To improve access to quality of care for patients with osteoarthritis and other musculoskeletal pain, the U.S. Department of Veterans Affairs (VA) launched a continuing education program designed to strengthen the musculoskeletal knowledge and skills of primary care providers (PCPs). In the program’s initial trial in 2012, 19 physicians were trained on exams, treatments and joint injections. Two years after course completion, some participants increased the number of intraarticular corticosteroid injections at their clinics without needing to refer patients to specialists…
Search results for: osteoporosis
Rheumatology Coding Corner Questions: ICD-10 Coding Guidelines, Conventions Refresher Quiz Part 1
What is the ICD-10 guideline to code for osteoporosis without a current pathological fracture? There is no rule. Code for the osteoporosis, and code for the pathological fracture. Code for the osteoporosis from the M81._ category, and code for the history of a pathological fracture. None of the above is correct. How many characters are…
Rheumatology Coding Corner Answers: ICD-10 Coding Guidelines, Conventions Refresher Quiz Part 1
Take the challenge. C—The guideline for coding from category M81._ is that an additional code is needed if the physician has knowledge that the patent had a past pathological fracture. The code for personal history of (healed) pathological fracture is Z87.310. B—Osteoporosis with a current pathologic fracture is one of the few ICD-10 codes that…
Rheumatology Coding Corner Answer: Coding for Acute Flare of Idiopathic Gout
Take the challenge. M10.072—Acute gout has an Excludes 1 note of chronic gout (M1A.-). This means that acute gout and chronic gout cannot be coded for the same encounter, as the codes are mutually exclusive. M45.6—The patient is diagnosed with ankylosing spondylitis of the lumbar region. M81.8—Other osteoporosis without current pathological fracture. M79.622—The patient has…
Rheumatology Coding Corner Question: Coding for Acute Flare of Idiopathic Gout
It has been two months since the implementation of ICD-10, so everyone has gotten a feel for the new code set. Let’s see how well you are doing in your diagnosis coding for rheumatology-specific conditions. A 55-year-old female patient presents for a follow-up visit of idiopathic chronic gout of multiple joints without tophi. She complains…
Understanding the Z Codes in ICD-10
Two months into the transition, the ICD-10 code set is still not exactly the most enticing reading material. But there is still so much to learn and apply, that it is necessary for physicians, coders and billers to stay abreast of the coding and billing guidelines. Although all of the guidelines and conventions may be…
Rheumatologists on the Move, November 2015
Nancy Baker, ScD, Completes Sabbatical Year at CDC Nancy Baker, ScD, MPH, OTR/L, associate professor in the Department of Occupational Therapy at the University of Pittsburgh, recently completed a yearlong sabbatical as a researcher at the Centers for Disease Control & Prevention (CDC), Division of Population Health. Her mentor at the CDC, Kristina Theis, MPH,…
When Sense Disorders Signal Immune System Interactions
I sometimes find myself mired in sticky clinical circumstances. I am facing a distraught patient who is seeking my opinion about a condition that, according to some, may not truly belong in the rheumatologist’s bailiwick. Case example: hearing loss. The Steroid Test Sudden sensorineural hearing loss (SSNHL) and its relative, autoimmune inner ear disease (AIED),…
Improve RA Care with Vitamin D
Background Autoimmune diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematous, occur when the body attacks its own tissue because it cannot differentiate between self and non-self. This is mainly through deregulation of the immune system. Vitamin D has been known to play a critical role in bone mineralization and bone health. Activated vitamin…
Fellows’ Forum Case Report: Palmar Fasciitis & Polyarthritis Syndrome
Case report: A 78-year-old Caucasian female presented to our outpatient rheumatology clinic with pain in her bilateral shoulders, hands and knees that began suddenly one month earlier. She admitted to stiffness in her hands lasting several hours, and expressed an inability to extend her fingers. She denied fever, rashes, jaw claudication, headache or visual changes….
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