Psoriatic Arthritis ICD 10 – Clinical Information and Coding

Touseef Riaz

November 10, 2021

Psoriatic arthritis

According to the National Psoriasis Foundation, up to 30% of people with psoriasis develop psoriatic arthritis (PsA), an inflammatory form of arthritis. It can also occur in people without the skin symptoms of psoriasis. This chronic inflammatory arthritis associated with psoriasis can also be confused with osteoarthritis (OA), the most common form of arthritis. This highly heterogeneous disorder can affect multiple different tissues, including the peripheral joints, skin, axial joints, enteritis and ductility’s (swelling of a whole toe or finger). As the condition is easy to confuse with other diseases, specialists in musculoskeletal disorders, and rheumatologists are more likely to make a proper diagnosis and advise patients about the best treatment options. Outsourcing medical billing tasks will help these specialists reduce documentation work and focus on patient care.

Typical symptoms are fatigue, nail changes (pitting, white patches) and reduced range of motion of affected joints. PsA can affect any joint in any pattern, and may affect one joint at a time, to start with. Patients are also at the risk of developing further complications such as

arthritis multilane which destroys the small bones in the hands

eye problems such as conjunctivitis, uveitis, and an increased risk of cataracts and glaucoma

co-morbid conditions – stroke, cardiovascular problems, depression, diabetes mellitus type 2, lymphoma, skin cancer, osteoporosis (especially in men), and hearing loss

About the ICD 10

The International Classification of Diseases, tenth revision is a clinical system applied by healthcare providers and physicians to code and classify the diseases, diagnoses, symptoms and procedures that are recorded during health care provided. The ICD 10 is important to compile diagnostic specificity and morbidity data in the US.

The International Classification of Diseases is published by the World Health Organization, used by physicians, health information managers, coders, nurses and other professionals associated with the healthcare sector for storage and retrieval of information relating to diagnosis. In the bigger picture, the data is compiled to provide national morbidity and mortality statistics.

The ICD 10 comprises known disease and health problems listed in a systematic way, and uses unique alphanumeric codes that correspond to each disease and condition to make identification easy. After the ICD 10 was formally regulated in the US health system, all HIPAA (Health Insurance Portability and Accountability Act) compliant/covered entities are required to adhere to the ICD 10 code sets.

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RA vs PsA

Many people are unsure of what psoriatic arthritis (PsA) is, or mistakenly think it is rheumatoid arthritis (RA). PsA is similar to RA, but confusing the two will lead to incorrect coding. Take a moment to learn their differences and better understand PsA etiology, treatment, and diagnosis coding.

RA vs. PsA

RA typically affects joints symmetrically and affects the lining of the joints, eventually causing bone erosion and joint deformity. PsA is an autoimmune, inflammatory disorder that occurs in approximately 15-30 percent of people with psoriasis, and can occur in people without the skin symptoms of psoriasis. Unlike RA, PsA can affect any joint in any pattern, and may affect one joint at a time, to start. It typically affects the distal joints in the fingers and toes, but can also affect other joints, including the spine (spondylitis), sacroiliac joint, knees, wrists, elbows, and ankles.

Signs and Symptoms of PsA

The typical symptoms of PsA can include:

·         Tender, swollen, and painful joints;

·         “Sausage digits” (dactylitis-inflammation/swelling of an entire finger or toe, giving it the appearance of a sausage link);

·         Fatigue;

·         Nail changes (pitting, white patches);

·         Reduced range of motion of affected joints; and

·         Tenderness, pain, and swelling of the areas where tendons and ligaments join onto bones (enthesitis).

Enthesitis and dactylitis are two characteristic features of PsA not found together in any other form of arthritis. Symptoms can vary and can range from mild to severe, and may present occasionally or continuously.

Patients with PsA are also at risk of developing certain complications. One of the most damaging is arthritis multilane, which destroys the small bones in the hands — especially the distal interphalangeal and proximal interphalangeal joints due to osteolysis, which causes permanent deformity. The patient also may experience eye problems such as conjunctivitis, uveitis, and an increased risk of cataracts and glaucoma.

Patients with PsA are also more likely to develop comorbid conditions, including stroke, cardiovascular problems, depression, Crohn’s disease, metabolic syndrome, diabetes mellitus type 2, lymphoma, skin cancer, obesity, osteoporosis (especially in men), nonalcoholic fatty liver disease, and hearing loss.

PsA Treatment

Regular appointments with a primary care physician, ophthalmologist, and rheumatologist are critical to keep symptoms, complications, and risk of comorbid conditions at a minimum. Available treatments include:

·         Non-steroidal anti-inflammatory drugs (such as Mobic, Naprosyn, Relafen, and Voltaren);

·         Disease-modifying ant rheumatic drugs (DMARDs) (such as Methotrexate);

·         Biologics that affect the immune system, either by blocking T-cells or certain proteins known as interleukins 17-A, 12 and 23 or TNF-alpha (such as Enbrel, Humira, Remicade, Simponi, Cimzia, Stelara, Orencia, Taltz, Siliq, Tremfyz, and Cosentyx); and

·         Newer medications on the market (such as Otezla).

Some of these medications require periodic blood work during treatment and others require blood work, a TB test, and Hepatitis B and C tests before starting treatment. As with all medications, there can be side effects, such as stomach irritation, heart problems, liver damage, bone marrow suppression, severe lung infections, and being more susceptible to other infections.

Diagnosis Coding

Etiology and treatment can be helpful when reviewing charts for documentation improvement, especially with the new quality payment models. ICD-10 codes for psoriasis are in the range of L40.0-L40.9, with the PsA codes in the range of L40.50-L40.59.

Diagnosis codes include:

L40 Psoriasis

L40.0 Psoriasis vulgaris

Nummular psoriasis

Plaque psoriasis

L40.1 Generalized pustular psoriasis

Impetigo herpetiformis

Von Zumbusch’s disease

L40.2 Acrodermatitis continua

L40.3 Pustulosis palmaris et plantaris

L40.4 Guttate psoriasis

L40.5 Arthropathic psoriasis

L40.50 Arthropathic psoriasis, unspecified

L40.51 Distal interphalangeal psoriatic arthropathy

L40.52 Psoriatic arthritis mutilans

L40.53 Psoriatic spondylitis

L40.54 Psoriatic juvenile arthropathy

L40.59 Other psoriatic arthropathy

L40.8 Other psoriasis

Flexural psoriasis

L40.9 Psoriasis, unspecified

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