People joke about Friday the 13th, but you never see Friday the 714th.  Although some office buildings have a 13th floor, you’ll never see a skyscraper with 714 floors.  This is not (as some believe) due to engineering difficulties of such a tall building; it’s because 714 is such an awful number, nobody wants anywhere near it.  If you’re invited anywhere on July 14, play it safe and stay home.

I nominate 714 as a credible replacement for 13 as an unlucky number. 

When a doctor submits claims to an insurer, included are procedure codes and diagnosis codes.  The ICD-9 codes beginning with 714 are for “rheumatoid arthritis and other inflammatory polyarthropathies.” 

  • 714.0 Rheumatoid arthritis
  • 714.1 Felty’s syndrome
  • 714.2 Other rheumatoid arthritis with visceral or systemic involvement
  • 714.3  Juvenile chronic polyarthritis
  • 714.4 Chronic post-rheumatic arthropathy/Jaccoud’s syndrome
  • 714.8 Other
  • 714.9 Unspecified

For a long time, my rheumatologist used 719.49 (joint pain, multiple sites), not wanting to give my insurance company that RA label until she was positive.  Eventually, though, she switched to 714.0.

When the doctor told my daughter that her diagnosis is “enthesitis” and she does not have arthritis, I assumed that there’s an ICD-9 code for that.  One would think that “not arthritis,” would use an ICD-9 code not beginning with 714.  I was wrong.

The nutritionist, the occupational therapist, and the physical therapist ALL billed my daughter’s last appointment with an ICD-9 code of 714.32!  The rheumatologist’s claim still hasn’t been processed, so I don’t have that EOB, but since she wrote the referral for the other appointments, one would assume that’s where they got that particular diagnosis.

  • 714.30 chronic juvenile polyarthritis, unspecified
  • 714.31 chronic polyarticular juvenile rheumatoid arthritis
  • 714.32  chronic pauciarticular juvenile rheumatoid arthritis
  • 714.33 chronic monoarticular juvenile rheumatoid arthritis

My daughter has been specifically told that this is just enthesitis, not JRA.

  • If it’s not JRA, don’t tell the insurance company that it is.  This makes a huge impact on the rest of her life.
  • If it is JRA, why were we not told?  Why are we screwing around with NSAIDs instead of a DMARD?

Why pauciarticular?

  • Pauciarticular means 4 or fewer joints involved for the first six months.  My daughter has had many joints involved.
  • Pauciarticular does not tend to be symmetrical.  My daughter’s joint pain is symmetrical.
  • Pauciarticular usually does not involve the hips.  Hips were my daughter’s first symptom.
  • Pauciarticular means increased risk for eye involvement.  My daughter has not been given a referral to an ophtholmologist.

I don’t understand how her problem qualifies as 714.32.  Apparently it is time for me to learn a lot more about the different types of arthritis.  I think, for my birthday, I’m getting myself a 714-page rheumatology textbook.

More on EMR’s next week.
Then a follow-up post to this one – once I regroup.