Alicia: Q: Rheumatoid arthritis. The abbreviation for that is RA. You noticed I put the HCC on here. This is code 714.0 HCC 38, and it has RxHCC of 41. What should a coder know about RA?
A: There are lots of things about RA that you should know especially when you’re doing HCC coding, since we’ve talked about it. You’ve got to be able to back up that the person has RA. With HCC coding, the doctor just can’t list patient has RA. You have to be able to show that’s being treated. Once you have RA you don’t get rid of it, but it has to be shown that it’s being treated.
Medical Coding Rheumatoid Arthritis – Video
What is RA? It’s arthritis or polyarthritis: atrophic, rheumatic (chronic). This is different than juvenile rheumatoid arthritis.
Notice that “use additional code to identify the manifestation”? That’s something to pay attention. Don’t ever forget that.
In this description about it, RA is really an autoimmune disease. It usually affects the synovial lining of the joints. You’ve ever heard of synovial fluid? Like, if a person has a bad knee or something, it swells up, and they say they went and had it drained. That’s synovial fluid.
It comes in three stages: first, they’ll have swelling and pain. They’ll get warmth, they’ll be real hot and stiff around the joint. Then, they started getting division of new cells and stuff, so it starts increasing and they start having problems and you get the synovium starts to thicken, and that’s when you start seeing people with their fingers real crooked and curled. Their knuckles will get bumps on them and stuff. You can really wreak havoc on your extremities, your hands and your feet and your knees as water works on. It gets into the cartilage. Pain is the main thing; you’ve got a lot of pain. That’s one of the treatments is they’re treating the pain. The joint deformity, the instability of the joint too, and it gets to where you just can’t function. You can’t move the joint because it’s so stiff and hard. RA commonly begins in a small joint so usually in the hands and in the wrist and it usually happens bilaterally…It always affects both sides, both joints.
There are other physical symptoms that you’ll see. When you’re coding that, that means you want to look at the review of body systems that the doctor does because he will probably mention that. Look in the musculoskeletal section.
[Static audio] That shows you the deformity; look at how those knuckles are deformed. You get pain mostly in the morning, stiffness, or if you sat down for a long time. You can even run a fever, muscle aches and stuff, make you feel like you’ve got flu.
Let’s see cartilage, bone, and ligament damage occurs in the advance stages. You can imagine, you saw that person’s hand, the [static audio]… but it can affect the lungs and the heart.
Boyd: Alicia, we lost you a lot. For the last 30 seconds we lost you there.
Alicia: OK. I’ll back up.
Not only can it affect, give you flu-like symptoms and you can run a fever, but it also can affect your heart and your lungs. Most people don’t realize that, but it will. So, if a person, if the doctor is taking special care with a person with RA and he mentions their lungs or he mentions their heart, that can be documentation to support the current RA condition. Now, RA usually happens in people between the age of 30 and 50, but it can afflict children and men more severely than women, I don’t know why.
Laureen: “What can be done about rheumatoid arthritis? A particular genetic marker in white blood cells, HLA-DR4, puts certain people at increased risk for RA. The immune system in people with RA mistakes the body’s own healthy tissue for foreign invaders and attacks it. Some people also have an increase in rheumatoid factor antibody that helps direct the production of normal antibodies. It is also believed that RA may be triggered by an abnormal response to some kind of infection.” I have heard that. “Many researchers are in debate over whether RA is one disease or actually a complex of several different related diseases. Medications used: Humira, Enbrel, Prednisone, Celebrex, Metotrexate, Voltaren, Gold.” That’s your little tidbit about rheumatoid arthritis.