Electronic health records enable researchers to access significant amounts of patient data, but identifying subjects with a specific condition can be difficult. In a recent study, researchers successfully designed three algorithms to identify patients with SLE, incorporating multiple counts of the ICD-9 code, laboratory testing, medication data and keywords. In the future, these algorithms may successfully transfer to other systems to aid research…
Rheumatology Coding Corner Question: Billing Infusion Procedure with JW Modifier
An 82-year-old female established patient diagnosed with ankylosing spondylitis in multiple joints returns to the office for her second infliximab infusion. She denies any fevers, cough or concurrent illness. Her joint pain is 7 on a scale of 1–10. She complains of achy pain in the cervical, lumbar and sacral regions of her spine. She…
Rheumatology Coding Corner Answer: Billing Infusion Procedure with JW Modifier
Take the challenge. CPT: 99214-25, 96413, 96375, 96361-59, J1745 x 4 J1745 JW* x 36, J1200 x1 ICD-10: M45.09, T50.995A, R06.02, E66.3, Z68.2 Rationale Modifier 25 is appropriate to use because it indicates the patient received a significant, separately identifiable E/M service on the same day as the infliximab infusion. This E/M service entailed the…
ACR Advocates for Regulatory Relief and Flexibility for MACRA
The American College of Rheumatology (ACR) continues to provide feedback to the Centers for Medicare & Medicaid Services (CMS) about the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 on behalf of rheumatologists. The bipartisan bill repealed the Sustainable Growth Rate and transitioned Medicare from fee for service to a system…
Straightforward Approach Can Help Rheumatology Health Professionals Engage with Fibromyalgia Patients
“I have pain all over my body” is a challenging response after you’ve asked a new patient what brings them in for their visit. You immediately suspect that this patient has fibromyalgia. The prevalence of fibromyalgia in the U.S. is 5 million people, and it is among the most common conditions in many rheumatology practices….
How to Bill Medicare Patients for Non-Covered Services
What do you do when you are presented with a patient who needs treatment but the patient’s insurance company will not pay for the services? Can you provide the services anyway? Who will pay for them? How do you collect payment for such services? If the patient consents to receive the services in spite of…
Use Time Component When Coding Counseling, Coordination of Care Visits
Although there are seven components for the levels of evaluation and management (E/M) services, most encounter levels are coded on the basis of the history, examination and medical decision making (MDM), which are the key components extracted from documentation in the medical record. However, when counseling and coordination of care for a patient are the…
The ACR Advocates for More MIPS Points for RISE Use
On behalf of the rheumatology community, the ACR recently submitted an entry for a rheumatology-specific Clinical Practice Improvement Activity (CPIA) that, if accepted, will be included in the 2018 performance year. The CMS put a call out to the public for CPIAs in an attempt to make MACRA more meaningful for participating providers. The ACR…
CORC: The Uncomfortable Move from Fee for Service to Value
ACR members are spread out across the U.S., but we all work in the same place: the land of fee for service. FFS, as it’s known to policy nerds, poses certain problems for cognitive subspecialists like rheumatologists. For instance, much of the work we do—calling providers and patients, coordinating care after hours—often isn’t compensated. And…
Insurance Subcommittee Responds to Health Plan Complaints
The ACR Insurance Subcommittee (ISC) regularly engages with insurance companies to discuss concerns raised by ACR members and advocate for appropriate coverage and payment policies. The ISC has gotten off to a busy start in 2017, working on a variety of patient access and reimbursement issues. Two recent issues the ISC has taken action on…
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