by David Borenstein, MD Executive EditorTheSpineCommunity.com9/2020
Most patients have minimal interest in the International Classification of Disease (!CD-10) coding manual. They should. The manual contains all the illnesses that are recognized as a specific disease. The code for an illness allows physicians to identify the patients who have a specific from of illness. It is also the means that Medicare and other insurance companies identify problems and pay for them.
Spondyloarthritis has two major forms – radiographic and non-radiographic. Radiographic spondyloarthritis is most closely associated with ankylosing spondylitis (AS). AS patients have changes identifiable on xrays in the sacroiliac joints or lumbar spine. Individuals with nr-SPA have identifiable changes with xrays but do have signs of inflammation on magnetic resonance imaging (MRI). MRI is able to identify areas with increased swelling and tissue fluid indicative of inflammation.
The debate that remains regarding nr-SPA is whether it is a separate illness from AS or the initial form of the illness. Up to this time, nr-SPA patients were lumped with AS patients, under the same ICD-10 diagnostic code. This lumping made it difficult to identify nr-SPA patients. Many of these patients could not be followed over time because of the lack of a distinct code.
The new ICD-10 manual being released in October 2020 will have the new M46.8 ICD-10 code. This will make it easier to allow for the use of those agents that have been approved this specific diagnosis. Certolizumab and secukinumab have been approved for this specific illness. The availability of this code should help with obtaining appropriate therapy for this illness.