On July 1, Blue Cross Blue Shield of North Carolina introduced a machine-learning technology platform to make decisions about patients’ care and treatment. The ACR opposes its use on grounds that it may harm patients’ access to treatment and undermine the doctor-patient relationship.
Rheumatology Coding Corner Answers: 2017 End-of-Year Quiz
Take the challenge. 1. B—No. CPT 99358, prolonged evaluation and management service can be billed before or after direct patient care, first hour or 99539 —each additional 30 minutes (list separately in addition to code for prolonged service). This code cannot be used to bill a higher level E/M visit code. According to 2017 CPT:…
Rheumatology Coding Corner Questions: 2017 End-of-Year Quiz
1. A 68-year-old new female patient has an appointment to see the rheumatologist in four days. The patient has her medical records sent over from her primary care physician, neurologist and endocrinologist for the rheumatologist to review prior to the visit. Upon receipt, the rheumatologist spends 55 minutes reviewing the records and making notes. Can…
Ethics Forum: A Physician’s Medical Error & the Patient’s Right to Know
Case Ms. A is an 82-year-old woman who presented to the rheumatology office for evaluation of osteoporosis. She had been diagnosed with postmenopausal osteoporosis at age 62 after sustaining a right wrist fracture. She was started on alendronate 70 mg weekly and reported medication compliance. At age 79, she sustained an atraumatic right femur fracture….
Clinical Thought Process for Proper Medical Decision Making, Part 2
In Part 1 of this series, we covered the vital role of medical decision making in determining the final level to bill for a patient encounter. Medical decision making is the key component in coding because it reflects the intensity of the provider’s cognitive labor. This implies that there’s an unseen component involved in the…
Documentation Guidelines for Proper Medical Decision Making
The Medical Decision Making (MDM) of an evaluation and management (E/M) visit is one of the three components of determining the level of a patient’s visit. But the MDM can sometimes be the most difficult component, as this is where the provider’s thought process is quantified in deciding the correct level of E/M service. In the…
How to Document E/M Services
Documenting evaluation and management (E/M) services involves many factors, and it’s important to code to the most appropriate level of service to avoid compliance risks. To assist providers with documentation, the Centers for Medicare & Medicaid Services (CMS) provides its 1995 and 1997 Documentation Guidelines for Evaluation and Management Services. For billing purposes, either version…
Coding Corner Question: January
Test your coding knowledge for identifying the determining factors for determining the level of risk in the medical decision making for a patient with rheumatoid arthritis.
Coding Corner Answer: January Coding Challenge
Identifying multiple determining factors—including prescription drug management, drug therapy, and chronic illness with severe exacerbation, progression, or side effects to treatment—in determining the level of risk in the medical decision making for a patient with rheumatoid arthritis
Elements of Medical Decision Making for Rheumatologists When Coding and Billing
What rheumatologists need to know about determining the level of medical decision making (MDM) for an office visit