Medicare’s Merit-Based Incentive Payment System (MIPS) has been on a gradual incline toward requiring full participation by eligible providers. During its transition stage, reporting for the first year (2017) allowed providers the option to report as partial, full, minimum or not at all, with varying degrees of penalties and incentives across all three reporting components:…
Rheumatology Coding Corner Answer: Evaluation for Possible Systemic Lupus Erythematosus
Take the challenge. CPT codes: 99245/99205 ICD-10: M79.1, R21, R53.83, L65.9, K13.79, R00.0 This visit can be billed out as a 99245 only if the insurance carrier allows the billing of consultation codes. If the carrier does not allow consult codes, then this visit must be billed as a new patient visit. Because many outpatient…
Rheumatology Coding Corner Question: Evaluation for Possible Systemic Lupus Erythematosus
History A 25-year-old female patient is seen in the office after her primary care physician requested a consultation for a possible diagnosis of systemic lupus erythematosus (SLE). The patient presents today with muscle pain in both legs, she rates the pain at an 8 on a scale of 10. She states she experiences throbbing, usually…
Rheumatology Future Physician–Scientist Award Available for MD/PhD Students
The Rheumatology Research Foundation is now offering the Rheumatology Future Physician-Scientist Award to enhance the training of promising MD/PhD or DO/PhD students who intend to become physician-scientists. As part of the Foundation’s work to recruit and train the next generation of rheumatology professionals, the award supports the nation’s top emerging physician-scientists. S. Louis Bridges Jr., MD,…
ACR Monitoring Saline Supply Shortage Due to Hurricanes in Puerto Rico
The ACR is aware of the shortage of intravenous saline solutions produced in Puerto Rico that is beginning to emerge across the U.S. and in rheumatology practices. In September, Hurricanes Irma and Maria wreaked havoc on the island, wiping out the island’s power grid and greatly hindering saline solution production. Puerto Rico produces about 10%…
AMA Workshop Focuses on Alternative Payment Models
On Oct. 4 in Chicago, the AMA hosted its second workshop on alternative payment models (APMs). The conference room was packed with providers and staff from specialty societies ready to listen to a whole day’s worth of APM presentations from professionals in the field. To kick off the meeting, AMA President-Elect Barbara McAneny, MD, welcomed…
Final Quarter for 2017 MIPS Reimbursement Has Begun
The final stage of reporting for the Merit-Based Incentive Payment System (MIPS) began Oct. 2, 2017, if you chose the option to report for 90 consecutive days. The MIPS transition year began Jan. 1, 2017, and runs until Dec. 31, 2017. If you subscribed to the Centers for Medicare & Medicaid Services’ (CMS) email, you…
Advocacy in the Social Media Era
Advocacy efforts in the medical profession are evolving as technology evolves. The rise of social media, in particular, has brought about great change in the way organizations, such as the ACR, interact with Congress. At the 2017 ACR/ARHP Annual Meeting, Nov. 3–8 in San Diego, former Sen. Tim Hutchinson (R-Ark.) will discuss how to continue…
Rheumatology Coding Corner Answer: Prolonged Service without Direct Patient Contact, Part 2
Take the challenge. CPT codes 99358—prolonged evaluation and management (E/M) service before and/or after patient care; first hour 99359—each additional 30 minutes (list separately in addition to codes for prolonged service) Coding Rationale No—This scenario would not support the medical necessity to bill the prolonged service code(s). Keep in mind, the time that the supporting…
Rheumatology Coding Corner Question: Prolonged Service without Direct Patient Contact, Part 2
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…
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