# Primary Raynaud's?



## ohn0disaster (Jan 10, 2011)

I have a patient with Raynaud's phenomenon. I see that the code for secondary Raynaud's is 443.0. 

I'm an extremely curious person and, when a DX arises that I'm unfamiliar with, I sometimes will take the time to learn some information about it. While looking up Raynaud's, I noticed that, while there is available information on SECONDARY Raynaud's, there is really no information on Primary Raynaud's disease. Also, I could not find a code for Primary Raynaud's. What little information that I found was on Wikipedia. 

A direct quote from the wikipedia page states, "Raynaud's disease, or "Primary Raynaud's", is diagnosed if the symptoms are idiopathic, that is, if they occur by themselves and not in association with other diseases."

Well, my doc has the DX written as "Idiopathic Raynaud's Phenomenon". This would mean that the 443.0 code doesn't fit this patient's situation. I cannot find the code for primary. Maybe I am missing something? I'd appreciate any information you all can come up with pertaining to this diagnosis. 

Thanks in advance!


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## preserene (Jan 10, 2011)

Hi you have brought forth all the valiant points. I do not come up with some thing new. Yet I come up with seconding your openion. 

Raynaud's disease (also known as "Primary Raynaud's phenomenon".
Raynaud's syndrome (secondary Raynaud's)
What ever the etiology , the ICD- 9 tabular assigns the same code 443.0 for both with name specific.
If it does not appropriate/ or if you are not satisfied with 443.1 ( I feel it is ok and it is more reasonable to go with our ICD-9 categorization), the next one you can think of is  443.9 because it depicts the exact effect that happens in primary phenomenon namely the peripheral vascular disease NOS or even more closer description of spasm ( vasoconstriction) of the artery 443.9 again. But it only a manifestation code, in the event of absent diagnosis code.
Primary Raynaud's or Raynaud's disease:
In medical terms, "primary Raynaud's" may also be called Raynaud's disease or idiopathic Raynaud's. The terms *idiopathic and primary* here, both mean that the cause is unknown. Most people who have Raynaud's have the primary form (the milder version). A person who has primary Raynaud's has no underlying disease or associated medical problems. More women than men are affected, and approximately 75 percent of all cases are diagnosed in women who are between 15 and 40 years old.
People who have only vasospastic attacks for several years, without involvement of other body systems or organs, rarely have or will develop a secondary disease (that is, a connective tissue disorder such as scleroderma) later. Several researchers who studied people who appeared to have primary Raynaud's over long periods of time found that less than 9 percent of these people developed a secondary disease.
Cold or emotional stress are factors said to bring  forth the manifestations of the disease.
Thank you.


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## ohn0disaster (Jan 10, 2011)

*thanks*



preserene said:


> Hi you have brought forth all the valiant points. I do not come up with some thing new. Yet I come up with seconding your openion.
> 
> Raynaud's disease (also known as "Primary Raynaud's phenomenon".
> Raynaud's syndrome (secondary Raynaud's)
> ...



I don't know why it didn't occur to me to look at the unspecified peripheral vascular disease code, 443.9, but I hadn't even thought of that. So after a bit more digging for information, I definitely agree with what you're saying and where you're going with what you're saying. I am wondering now,though, since we know that it is Idiopathic Raynaud's Phenomenon, can we not assign code 443.89 for other specified PVD? That would be the most specific code we could assign?


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## preserene (Jan 10, 2011)

Just because the ICd-9 categorized both  with  the same code, we are obligated with the terminology and the specific name for the diagnosis. And all Raynauds primary phenomenon not necessarily and invariably present with the manifestations all the time ,and some may escape, and are episodic (as and when influencing factors appear). So logically, when  it presents with specific manifestations of spasm of the vessel, why can't it  be reported along with the its terminology code. Don't you think so? (The actual pathology being vasoconstriction /Vaso spasm. But as per our ICD-9, 443.9 is for unspecified  mostly, though , for spasm of the artery. You can tryand see how it works with the payers!!! Honestly, I have no experience of having encounters with the payers.

Yes, you know, we can analyse for argument sake, but the realty is we have to go with our manual which is the coding  authority. You know we get stuck with many such situations. I am  perplexed with my gray area itself!
Thank you


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