Exclusive: ACR Convergence 2024| Focus Rheums

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Billing/Coding

Rheumatology Coding Corner Answer: Proper Coding for Post-Traumatic Osteoarthritis

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CPT: 99213, 73500-RT, 73500-LT ICD-10: M16.52 This E/M service entailed: The history is detailed; The examination is expanded problem focused; and The medical decision making is of low complexity. The X-ray reviewed was for radiologic examination, hip, unilateral: one view for the left hip and for the right hip. M16.52—The diagnosis identifies unilateral post-traumatic osteoarthritis…

Use of Unspecified Codes in ICD-10: What You Need to Know

From the College  |  

The ACR Practice Management and Coding department will periodically update the membership on the new ICD-10 coding guidelines and conventions to assist practices with accurate billing. Our top question during the first week of ICD-10 implementation was on the use of unspecified codes…

Rheumatology Coding Corner Answer: Coding for a Knee Injection

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Take the challenge. CPT: 20611-LT, J7325 X 1 ICD-9: 715.16—Osteoarthritis, localized, primary, lower leg ICD-10: M17.12—Unilateral pri- mary osteoarthritis, left knee Note: When billing for 20611—Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa), with permanent recording and reporting, there must be a permanent photograph of the needle placement in…

Rheumatology Coding Corner Question: Coding for a Knee Injection

From the College  |  

Coding for a Knee Injection A 68-year-old female patient with primary osteoarthritis of the left knee returns to the office for her scheduled hyaluronan injection. The patient reports that her knee is a little tender, but on a scale of 1–10, it is a 4. She is stiff in the morning for 10–20 minutes. The…

Documentation: A Key Factor of Risk Adjustment

From the College  |  

In an age of constant change and regulations, one thing remains the same in coding and billing: If it’s not documented, it wasn’t done. This is the main rule for documentation. Good documentation is and always has been the foundation of accurately capturing a provider’s work and the patient’s condition, management and treatment. Introduced by…

Moving to ICD-10 Has Promises, Challenges

Will Boggs, MD  |  

NEW YORK (Reuters Health)—While the new International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes offer greater diagnostic precision, their implementation will require training of clinicians, coders, and other staff to minimize payment denials or delays from both public and private payers. Brian Outland and colleagues from the American College of Physicians in Washington,…

Preparing for the Transition to ICD-10

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The transition to ICD-10 is not just another yearly diagnosis codes update; it is a complete overhaul. This not only will affect providers, but also all payers, vendors and stakeholders are being affected by the expanded ICD-10 code sets through medical coding operations, software systems, reporting, administration, registration and more. With approximately 20 days before…

One-Year Transition Period May Ease the Pain of ICD-10

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As the Oct. 1 deadline to transition to ICD-10 approaches, the CMS has released multiple resources, including a joint guidance statement with the AMA that details one year of claims leniency to help physicians adjust to the new coding system and smooth the transition process…

Rheumatology Coding Corner Answer: Office Visit for Chronic Idiopathic Gout

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CPT code: 99214 Diagnosis: ICD-9 274.02 **ICD-10: M1A.0720 History—The history of present illness was extended. The review of systems was extended (six systems were reviewed), and two of the three elements for past family social history were documented. This makes the history level detailed. Examination—Three systems were examined. This makes the exam expanded problem focused….