When coding evaluation and management (E/M) services provided to a patient, one of the most persistent concerns is whether a patient is new or established to the practice. Although this may seem like a simple coding answer, the distinction is an important one, because it enables providers to appropriately bill and receive reimbursement correctly. E/M…
Take the challenge. CPT codes: 96413, 96415, 96375, Q5103x20, J1200 ICD-10: M07.9 Coding Rationale This procedure is billed with CPT code 96413 for the initial hour of the intravenous infusion and CPT code 96415 for each additional hour. The patient was given 50 mg of diphenhydramine prior to the infusion to prevent reactions and should…
A 68-year-old female patient returns to the office for a second round of Inflectra (infliximab-dyyb) infusion for her rheumatoid arthritis with rheumatoid factor of multiple joints without organ or systems involvement. She reports pain, stiffness and swelling in her left and right knees and right elbow and rates the pain at a 9 on a…
The ACR praises Congressional leaders for passing the sweeping spending agreement, which includes a technical provision reversing a Centers for Medicare & Medicaid Services (CMS) policy that would have linked physicians’ quality payment adjustments to Medicare Part B drug costs starting in 2019. The ACR also applauds the inclusion of provisions that permanently repeal Medicare…
Few opportunities exist for rheumatologists in community-based practice who, in addition to taking care of patients, want to test their own observations through research. Limited funding, time constraints and competition from larger academic medical centers are some of the barriers hindering clinical research in this setting. The Rheumatology Research Foundation is addressing this issue with…
The ACR continues to actively advocate for certification reform and recently testified to the Continuing Board Certification: Vision for the Future Commission. The Commission is leading a collaborative effort to assess the current state of continuing board certification, and to envision a framework that is relevant and meaningful to physicians, patients, hospitals and health systems….
You can now use the updated CMS MIPS Participation Lookup Tool to check on your 2018 eligibility for the Merit-Based Incentive Payment System (MIPS). Enter your National Provider Identifier (NPI) in the tool to find out whether you need to participate during the 2018 performance year. Changes to Low-Volume Threshold To reduce the burden on…
Since the beginning of the year, the ISC has sent eight letters to payers in response to problematic policies. Each letter outlines the ACR’s concerns and requests corrective action…
Take the challenge. CPT codes: 99214, 71045, 86580 ICD-10: M05.79, R05, R06.2 History—Detailed: The history of present illness (HPI) was extended; the review of systems (ROS) was extended; and the past medical, family and social history (PFSH) were documented. All three components of the HPI, ROS and PFSH are needed to achieve the detailed history…
History A 39-year-old woman returns for follow-up for her rheumatoid arthritis. She has positive rheumatoid factor, but no organ or systemic involvement. She has joint swelling and pain in her left hand, right elbow and right knee. Her pain is at an 8 on a 10-point scale. She states the pain is worse in the…