RA with positive or negative RF

mdowd51

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Hi,
I have a question that may seem silly but, if a patient has a negative Rheumatoid Factor and a positive Anti- CCP would you use M05.79 Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement (Seropositive rheumatoid arthritis) or M05.09 Rheumatoid arthritis without rheumatoid factor, multiple sites (Seronegative rheumatoid arthritis) BY DEFINITION giving a positive result in a test of blood serum. i.e. rheumatoid factor blood test is positive, BUT some of our physicians also count the anti-CCP positive test as seropositive. when coding, should Rheumatoid Factor be the only consideration?
 
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812
Best answers
0
Hi,
I have a question that may seem silly but, if a patient has a negative Rheumatoid Factor and a positive Anti- CCP would you use M05.79 Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement (Seropositive rheumatoid arthritis) or M05.09 Rheumatoid arthritis without rheumatoid factor, multiple sites (Seronegative rheumatoid arthritis) BY DEFINITION giving a positive result in a test of blood serum. i.e. rheumatoid factor blood test is positive, BUT some of our physicians also count the anti-CCP positive test as seropositive. when coding, should Rheumatoid Factor be the only consideration?
I found a few links that might be helpful:
http://rawarrior.com/seronegative-rheumatoid-arthritis/
http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/articles/what-type-do-you-have.php

Because the test for RF and anti-CCP are separate, they don't have to be used in combination; a provider could easily use the anti-CCP (which appears to be more accurate) to conclude seropositive.

Another thing to consider, generally speaking, is that these types of tests look for a specific level of antibodies in the blood to indicate a positive or negative result. However, there's a threshold to what's considered positive. So if the levels for the RF test are too low to flag as positive, it doesn't necessarily mean they aren't any; they could just be low enough that they don't show yet, especially in someone with newly developed RA.
A comparative example might be hCG and pregnancy. You can't take an at-home pregnancy test and get an accurate result until your hCG level is high enough for the test to detect. A negative at-home preg test doesn't always mean you're not pregnant. On the flip-side, a blood test for your hCG level would be more accurate because it can detect low levels, enough to prove pregnancy, if that makes sense. The at-home test would be compared to the RF and the blood test would be compared to the anti-CCP.

Have you considered M06.09 Rheumatoid arthritis without rheumatoid factor, multiple sites? I'm not sure that would be correct, but I thought I'd throw it out there.
 
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