Effective May 22, 2017 Noridian has updated the Local Coverage Determination (LCD) coding guidelines for CPT procedures 20552, injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) and 20553, injection(s); single or multiple trigger point(s), 3 or more used to affect therapy for a pathological condition. Noridian states the goal of the updated diagnostic…
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Improved Diagnosis of Greater Trochanteric Pain Syndrome
New research evaluated the diagnostic accuracy of 10 clinical tests of hip pathology typically used to diagnosis greater trochanteric pain syndrome (GTPS). However, pain provocation tests, such as the FABER test, proved most useful for ruling out the condition rather than diagnosing it…
Ultrasound for Underserved Patients
Beverly Johnson, MD, has experienced exactly how rheumatologists and their patients benefit from musculoskeletal ultrasound imaging for the diagnosis and treatment of autoimmune disease…
Rheumatology Coding Corner Question: Joint Injection with Ultrasound Guidance, No Office Visit
A 66-year-old male patient presents to the office with right knee pain. He was in the office two weeks prior for a follow-up visit of his primary osteoarthritis. He received an injection of hyaluronate sodium in his right knee four months before and states that his knee felt like new. He states that everything was…
Lateral Hip Pain: Could It Be Gluteal Tendinopathy?
Researchers recently found that physical tests that involve an active muscle contraction were most useful in identifying gluteal tendinopathy in patients with lateral hip pain. However, patients who were not palpably tender over the greater trochanter were unlikely to have GT detected during an MRI…
Chronic Reactive Arthritis Secondary to Intravesical Bacillus Calmette–Guerin in Bladder Carcinoma
A 50-year-old man with history of superficial bladder carcinoma presented to our rheumatology clinic for a three-year history of symmetric polyarthralgias. He had undergone multiple transurethral resection of bladder tumor procedures and bacillus Calmette–Guerin (BCG) treatments. Prior to receiving BCG, he was fully functional and employed. Days after receiving his second BCG treatment, he developed…
3 Cases of Glomus Tumor—An Unusual Cause of Hand Pain
Hand and digit pain are common presenting symptoms to primary care physicians, rheumatologists, physiatrists and neurologists. There are many causes, but quality and location of the pain can be important clues to the diagnosis. Glomus tumors, neurovascular hamartomas of the glomus body, are an uncommon cause of hand pain. The glomus unit itself is a…
What Listening to Lungs Might Teach About Rheumatic Disease
One of your first clinical assignments as a medical student was likely to have been the lung exam. Its key descriptors may still resonate in your mind: inspection, palpation, percussion and auscultation. Proudly parading down the hospital corridors, your newly purchased stethoscope snugly tucked inside your lab coat pocket, you carefully place its cold metal…
Case Report: Sternoclavicular Erosions in a Patient with Uncontrolled RA
Sternoclavicular joint involvement has rarely been reported in the context of active rheumatoid arthritis (RA).1 Traditionally, rheumatologists use serial radiographs of hands and feet to diagnose, monitor for progression or evaluate the response to treatment. The sternoclavicular (SC) joint is not a typical joint assessed for RA. However, the fact that it is a diarthrodial…
Rheumatology Coding Corner Question: Coding for Post-Traumatic Osteoarthritis
Post-Traumatic OA A 70-year-old female patient comes in for a follow-up visit for pain and stiffness in her left hip. She injured her hip in a skiing accident three years before and reports the X-rays at that time showed no fractures. Due to no obvious fracture at the time, she was given ibuprofen and advised…