What codes are used for a patient presenting with polyarticular (multiple joint) arthritis and joint pain, with a concern for Lyme disease?

From the Guidelines

For a patient presenting with polyarticular arthritis and joint pain with concern for Lyme disease, I would use ICD-10 codes M13.0 (Polyarthritis, unspecified) for the polyarticular arthritis and M25.5 (Pain in joint) for the joint pain. If Lyme disease is suspected but not confirmed, A69.20 (Lyme disease, unspecified) would be appropriate. According to the 2020 guidelines for the prevention, diagnosis, and treatment of Lyme disease by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) 1, the diagnosis and treatment of Lyme arthritis is a critical aspect of managing the disease. Some key points to consider when coding for Lyme disease include:

• The specific joints affected, with Lyme arthritis typically affecting large joints, particularly the knee
• The duration of symptoms
• Any associated symptoms like rash, fever, or neurological manifestations
• The need to update coding as diagnostic testing results become available, with A69.23 (Arthritis due to Lyme disease) being the primary code if laboratory testing confirms Lyme disease, as it captures both the arthritis and its etiology 1. Accurate coding is essential for proper treatment planning, insurance reimbursement, and epidemiological tracking of Lyme disease cases. It's also important to note that Lyme arthritis occurs in about 60% of untreated Lyme disease cases, highlighting the importance of prompt diagnosis and treatment. The use of oral antibiotic therapy for 28 days is recommended for the initial treatment of Lyme arthritis, as stated in the guidelines 1.

From the Research

Diagnosis Codes for Lyme Disease

To diagnose Lyme disease with polyarticular arthritis and joint pain, the following codes can be used:

• ICD-10 code A69.2 for Lyme disease
• ICD-10 code M01.2 for arthritis in Lyme disease
• ICD-9 code 088.81 for Lyme disease

Clinical Presentation

Lyme arthritis typically presents as:

• Monoarthritis or oligoarticular arthritis in large joints, especially the knee 2, 3
• Intermittent or persistent attacks of joint swelling and pain in one or a few large joints 4, 5
• Polyarticular arthritis is less common, but can occur in some cases

Diagnostic Testing

Diagnostic testing for Lyme disease includes:

• Serologic testing, such as ELISA and Western blotting 6, 4, 5
• Polymerase chain reaction (PCR) from synovial fluid or tissue 2, 3
• Positive 2-tier Lyme serologies or PCR from synovial fluid/tissue is considered diagnostic for patients from an endemic area 2

Treatment Codes

Treatment codes for Lyme disease include:

• Antibiotic therapy, such as doxycycline or amoxicillin 6, 4, 2, 3
• Anti-inflammatory agents or arthroscopic synovectomy for patients with persistent arthritis despite antibiotic treatment 4, 3