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

Billing/Coding

Rheumatology Coding Corner Questions: 2017 End-of-Year Quiz

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1. A 68-year-old new female patient has an appointment to see the rheumatologist in four days. The patient has her medical records sent over from her primary care physician, neurologist and endocrinologist for the rheumatologist to review prior to the visit. Upon receipt, the rheumatologist spends 55 minutes reviewing the records and making notes. Can…

CMS Finalizes Changes in CY 2018 for Musculoskeletal Ultrasound

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We previously alerted you to a CMS-proposed change that would cut reimbursement for the complete diagnostic musculoskeletal ultrasound (MSUS) significantly. We are pleased to report that, in its final rule, the CMS reversed that decision, and providers will see a reasonable reimbursement for the exam. The ACR advocated on your behalf for this change through…

ACR Works to Eliminate Part B Drug Costs from MIPS Payment Adjustments

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The ACR is taking steps to clarify a proposed rule from the Centers for Medicare and Medicaid Services (CMS) that, as currently written, would consider the cost of Part B drugs when calculating physician reimbursement under the Merit-Based Incentive Payment System (MIPS). “The ACR is concerned about this, because large cuts to reimbursement for pass-through…

Rheumatology Coding Corner Answer: Prolonged Service without Direct Patient Contact, Part 2

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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

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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…

Tips to Manage, Prevent Medical Billing Claim Denials

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Physicians are increasingly fighting multiple forces in running a practice, and one of the most common barriers to effective revenue cycle management is frequent medical billing and claim denials. An insurance company’s denial for services places a significant strain on the financial process of the practice, which affects the bottom line. According to the Medical…

Rheumatology Coding Corner Answer: New Patient Prolonged Service Without Direct Patient Contact, Part 1

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Take the Challenge. ICD-10 Codes R76.1—Raised antibody titer L20.8—Other atopic dermatitis R20.2—Paresthesia of skin R20.1—Hypoesthesia of skin CPT Codes 99358 and 99359 Rationale The Centers for Medicare & Medicaid Services (CMS) typically does not allow separate payment for physician services that do not require face-to-face time with a patient, but as of Jan. 1, 2017,…

ACR Opposes UnitedHealthCare’s Move to End Consultation Reimbursement

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Effective for claims with dates of service on or after Oct. 1, 2017, UnitedHealthCare (UHC) plans to no longer reimburse consultation services represented by CPT codes 99241–99245 and 99251–99255. In lieu of a consultation services procedure code, UHC says it will “reimburse the appropriate evaluation and management (E/M) procedure code which describes the office visit,…