Take the challenge. Answer: No, if billed as incident-to for the NP. Note: The patient’s current insurance carrier is Blue Cross Blue Shield of Massachusetts (BCBS of MA). Under BCBS of MA, nurse practitioners and nurse practitioner primary care providers are not allowed to perform or interpret radiology services. Therefore, the physician would have to…
Coding Corner Question: Is This Shoulder Ultrasound Billable?
A 32-year-old male patient with rheumatoid arthritis affecting multiple joints without rheumatoid factor returns to the office for a follow-up visit with the nurse practitioner (NP). The patient states his overall pain has improved since his previous visit, although he rates the severity of his right shoulder and right wrist pain at a 5 on…
The Association of Rheumatology Professionals Names Grant Recipients
It is with great pleasure that the ARP congratulates the 2019 recipients of the Mentored Nurse Practitioner/Physician Assistant Award for Workforce Expansion. The purpose of the NP/PA Award is to increase the supply of rheumatology healthcare providers to better meet the needs of people with rheumatic diseases across the U.S., particularly in geographically underserved areas….
Proposed 2020 E/M Codes Include Reimbursement Changes
Increased reimbursement would reflect value of cognitive care and other time-intensive services provided by rheumatologists.
CMS Proposes Major Payment Increases for E/M Services
CMS estimates that under their proposal, released July 29, rheumatologists would see on average a 15% payment increase, beginning in 2021.
Cigna to Eliminate Consultation Codes
Cigna recently announced that they will discontinue payment for consultation codes later this year. As of Oct. 19, 2019, the payer will implement a new policy on Evaluation and Management (R30) that will deny claims billed with CPT codes for consultation services as not valid. Impacted CPT codes are 99241, 99242, 99243, 99244, 99245, 99251,…
Coding Corner Answer: Interprofessional Consultations
Take the challenge. Answer: This is a two-part office visit scenario. The first part of the scenario illustrates the original new patient office visit, and the second portion is for the follow-up, interprofessional telephone consultation with the patient’s ophthalmologist. For the office visit … CPT: 99203 ICD-10: B30.8, M45.5, I73.00 The history was detailed, because…
Coding Corner Question: Interprofessional Consultations
A 68-year-old patient reports that her eyes have been itchy and red for approximately one month. She was treated with erythromycin gel on Jan. 10; while the itching did not stop, the redness resolved. She denies any matting and has not used any other type of eye drops. She states there has been no change…
CMS 2018 MIPS Performance Feedback, Final Score & Targeted Review Now Available
Your 2018 MIPS performance feedback and final score from the CMS are now available on the Quality Payment Program website. To learn more about performance feedback, view the frequently asked questions document from the CMS. The payment adjustment you will receive in 2020 is based on your score for the 2018 performance year. If you…
New Wins, Ongoing Challenges for ACR Insurance Subcommittee
Corrections to reimbursement system errors with Aetna and a Medicare contractor demonstrate the latest wins for all providers by the ACR’s Insurance Subcommittee. But the committee remains hard at work advocating for rheumatologists on several fronts.
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