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Rheumatoid Arthritis-code is completely narrowed

  1. Default Rheumatoid Arthritis-code is completely narrowed
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    So I was wondering if anyone would be able to help me with this diagnosis? When a diagnosis isn't specific enough, I'm sending it back for the doctor to specify until the code is completely narrowed down. But I don't understand enough about RA to even begin to know what I'm looking for in the 400 + codes :/ They're saying rheumatoid arthritis, then the area (RT/LT knee, hip, etc.) I just want to be able to narrow these codes down to be more specific than M06.9 but I need to know what to ask for to make it easier for them to understand what they need to dictate.... I'm trying to make it so that none of the codes that go out are 'unspecified'.

    ANY suggestions?

    Thank you!

  2. #2
    Location
    Marietta, GA chapter
    Posts
    38
    Default RA coding
    You are on the right track with M06.9. The doctor should give you the location being examined or treated at that visit. For limbs, you need laterality - those codes can be found in the M06 category just before the unspecified code. I work in radiology, so I don't know the code if it's just a positive RA factor blood test,but I think it would be in the R codes.

    Are you getting claims denied due to unspecified codes? I don't see that end of it and have been wondering if other insurance companies are giving the same leeway on unspecified codes for the first year.

    Hope this helps!
    Amy Meyers, CPC

  3. #3
    Location
    Columbia, MO
    Posts
    12,800
    Default
    You should be coding from the documentation. So it will depend on what the provider has documented not the code they selected. Then looking at the documentation it will be easier to know if you need more specific information and if so what you do need.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    I haven't seen any denials for unspecified YET. But the reason why I posted this is because I'm sending EVERYTHING back to the doctors until the code is the most specific. We're avoiding using any unspecified codes. This is the only one I don't know enough about to be able to tell them what I need to have a more specific code. Usually they just say rheumatoid arthritis right knee for example. But I don't know about the whole myopathy, polyneuropathy, or the rheumatoid factor thing. I didn't know that this set of codes would be so huge! I can talk to someone here maybe and see if they can help me understand how to narrow it down. Let me know if you all think of anything more, thank you for your input

  5. #5
    Default Rheumatoid Arthritis
    What is the default for coding RA if the positive factor is not documented?

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