Coding Corner Answer

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Answer: 99213-25, 96413, J0129 x 75 G8490, G8499

Diagnosis: 714.0

The E/M services related to the patient’s knee pain included:

• Expanded problem-focused history;
• Expanded problem-focused exam; and
• Low-complexity decision making—established problem, worsening, lab and X-ray ordered, and one or more chronic illness with mild exacerbation.

G8490—When reporting PQRI through claims using the RA measure group, the first patient’s claim must have this code to alert Medicare that the physician is reporting PQRI as a measure group and not individual measure reporting.

G8499—Was used in place of the following six codes because all six measures are reported on this visit. Medicare has developed a code to encompass all of the codes.

The following individual codes must be part of your report to use the CPT II code G8499:

• 4187F—This is measure 108: Rheumatoid Arthritis: Disease-modifying antirheumatic drug therapy in rheumatoid arthritis.
• 4196F—This is measure 176: Rheumatoid Arthritis: Tuberculosis screening.
• 3471F—This is measure 177: Rheumatoid Arthritis: Periodic assessment of disease activity.
• 1170F—This is measure 178: Rheumatoid Arthritis: Functional status assessment. An 8P modifier was attached to this measure because the functional status was not assessed on this visit. It is permissible to report the measure even if the task is not performed if you use the appropriate modifier. The patient’s encounter fit the criteria as far as the diagnosis and the CPT code needed for this PQRI measure.
• 3476F—This is measure 179: Rheumatoid Arthritis: Assessment and classification of disease prognosis. An 8P was also attached to this measure because the assessment was not performed at this encounter.
• 4192F—This is measure 180: Rheumatoid Arthritis: Glucocorticoid management.