CCO Admin asked:
Would you code a patient that has active RA with a dx of Hyperuricemia? There is no excludes notes for the two dxs; however; the hyperuricemia code states "without signs of inflammatory arthritis and tophaceous disease?
Answer:
Yes you can code them together. BUT they are stating do you have a higher specificity. Hyperuricemia is headed toward Gout. Tophaceous is the knots/Chrystals they get in the joint. RA can also cause those knots in the joint and for example make the fingers and toes look knarled.
So it is really a matter of the disease process. The reason the note is there is that you want to confirm that it is the RA our the Gout that has disfigured the joint.
**Gout** is a form of inflammatory arthritis that develops in the joints of some patients with high levels of uric acid in their blood. It manifests as swollen; painful joints that may have _tophi_ (gout crystals that have formed white bumps) visible beneath the skin. Uric acid forms when the body breaks down purines in the body; which then travel through the bloodstream to the kidneys where it is eliminated during urination. When an abnormal amount of uric acid builds in the bloodstream it is referred to as hyperuricemia. This abundance of uric acid overloads the kidneys and may cause them to become impaired or fail completely. Diet; drugs; toxin exposure; obesity; and certain diseases can cause uric acid buildup. Gout can affect any joint in the body; be acute or chronic in nature; include the presence of tophi or not; and may be caused by malfunctioning kidneys or secondary causes (eg; toxin or drug exposure). ICD-10-CM code options include:
* **Idiopathic:** Unknown cause
* **Lead-induced:** Lead exposure can cause an increase in uric acid levels as the kidneys that process the lead toxins become overburdened and cannot efficiently eliminate the uric acid.
* **Drug-induced:** Certain drugs (eg; diuretics; immunosuppressant agents; fructose; testosterone; aspirin) can cause increased reabsorption or decreased secretion of uric acid in the blood; leading to renal impairment and uric acid crystal formation.
* **Other secondary causes:** An underlying cause of uric acid build up identified within the documentation other than those listed above.
Documentation should include the type; cause; anatomic location; laterality; whether it is chronic; and if tophi is present.
**Rheumatoid arthritis (RA)** is an autoimmune disorder where the immune system attacks the bodys own tissues; resulting in inflammation; pain; and joint deformity. Early RA usually affects the smaller joints in the body first; progressing to larger joints (usually bilaterally); and eventually other organs such as the skin; lungs; eyes; heart kidneys; nerves; blood vessels; salivary glands; and bone marrow. Patients with RA tend to have periods of intense symptoms (flares) and periods with no symptoms (remission) and over time and due to severe inflammatory changes; affected joints tend to become disfigured. Rheumatoid factor (RF) is an antibody present in the blood tests in most adults with rheumatoid arthritis. **Other specifed rheumatoid arthritis** is reported when the documentation identifies a specific type of rheumatoid arthritis for which an accurate code description does not exist. Documenation should include the specific type of rheumatoid arthritis; anatomic site; and laterality. When the documentation does not provide enough detail to identify a type of rheumatoid arthritis; **Unspecified rheumatoid arthritis** (M06.9) should be reported.
Would you code a patient that has active RA with a dx of Hyperuricemia? There is no excludes notes for the two dxs; however; the hyperuricemia code states "without signs of inflammatory arthritis and tophaceous disease?
Answer:
Yes you can code them together. BUT they are stating do you have a higher specificity. Hyperuricemia is headed toward Gout. Tophaceous is the knots/Chrystals they get in the joint. RA can also cause those knots in the joint and for example make the fingers and toes look knarled.
So it is really a matter of the disease process. The reason the note is there is that you want to confirm that it is the RA our the Gout that has disfigured the joint.
**Gout** is a form of inflammatory arthritis that develops in the joints of some patients with high levels of uric acid in their blood. It manifests as swollen; painful joints that may have _tophi_ (gout crystals that have formed white bumps) visible beneath the skin. Uric acid forms when the body breaks down purines in the body; which then travel through the bloodstream to the kidneys where it is eliminated during urination. When an abnormal amount of uric acid builds in the bloodstream it is referred to as hyperuricemia. This abundance of uric acid overloads the kidneys and may cause them to become impaired or fail completely. Diet; drugs; toxin exposure; obesity; and certain diseases can cause uric acid buildup. Gout can affect any joint in the body; be acute or chronic in nature; include the presence of tophi or not; and may be caused by malfunctioning kidneys or secondary causes (eg; toxin or drug exposure). ICD-10-CM code options include:
* **Idiopathic:** Unknown cause
* **Lead-induced:** Lead exposure can cause an increase in uric acid levels as the kidneys that process the lead toxins become overburdened and cannot efficiently eliminate the uric acid.
* **Drug-induced:** Certain drugs (eg; diuretics; immunosuppressant agents; fructose; testosterone; aspirin) can cause increased reabsorption or decreased secretion of uric acid in the blood; leading to renal impairment and uric acid crystal formation.
* **Other secondary causes:** An underlying cause of uric acid build up identified within the documentation other than those listed above.
Documentation should include the type; cause; anatomic location; laterality; whether it is chronic; and if tophi is present.
**Rheumatoid arthritis (RA)** is an autoimmune disorder where the immune system attacks the bodys own tissues; resulting in inflammation; pain; and joint deformity. Early RA usually affects the smaller joints in the body first; progressing to larger joints (usually bilaterally); and eventually other organs such as the skin; lungs; eyes; heart kidneys; nerves; blood vessels; salivary glands; and bone marrow. Patients with RA tend to have periods of intense symptoms (flares) and periods with no symptoms (remission) and over time and due to severe inflammatory changes; affected joints tend to become disfigured. Rheumatoid factor (RF) is an antibody present in the blood tests in most adults with rheumatoid arthritis. **Other specifed rheumatoid arthritis** is reported when the documentation identifies a specific type of rheumatoid arthritis for which an accurate code description does not exist. Documenation should include the specific type of rheumatoid arthritis; anatomic site; and laterality. When the documentation does not provide enough detail to identify a type of rheumatoid arthritis; **Unspecified rheumatoid arthritis** (M06.9) should be reported.
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