Overcoding is a common term used when discussing fraud and abuse in reporting procedures and services not supported by the actual work performed. Alternatively, undercoding—or failing to report the full extent of services or procedures provided—is an equally unsound practice and a compliance risk. In the world of quality reporting, undercoding can have damaging effects…
WASHINGTON, D.C.—In 2017, rheumatologists will begin to track and report quality data for reimbursement under the the Medicare and CHIP Reauthorization Act of 2015 (MACRA). Panelists shared their tips on how to score more points under MACRA and utilize existing technology at a Nov. 14 session called Implementing Quality Measurement in Your Clinical Practice at…
A new presidential administration took office in January 2017. Although no one truly knows what directions our government and economy will take, one projection is that healthcare regulatory and insurance coverage policies will change, possibly dramatically. In a time of uncertainty, rheumatologists and rheumatology health professionals can turn to the ACR/ARHP for support, guidance and…
A 50-year-old male patient returns to the office for a follow-up visit for a diagnosis of generalized primary osteoarthritis of multiple sites. The patient tells the medical assistant that he is experiencing sharp throbbing pain in his left hip and right and left knees. He states the pain level is 6 out of 10 and…
Take the challenge. Answers: B: No—Only the treating physician can take the HPI. The medical assistant is allowed to take the review of systems. If the documentation indicates the treating physician did not take the HPI, the insurance can deny the claim as not medically necessary. B: No—If the high-risk medication is not assessed and…
Take the challenge. D—As of January 2015, there are three new codes added to the arthrocentesis codes of 20600–20611. The new codes, 20604, 20606 and 20611, should be reported when the procedure is performed with ultrasound guidance and CPT 76942 should not be billed separately. The three new codes are defined as: 20604—Arthrocentesis, aspiration and/or…
To be an effective practice owner, it is necessary to understand the financial circumstances and environment of the practice’s operation. Well-managed practices prevent the loss of time and money. Therefore, to improve productivity and operating efficiencies, you need to have a basic understanding of billing and payment initiatives that will impact the practice’s bottom line….
A 38-year-old female patient returns to the practice for the second of three hyaluronate sodium injections of the left knee. The patient states the pain is somewhat better after her last injection. Her weight is 165 lbs., her height is 5 feet 6 inches, and her blood pressure is 120/81. After discussing the risks of…
Take the challenge. CPT: 20611-RT, J1040, 89060 ICD-10: M17.11 Coding Rationale Keep in mind, no evaluation and management services are billed because there wasn’t a separate and/or significant reason, other than the knee injection, addressed during the visit. Note: Although the injection was performed via ultrasound guidance, CPT code 76942 should not be billed with…
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…