Exclusive: ACR Convergence 2024| Focus Rheums

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Rheumatology Coding Corner Question: Prolonged Service without Direct Patient Contact, Part 2

  |  Issue: October 2017  |  

An established, 66-year-old male patient is seen in the office for a follow-up visit for his fibromyalgia. The physician makes the decision to prescribe venlafaxine for anxiety and depression, and gabapentin for nerve pain. After the visit, the physician informs his medical assistant (MA) to contact the patient’s insurance carrier because venlafaxine requires a prior authorization. The MA spends 32 minutes on the phone with the pharmacy benefit manager for approval. At the end of the day, the physician reviews the MA’s notes for an update and spends 30 minutes dictating the visit for the patient’s chart.

Does this scenario qualify for billing of a prolonged service without direct face-to-face contact?

ADVERTISEMENT
SCROLL TO CONTINUE

Click here for the answer.

Related Articles

    Revising Fibromyalgia: One Year Later

    The 2010 ACR fibromyalgia criteria capture the broader clinical picture and help ensure more appropriate diagnosis and management by primary care

    Is Fibromyalgia Overdiagnosed?

    Are too many patients diagnosed with fibromyalgia? The co-authors of one new study believe that close to 75% of patients who have received a clinical fibromyalgia diagnosis do not meet the 2010 Preliminary American College of Rheumatology (ACR) Criteria for Fibromyalgia.1 They say these patients are false-positive and may be taking treatments they don’t need….

    Rheumatology Coding Corner Answer: New Patient Prolonged Service Without Direct Patient Contact, Part 1

    Take the Challenge. ICD-10 Codes R76.1—Raised antibody titer L20.8—Other atopic dermatitis R20.2—Paresthesia of skin R20.1—Hypoesthesia of skin CPT Codes 99358 and 99359 ad goes here:advert-1ADVERTISEMENTSCROLL TO CONTINUERationale The Centers for Medicare & Medicaid Services (CMS) typically does not allow separate payment for physician services that do not require face-to-face time with a patient, but as…

    Diagnosing & Caring for Patients with Fibromyalgia

    Doebl et al. compared the effect of symptoms and the healthcare use of people with fibromyalgia with those who fulfilled the criteria for fibromyalgia but had not been diagnosed and those with chronic pain. They found patients diagnosed with fibromyalgia reported the poorest healthcare experiences and were more likely than other study participants to be unemployed due to health issues. Their findings reveal an urgent need exists for a model of care for patients with fibromyalgia.