimmune disorder, it can stunt bone development in the growth stage. There are different types of JIA, distinguished by the number of joints affected, their signs and symptoms, the results of laboratory tests, and family history. Symptoms include swollen, stiff, and painful joints, usually in the morning, eye inflammation, fatigue, and appetite loss. Systemic JIA can cause high fever and rash and swollen lymph nodes.

08:48 Osteoarthritis is the most common type of arthritis. It is actually not considered a rheumatic disease as it is caused by the natural wearing down of the joint’s cartilage over time, as opposed to causing inflammation. OA causing stiffness, pain and loss of movement in the joint. Though the condition can damage any joint OA usually affects the joints in the hands, knees, hips and spine. Staying active, maintaining a healthy weight and some treatments can help manage the OA symptoms, slow disease progression and help improve pain and joint function.

 09:21 Osteoporosis causes bones to become weak and brittle due to a decrease in bone mass and density. Bone is constantly broken down and replenished. Osteoporosis occurs when the body stops creating new bone to replace the loss of old bone. The condition affects more than 10 million Americans. Up to 1 in 2 women will break a bone due to osteoporosis, according to the Johns Hopkins University School of Medicine.

 09:58 Polymyalgia Rheumatica is an inflammatory disorder that usually affects people over 65, causing muscle pain and stiffness in the shoulders, neck, hips, and lower back. It can occur along with giant cell arteritis, another inflammatory disease of the arteries that causes headaches, vision difficulties, jaw pain and scalp tenderness.

10:21 Polymyositis is an inflammatory rheumatic disease that can affect the whole body. Signs and symptoms usually develop gradually over time, causing muscle weakness and ultimately, disability.

10:33 Psoriatic Arthritis is a chronic disease that usually occurs in people with skin psoriasis. It can affect just one joint, several joints or multiple joints. It typically affects the joints at the end of the toes and fingers and the back of the sacroiliac joints of the pelvis. Early accurate diagnosis is critical as research suggests that persistent inflammation from psoriatic arthritis can ultimately damage the joints.

10:57 Rheumatoid Arthritis is the most common type of autoimmune arthritis. It is estimated that about 1.3 million people in the US are living with RA. This chronic condition is characterized by pain and swelling in the wrist and small joints of the hand and feet. It can cause long-term joint damage, with chronic pain, loss of function and disability. Fortunately, early treatment for RA can improve symptoms and help people live an active life.

11:27 Scleroderma is a rare condition caused by overproduction of collagen in the skin. It is characterized by thickening and tightening of the skin and inflammation and scarring in many areas of the body. Systemic scleroderma, the most serious form of the disease, can also affect the lungs, kidneys, heart, intestinal system and other areas.

 11:50 Sjögren's Syndrome is an autoimmune disease that causes dry eyes and a dry mouth. It typically affects older women. Many patients develop Sjögren's syndrome as a complication of rheumatoid arthritis or lupus. In some patients, the disease may cause lung problems, abnormal liver and kidney function, skin rashes, and neurologic problems.

12:13 Spondyloarthropathies are a group of rheumatic diseases that cause arthritis. They mainly cause pain and inflammation in the spine. Some forms also affect the arms and legs, hands and feet, hips, shoulders and knees.  Axial spondyloarthritis can progress into ankylosing spondylitis, may be associated with eye problems, skin rashes and mouth sores.

12:39 and then there is Lupus: Lupus causes widespread inflammation in the body and affects the joints, muscles, skin, blood vessels and even kidneys.  It is believed to be caused by a combination of genetics, hormones and environmental factors. It is more common among women and about 20 percent of people with lupus develop the disease before age 20.

13:00 Tendinitis or bursitis involves inflammation of the tendons in the shoulder, elbow, wrist, hip, knee and ankle. It is usually the results of overuse or repetitive stress, but can also occur as a result of a sudden intense injury or a pre-existing rheumatic condition. Tendinitis symptoms include pain, tenderness and restricted mobility.

13:23 Diagnosing Rheumatic Disease

 Diagnosing rheumatic disease begins with a physical exam, discussion of symptoms, and questions about present and past health. The rheumatologist will examine the patient’s range of motion and reflexes and check for conditions like swollen glands and eye inflammation. Laboratory tests may be recommended to detect various signs of inflammation and test for inflammatory markers. Imaging tests can show progression of the disease in the joints.

Early and rapid diagnosis is an important prerequisite for managing rheumatic disease. However, while some conditions like gout are usually easy to diagnose, some autoimmune rheumatic diseases are challenging to detect during the early stages.

Another thing that makes diagnosis difficult is that in the early phases, rheumatic illnesses will not present the way that they’re described in textbooks. For example, in patients who have rheumatoid arthritis, the early symptoms may be just a little morning stiffness and the typical exam may not reveal much.

The elements that go into diagnosing a rheumatic disease are a careful detailed history and a very good detailed physical, supported by both laboratory studies and imaging studies.

14:36 Treatment options of rheumatic diseases

 As rheumatic diseases are chronic conditions, the focus of treatment is to ease the symptoms, reduce inflammation, slow progression, and/or achieve remission. Treatment would depend on the patient’s condition. Medications for musculoskeletal disorders include Oral and topical analgesics, corticosteroids to address inflammation, disease-modifying anti-rheumatic drugs including JKI inhibitors, injections into a joint or the soft tissues, physical therapy, chiropractic treatment, and surgical options. Individual response to treatments for arthritis may vary.

15:16 Billing and Coding Rheumatic Disease

In order to get paid, physicians should report a valid ICD-10 code that informs payers the reason for services. Medical necessity generally determines the payment. I will include a transcript along with this podcast with all associated ICD 10 codes related to this condition.

(ICD 10 codes related Rheumatic Disease

  1. Ankylosing spondylitis - M45.
  2. Arthralgia (joint pain) - M25.5
  3. Arthopathy - M12.8
  4. Baker's Cyst - M71.2
  5. Bechet's syndrome - M35.2
  6. Bursitis knee - -M70.5
  7. Bursitis olecranon - M70.2
  8. Carpal tunnel syndrome - G56.0
  9. Chronic pain - G89.29
  10. Costochondritis - M94.0
  11. Cushing syndrome, other - E24.8
  12. De Qervain's tenosynovitis - M65.4
  13. Effusion - M25.4
  14. Elevated CRP - R79.82
  15. Elevated SED rate - R70.0
  16. Enteropathicarthopathies, multiple sites- M07.69
  17. Fibromyalgia - M79.7
  18. Gout, acute idiopathic – M10.0
  19. Gout, chronic, idiopathic – M1A,0
  20. Juvenile rheumatoid arthritis, Still's disease NOS - M08.20
  21. Lupus erythematous NOS - L93.0
  22. Lupus SLE, NOS - M32.9
  23. Myalgia - M79.1
  24. Osteoarthritis primary - MlS.0
  25. Osteoarthritis bilateral, hip - M16.0
  26. Osteoarthritis unilateral, hip - M16.1
  27. Osteoarthritis bilateral, knee - M17.0
  28. Osteoarthritis unilateral, knee - M17.1
  29. Osteoarthritis bilateral, first carpometacarpal joint - M19.0
  30. Osteoarthritis unilateral, first carpometacarpal joint - M19.1
  31. Osteopenia -M85.89
  32. Osteoporosis w/pathological fracture, age related - M80.0l
  33. Osteoporosis w/o pathological fracture, age related - M81.0
  34. Polymyalgia rheumatica - M35.3
  35. Pseudo gout - Mll.29
  36. Psoriatic arthritis - L40.50
  37. Psoriatic spondylitis - L40.53
  38. Raynaud's syndrome w/o gangrene -173.00
  39. Reactive arthritis (Reiter's) - M02.3
  40. R/ Aw/rheumatoid factor w/o organ or systems involvement - M05.7
  41. R/A w/o rheumatoid factor- M06.0
  42. Sjogrens disease - M35.0
  43. Spondylosis with myelopathy- M47.1
  44. Stills disease, adult onset - M06.1
  45. Trigger finger - M65.3
  46. Wegener's granulomatosis - M31.3
  47. Drug monitoring long term use - 279.899
  48. Drug monitoring - current (NSAIDS)- Z79.1
  49. Drug monitoring - current (steroids) - 279.52
  50. Pregnant state - Z33.1

)

Along with choosing the correct ICD-10 code, physicians should ensure relevant documentation in the medical chart to support the level of the ICD-10 code. Based on the diagnosis, documentation should specify:

  • If the condition is chronic or acute
  • The etiology of the disease
  • The anatomical site is affected
  • And the side of the body that is affected

If the provider has not established a related, definitive diagnosis, codes that describe signs and symptoms can be reported. The patient’s signs and symptoms should be clearly recorded in the medical record documentation. This will allow medical coding service providers to code to the highest level of certainty based on the known signs and symptoms.

 16:16 Ensure Correct Diagnosis and Appropriate Treatment by a Rheumatologist

Rheumatologists specialize in diagnosing and treating musculoskeletal diseases and autoimmune rheumatic diseases. People who experience joint pain usually first consult their PCP, as inflammatory arthritic diseases can progress quickly, the PCP may initiate early tests prior to referral to a rheumatologist.

Rheumatic Disease Awareness Month is dedicated to increasing the public’s understanding and awareness about the prevalence or severity of rheumatic diseases.  The ACR’s Simple Tasks platform encourages patients to educate their close family members, friends, and even children about their disease. This can go a long way in addressing any potential confusion and anxiety on their end as well as helping them understand how the disease impacts the patient’s day to day life.

I hope this helps. But always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.