Summary & Overview
CPT 3476F: Prognosis Assessment for Rheumatoid Arthritis, Good
CPT code 3476F represents a clinician-documented assessment of disease prognosis for patients with rheumatoid arthritis, specifically indicating a good prognosis. This code conveys clinical judgment about the expected future course of disease activity and is used to categorize patients whose disease is anticipated to be less severe and less persistent. Nationally, prognosis codes like 3476F inform quality measurement, risk stratification, and care planning across outpatient rheumatology practices.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical meaning, typical service setting, and the types of benchmarks and policy considerations commonly associated with prognostic performance measures. The publication covers how 3476F is used in documentation and reporting, its relevance for quality programs and risk adjustment, and related clinical context for rheumatoid arthritis management.
This summary is intended for clinicians, billing professionals, and policy analysts seeking a concise national-level briefing on CPT code 3476F, including implications for coding practice, quality measurement, and administrative reporting. Data not available in the input will be noted in relevant sections.
Billing Code Overview
CPT code 3476F indicates that the provider assesses the disease prognosis — the expected future progression — for a patient with rheumatoid arthritis and documents that the patient has a good prognosis. This code is reported when the clinician determines the disease activity is likely to be less severe and persistent.
Service type: Prognostic assessment / clinical evaluation
Typical site of service: Outpatient clinic or rheumatology office visit
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Clinical & Coding Specifications
Clinical Context
A 52-year-old female with established seropositive rheumatoid arthritis (RA) presents for a routine rheumatology follow-up to assess disease trajectory and long-term prognosis. She reports intermittent morning stiffness lasting 30–60 minutes, improved with current disease-modifying antirheumatic drug (DMARD) therapy, and no recent extra-articular manifestations. The provider reviews prior disease activity scores (e.g., DAS28), recent laboratory markers including C-reactive protein and erythrocyte sedimentation rate, medication adherence, radiographic progression from prior hand and wrist x-rays, comorbid conditions, and response to biologic therapy. After synthesizing clinical data, the provider documents an assessment of prognosis as "good" based on sustained low disease activity, absence of erosive progression, and stable functional status.
Typical clinical workflow:
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Patient checks in for a scheduled outpatient rheumatology visit.
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Medical assistant obtains vitals, pain scores, and recent patient-reported outcome measures.
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Provider reviews chart, recent labs and imaging, medication list, and prior activity scores.
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Focused history and joint examination are performed to determine current disease activity and trajectory.
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Provider integrates objective and subjective data to assess disease prognosis and documents the prognosis as good when criteria for sustained low activity and functional stability are met.
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The assessment is coded and billed using
3476Fwhen the provider documents a good prognosis for rheumatoid arthritis.