Maintaining a health revenue cycle in a medical practice comes with myriad moving parts. Numerous external forces, such as economic conditions, government programs (e.g., the Zone Program Integrity Contractor [ZPIC], the Health Information Technology for Economic Clinical Health [HITECH]) and legislation passed under healthcare reform, mandate healthcare organizations to begin managing internal processes, such as…
Take the challenge. B or D—If it was not documented, it was not done is the motto of many coders. For those who follow this motto, the answer would be B. But there is another option for the coder and that is to query the physician about whether the injection was done with ultrasound guidance…
1. A 45-year-old female patient with a diagnosis of primary osteoarthritis returns to the office for her second scheduled injection of sodium hyaluronate (Supartz). The nurse takes the patient’s vitals: weight is 185 lbs., height is 5’2”, and temperature is 98.2°F. The patient is prepped and given the injection. How should this encounter be coded?…
With the wind in her hair and a smile on her face, a young girl flies through the air on the zip line at Camp Wekandu. She waves to her fellow campers on the ground and offers a thumbs up before the ride ends and one of the camp counselors lowers her from the zip…
I attended medical school in the 1960s, when Dr. Lawrence Weed reinvented the medical record to organize and leverage the physician’s patient evaluation for clarity and quality of care—what he dubbed “the problem-oriented medical record.”1,2 My internal medicine house officer training at Massachusetts General placed a high value on efficient, effective medical records and communication…
In our fast-paced world, a great deal can happen in 12 months. Reflecting on this past year and my service as ACR president, I find this has certainly been the case. For the foreseeable future, it appears the factors that influence our ability to effectively care for our patients with rheumatic and musculoskeletal disease will…
“Men work harder than women.” My mother is a pediatrician, and I have two sisters—one is a dermatologist, and one is a real estate attorney. Therefore, I think understandably, this message took me by surprise. Of late, I have been particularly awed by my lawyer-sister, with whom I catch up when she is taking the…
In a rheumatology practice, registered nurses take on multiple roles, from administrative tasks to engaging in patient support and assessment. They can aid rheumatologists and help provide the best care to patients…
On Sept. 12, the ACR and the Sjögren’s Syndrome Foundation presented an ICD-10 code change request for Sjögren’s syndrome to the ICD-10 Coordination and Maintenance Committee (C&M) at the CMS office in Baltimore. The request is intended to clarify ICD-10 M35.0: sicca syndrome [Sjögren]. Why Change the Code? The rationale behind this significant change request…
It is no surprise to practicing physicians that the healthcare landscape is becoming more and more unpredictable. Because of the volatility surrounding today’s healthcare environment, such as increasing overhead costs and decreasing reimbursement rates, many physicians are asking themselves whether there is a different, more lucrative way to practice medicine. Concierge medicine may just be…