Take the challenge. CPT: 99214-25, 96413, 96415 x 1, J1745 x 35 ICD-10: M07.68, K51.80 Billing Overview It is appropriate to bill for an E/M visit for this day of service along with the infusion procedure. Modifier 25 should be appended to the E/M, indicating that the patient received a significant, separately identifiable E/M service…
Rheumatology Coding Corner Question: Physical Examination with Infliximab Infusion
A 12-year-old male established patient with inflammatory bowel disease with associated juvenile spondyloarthropathy returns to the office for a follow-up visit for his infliximab infusion. The patient reports moderate pain in his right hip after walking for extended periods of time or after sports activities. He denies any other joint pain and denies any joint…
Medicare Sets Standards for Overpayments Received by Physicians, Healthcare Providers
In February 2016, the Centers for Medicare & Medicaid Services (CMS) published the final rule on Medicare Reporting and Returning of Self-Identified Overpayments. This final rule from CMS has now established official policy for timely reporting and returning of Medicare overpayments received by healthcare providers, with a goal to provide clear requirements for reporting and…
Rheumatology Fellow Faces Dilemma over Choice to Specialize or Generalize
Half a century ago, Konrad Lorenz, the pioneering animal behavior expert, wrote that “Philosophers are people who know less and less about more and more, until they know nothing about everything. Scientists are people who know more and more about less and less, until they know everything about nothing.” As I start the last year…
Rheumatology Research Foundation Awards Nearly 85 Education, Training and Research Grants
The Rheumatology Research Foundation recently announced that it has awarded grants to 85 rheumatology trainees and professionals. The recipients, who range from medical students and residents to experienced investigators and rheumatologists, will receive funding for essential education and training, as well as innovative research projects. Their applications, which were submitted last year, were closely examined…
Rheumatology Coding Corner Answer: Office Visit with DEXA Scan
Take the challenge. CPT: 99213-25, 77085 ICD-10: Diagnosis M81.0, Z79.52 The encounter is coded as 9913 as follows: History—The history of the present illness was extended. The review of systems was complete, and the past medical history was documented. This makes the history detailed. Examination—The examination was expanded problem focused. Medical decision making—The diagnosis was…
Avoid the Trap of Balance Billing
It is no secret that payers and providers have conflict as it relates to reimbursement rates for medical services, and there is another stakeholder, the patient, that plays an important role in the financial impact of healthcare reimbursement. Usually, patients are faced with unforeseen bills from their providers due to an unpaid portion of a…
Rheumatology Coding Corner Question: Office Visit with DEXA Scan
A 67-year-old female patient with Medicare returns to the office for a follow-up of her age-related osteoporosis. She states she has an achy pain in her left hip that lasts for 30–40 minutes in the morning. Currently, she has taken ibandronate sodium and alendronate sodium for the past year, and her pain level is a…
How Rheumatologists Can Engage Congress Locally, Advance Rheumatology
With limited time to spend away from your practice, you can still have an impact on issues important to Advancing Rheumatology! Below are several ways to have your voice heard, without ever leaving town. Set Up a Local Meeting with Your Elected Officials Every member of Congress has at least one local office in the…
Rheumatology Research Foundation Ranked in Top 2% of Charities by Charity Navigator
The Rheumatology Research Foundation recently received its seventh consecutive four-star rating from Charity Navigator. This prestigious, highest rating possible is based on good governance, sound fiscal management and commitment to accountability and transparency. As the nonprofit sector continues to grow at an unprecedented pace, savvy donors are demanding more accountability, transparency and quantifiable results from…
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