What ICD10 codes cover apremilast (Otezla) for psoriasis treatment?

ICD-10 Codes for Apremilast (Otezla) Coverage in Psoriasis

The primary ICD-10 codes that support coverage for apremilast (Otezla) in psoriasis are L40.0 (Psoriasis vulgaris/plaque psoriasis) and L40.50 (Arthropathic psoriasis, unspecified).

Primary Diagnostic Codes for Apremilast Coverage

• L40.0 - Psoriasis vulgaris/Plaque 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

Secondary Codes for Specific Psoriasis Manifestations

• L40.1 - Generalized pustular psoriasis
• L40.2 - Acrodermatitis continua
• L40.3 - Pustulosis palmaris et plantaris
• L40.4 - Guttate psoriasis
• L40.8 - Other psoriasis (including palmoplantar psoriasis)

Coding Considerations for Apremilast Coverage

Severity Documentation

When coding for apremilast coverage, it's important to document disease severity as the medication is indicated for moderate-to-severe psoriasis 1, 2. The American Academy of Dermatology guidelines specify that apremilast is appropriate for:

• Moderate-to-severe plaque psoriasis (BSA >3% or PASI score indicating moderate-to-severe disease)
• Patients with psoriatic arthritis with skin involvement

Special Anatomical Sites

For difficult-to-treat areas, additional codes may help support medical necessity:

• L40.8 - For palmoplantar psoriasis 3
• L40.0 with additional specification for scalp or nail involvement

Psoriatic Arthritis Considerations

When prescribing apremilast for patients with both skin and joint involvement, coding both conditions is essential:

• Primary code from L40.50-L40.59 series for the arthritis component
• Secondary code L40.0 for the skin manifestation

Coding Pitfalls to Avoid

1. Using general psoriasis code only: Always specify the type and location of psoriasis
2. Failing to document severity: Apremilast is indicated for moderate-to-severe disease 4
3. Missing comorbid conditions: Document relevant comorbidities that may influence treatment selection
4. Not updating codes when disease pattern changes: If psoriasis evolves from one form to another, update coding accordingly

Documentation Requirements for Coverage

For optimal coverage approval, ensure documentation includes:

• Disease severity metrics (BSA affected, PASI score if available)
• Previous treatments tried and reasons for discontinuation
• Specific anatomical areas affected, especially difficult-to-treat locations
• Impact on quality of life
• Presence of psoriatic arthritis if applicable 1

The American College of Rheumatology and National Psoriasis Foundation guidelines support the use of apremilast in patients with psoriatic arthritis who have intolerable side effects with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) 1, which should be documented when applicable.

Remember that appropriate ICD-10 coding is essential for ensuring coverage of apremilast, as it is specifically approved for moderate-to-severe plaque psoriasis and active psoriatic arthritis 2.