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Articles by From the College

Rheumatology Coding Corner Question: Follow-Up Knee Injection

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On Nov. 4, a 55-year-old female patient presents to the office for a follow-up visit for injection of the left knee for osteoarthritis. This is her third of three injections that were preauthorized through Oct. 31. She reports pain and swelling in her left knee and rates the pain at an 8 on a 10-point…

5 Steps to Help You Manage Prior Authorizations

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Despite continuous movement to streamline the prior authorization process, physician practices are still struggling with jumping through hoops to have procedures and medications covered. A prior authorization (PA) is the process insurance carriers have in place to approve or reject prescriptions based on plan formulary. The PA process is important in ensuring appropriate and cost-effective…

Rheumatology Research Foundation Welcomes New President, VP

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The Rheumatology Research Foundation has appointed Abby G. Abelson, MD, with the Cleveland Clinic to serve as president. She begins a two-year term alongside the new vice president, S. Louis Bridges Jr., MD, PhD, with the University of Alabama at Birmingham (UAB). Drs. Abelson and Bridges are highly accomplished leaders in the field of rheumatology…

Providers Using RISE Have Advantage with 2017 MIPS Reporting

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Hundreds of rheumatology providers across the country are finalizing submissions for the first year of reporting under the Merit-Based Incentive Payment System (MIPS). According to a presentation at the 2017 ACR/ARHP Annual Meeting in San Diego, providers that participate in and submit through the Rheumatology Informatics System for Effectiveness (RISE) Registry are poised to perform…

CMS Repeals Documentation Guidelines for Teaching Physicians

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As of March 5, physicians no longer have to write their own notes in addition to notes created by students, residents or fellows during patient examinations; instead, providers will only have to verify information documented by the student. Early last month, the Centers for Medicare and Medicaid Services (CMS) reversed the Obama administration policy that prohibited…

Participate in CMS Reporting Study to Receive 2018 Improvement Activity Credit

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The Centers for Medicare & Medicaid Services (CMS) is conducting the 2018 Burdens Associated with Reporting Quality Measures Study, as outlined in the Quality Payment Program Year 2 final rule (CMS 5522- FC). The CMS is conducting this study to: Examine clinical workflows and data-collection methods using different submission systems; Understand the challenges clinicians face when…

Anthem Cancels Planned Modifier 25 Cuts

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Anthem, a Blue Cross Blue Shield company that operates in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, Virginia and Wisconsin, has decided not to move forward with a policy that would have resulted in decreased reimbursement for evaluation and management (E/M) services when billed with modifier 25. As reported…

Tools & Training from the ACR Practice Management Team

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The ACR Practice Management Department actively works to provide valuable, accessible resources addressing practice issues on a local and national level to rheumatologists and their staff. Our trained professionals are devoted to providing the most up-to-date tools and resources to help improve practice efficiency while meeting the myriad compliance obligations of the ever-changing healthcare landscape….

Rheumatology Coding Corner Answer: Bilateral Knee Injections

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Take the challenge. CPT codes: 20611-LT, 20611-RT, J7326x2 or 20611, 20611-50, J7326x2 ICD-10: M17.0 Coding Rationale The CPT code 20611 is for an arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee or subacromial bursa with ultrasound guidance, with permanent recording and reporting). The code is billed twice because this was a…

Rheumatology Coding Corner Question: Bilateral Knee Injections

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A 68-year-old male patient returns to the office for his scheduled bilateral knee injections for primary osteoarthritis. The patient rates the pain in his right knee at an 8 on a scale of 10, and the pain in his left knee at a 7. He was in the office a week before, but the practice…