How to Code Rheumatoid Arthritis Medical Coding Tips
Alicia: Q: Rheumatoid arthritis. The abbreviationfor that is RA. You noticed I put the HCC on here. This is code 714.0 HCC 38, and ithas RxHCC of 41. What should a coder know about RAé A: There are lots of things about RA thatyou should know especially when you're doing HCC coding, since we've talked about it. You'vegot to be able to back up that the person has RA. With HCC coding, the just can'tlist patient has RA. You have to be able to show that's being treated. Once you have RAyou don't get rid of it, but it has to be shown that it's being treated.
What is RAé It's arthritis or polyarthritis:atrophic, rheumatic (chronic). This is different than juvenile rheumatoid arthritis. Notice that quot;use additional code to identifythe manifestationquot;é That's something to pay attention. Don't ever forget that. In this description about it, RA is reallyan autoimmune disease. It usually affects the synovial lining of the joints. You'veever heard of synovial fluidé 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 haveswelling 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 theystart having problems and you get the synovium starts to thicken, and that's when you startseeing people with their fingers real crooked and curled. Their knuckles will get bumpson them and stuff. You can really wreak havoc on your extremities, your hands and your feetand 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. Thejoint 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 jointso 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'llsee. When you're coding that, that means you want to look at the review of body systemsthat the does because he will probably mention that. Look in the musculoskeletalsection. 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 damageoccurs 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 last30 seconds we lost you there. Alicia: OK. I'll back up. Not only can it affect, give you flulikesymptoms and you can run a fever, but it also can affect your heart and your lungs. Mostpeople don't realize that, but it will. So, if a person, if the is taking specialcare with a person with RA and he mentions
their lungs or he mentions their heart, thatcan be documentation to support the current RA condition. Now, RA usually happens in peoplebetween the age of 30 and 50, but it can afflict children and men more severely than women,I don't know why. Laureen: quot;What can be done about rheumatoidarthritisé A particular genetic marker in white blood cells, HLADR4, puts certain peopleat increased risk for RA. The immune system in people with RA mistakes the body's ownhealthy tissue for foreign invaders and attacks it. Some people also have an increase in rheumatoidfactor antibody that helps direct the production of normal antibodies. It is also believedthat RA may be triggered by an abnormal response
CAse Study 17 Ann With Rheumatoid Arthritis IBS And Candida
I'm going to do another case history today.This is a 62yearold lady called Ann who came into the with rheumatoid arthritis,a yeast infection, and irritable bowel syndrome. I'm going to read some of the excerpts outof my book, and then I'll give you some comments on this case as well. If you've got rheumatoidarthritis or an autoimmune disease, something like lupus or Sjogren's, a scleroderma ora condition like that, you could well have an underlying yeast infection or bowel problem.It's very, very common. I'm just going to read some bits and pieces out of the bookto familiarize you with the case. Ann is a retired accountant who had been sufferingas long as she can remember with headaches,
nasal congestion, irritable bowel syndromeand several other complaints, including a persistent fungal infection of several toenails.Six years ago, she was diagnosed with rheumatoid arthritis. We also uncovered two root canalteeth that had been quite sensitive for several years.I referred Ann to a dentist friend who examined her mouth and mentioned that her two teethrequired extraction because a lowgrade infection was present. This can actually be seen onan xray. If you have root canal teeth, particularly if they're sensitive to touch, the gums bleedaround them, you may want to get an xray done. After careful extraction, the socketswere carefully cleaned, and we waited until
her mouth was sufficiently healed before weundertook a detoxification program that lasted about six weeks. It took four months of treatment,but her painful fingers and wrists were getting less painful by the week. Remember, this wasrheumatoid arthritis. This patient was taking several medications for rheumatoid arthritis,including antiinflammatories and even drugs like methotrexate, which is a chemotherapydrug. After six months, the pain had gone from ascale of 8 out of 10 down to 2 out of 10. It improved so much, in fact, her headacheswere long gone and so was her nasal congestion. Many people with root canal teeth, particularlyin the upper jaw, will often have nasal congestion
or a sinus infection as a result of basicallythe sockets seeding anaerobic bacteria into the maxillary sinus area here.Her bowel was almost back to normal at this stage. We put Ann on the low allergy diet,and she had followed this religiously for six months until one day she decided enoughwas enough. She started to drink a glass of wine with dinner each evening and then thechocolates crept back in. She was in my room within two weeks complaining that the painhad crept back 6 out of 10 and was steadily getting worse by the day.I asked Ann what had happened and she replied, quot;Well, I was feeling so good that I thoughta glass of wine here and there wouldn't hurt.quot;
And she said she was disappointed with thetreatment and she felt she was going backwards. This is when I showed her the diagram andI said it's common for someone to feel well and then all of a sudden feel unwell, particularly,if they slip back into bad habits. In my book, I've actually drawn a diagram of how peoplethink they get well and how they actually recover from a chronic Candida infection orany kind of chronic illness. I've written here, you improve and then youthink all is well, and then you go back to your normal lifestyle. I asked her this, quot;Didyou improve initiallyéquot; She said emphatically, quot;Yes. I haven't felt that well for as longas I can remember.quot; That's when I said, quot;Well,
you must have been on the right track then.The problem is we didn't keep you on the path long enough and somehow you got lost and tooka side track.quot; Ann's husband said that his wife thought thatshe was cured, and this is what I commonly find with many people. They start out withthe right intentions. They want to get well bad enough to be good for several weeks toseveral months, but then the boredom creeps in. The patient becomes frustrated and wantsto resume the same diet and lifestyle they had prior to developing the complaint. Whatthey may not be aware of is that one or several of these lifestyle or dietary factors contributedto the demise of their health initially. If