Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageApril 10, 2024

Optum Documentation and coding tips: Arthritis

Per the Centers for Disease Control and Prevention, an estimated 53.2 million adults in the US have been told by a doctor that they have some form of arthritis. Arthritis is the inflammation or swelling of one or more joints. There are many different types of arthritis with different causes and treatments. In some types, other organs, such as your eyes, heart, or skin, can also be affected.1

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Per the ICD-10-CM Official Guidelines for Coding and Reporting FY 2024: “A dash (-) at the end of an Alphabetic Index entry indicates that additional characters are required. Even if a dash is not included at the Alphabetic Index entry, it is necessary to refer to the Tabular List to verify that no 7th character is required.” The bolding of the ICD-10-CM codes represents categories, subcategories or codes that map to the CMS-HCC risk adjustment model for payment year 2024:
Announcement of Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (cms.gov).

The following references were used in the creation of this document at time of publication:

  • Optum360. ICD-10-CM: Professional for Physicians 2024. Salt Lake City, UT: Optum360; 2023.
  1. Centers for Disease Control and Prevention. CDC Arthritis Types. Published 2019. Accessed January 2, 2024.
  2. Centers for Medicare & Medicaid Services (CMS). ICD-10-CM Official Guidelines for Coding and Reporting FY 2024. Accessed February 23, 2024.

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MULTI-ALL-CR-054648-24

ATTACHMENTS: Optum Documentation and coding tips: Arthritis (pdf - 0.19mb)