Take the challenge. CPT codes: 99203/99243 ICD-10: M25.521, M25.522, M25.561, M25.562 History—Comprehensive: The history of present illness is extended, the review of systems is complete, and the past medical, family and social history are documented. All three of the HPI, ROS and PFSH are needed to achieve the history level as comprehensive. Examination—Detailed: This level…
Coding Corner Question: Coding Scenario for 1997 Musculoskeletal Exam
A 55-year-old female patient with pain in multiple joints is referred to the office by her primary care physician. She complains of pain in both knees and both shoulders. She rates the pain at 7 on the pain scale. Her pain is worse at night after she gets off work. Soaking in her hot tub…
Bone Mineral Density Most Important Determinant of Fracture Risk
NEW YORK (Reuters Health)—In what is believed to be the largest study investigating genetic and clinical determinants of osteoporotic fracture risk, only a genetic predisposition to low bone mineral density (BMD) had a potential causal role to play. “Notably, genetic predisposition to lower levels of vitamin D and estimated calcium intake from dairy sources were…
Osteoporosis Drugs Tied to Lower Fracture Risk & Health Costs
(Reuters Health)—Older women with osteoporosis who consistently take a bisphosphonate may have a lower risk of fractures and lower total health costs than their counterparts who stop taking these drugs, a U.S. study suggests. Researchers examined data on 294,369 women who were at least 66 years old, insured by Medicare and prescribed osteoporosis medicines for…
Pfizer-Lilly Pain Drug Meets Late-Stage Trial Goals
(Reuters)—An experimental osteoarthritis drug developed by Pfizer Inc and Eli Lilly and Co achieved its main goal of lowering pain in a late stage trial, the companies said on Wednesday, potentially offering a safer alternative to opioids. Opioid abuse has reached epidemic proportions in the United States and drugmakers have been looking for less addictive…

Don’t Rule Out Placebos for Osteoarthritis Pain Control
CHICAGO—The placebo effect in treating pain in osteoarthritis (OA) should not be discounted, an expert said at the ACR State-of-the-Art Clinical Symposium in April. It’s especially important to accept the effect as real considering that trials of pain therapies in OA generate such high placebo effects (typically at least 40%) and that OA treatment options,…

Improve Your Recognition & Treatment of Osteoporosis
BALTIMORE—Rheumatologists may not think about osteoporosis on a daily basis, but they should, said Dr. Karl Insogna, the Ensign Professor of Medicine at Yale University School of Medicine and director of the Yale Bone Center in New Haven, Conn., in his recent lecture at the Maryland Society for the Rheumatic Diseases. With approximately 75 million…

Tips to Get Knee Replacement Patients to Increase Their Physical Activity
Although total knee replacement (TKR) surgery can improve pain and function in individuals with knee osteoarthritis (OA), many patients who are sedentary before undergoing TKR don’t increase their physical activity levels after surgery. A new study led by Elena Losina, PhD, of the Department of Orthopaedic Surgery at Brigham and Women’s Hospital in Boston, examined…
Serum Bone Markers CTX, PINP Not Linked with Hip Fracture Risk in Osteoporosis
NEW YORK (Reuters Health)—Levels of two bone markers currently recommended for evaluating postmenopausal women with osteoporosis have no association with hip fracture risk, according to a new study using Women’s Health Initiative data. “At least in these postmenopausal women, it was not a useful endeavor to check bone turnover markers to predict hip-fracture risk. That…
Romosozumab Improves Bone Mineral Density in Men with Osteoporosis
NEW YORK (Reuters Health)—Romosozumab improves bone mineral density (BMD) in men with osteoporosis, but safety concerns are holding up its approval in the U.S. Up to 2 million men in the U.S. have osteoporosis, and up to 13 million have osteopenia, researchers note in a report online June 20 in The Journal of Clinical Endocrinology…
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