Roughly 15 years ago, Steven K. Magid, MD, rheumatologist and chief medical information officer at the Hospital for Special Surgery (HSS) in N.Y., attended a social event for hospital employees. While chatting with other physicians, nurses, and lab techs, he watched one of his colleagues slaughter her opponents at Ping-Pong. “She was very skilled,” recalls Dr. Magid,…
Take the challenge. CPT codes: 99245/99205 ICD-10: M79.1, R21, R53.83, L65.9, K13.79, R00.0 This visit can be billed out as a 99245 only if the insurance carrier allows the billing of consultation codes. If the carrier does not allow consult codes, then this visit must be billed as a new patient visit. Because many outpatient…
History A 25-year-old female patient is seen in the office after her primary care physician requested a consultation for a possible diagnosis of systemic lupus erythematosus (SLE). The patient presents today with muscle pain in both legs, she rates the pain at an 8 on a scale of 10. She states she experiences throbbing, usually…
A 57-year-old Ghanaian woman was referred to our rheumatology practice with acute, left elbow swelling and pain. The referring oncologist suspected gout, because the patient had hyperuricemia. Six months before, the patient was diagnosed with stage IV human T-lymphotropic virus type 1 (HTLV-1)-associated adult T cell lymphoma (ATLL). Her initial oncologic manifestations included multiple thoracic,…
Preconception planning is essential to help women with autoimmune disease have optimal pregnancy outcomes. Unplanned pregnancy can also negatively impact disease course in some patients. Yet many rheumatologic patients of childbearing age do not receive adequate contraception or prepregnancy education and counseling. Rheumatologists must work collaboratively with other healthcare providers to make sure rheumatic patients…
While medical advances in rheumatoid arthritis (RA) have led to improvements in disease control and quality of life for patients worldwide, the rate for stable remission remains low.1 Management of RA symptoms is traditionally accomplished through a combination of medications and nonpharmacological interventions.2 This approach can prevent the development of secondary adverse health outcomes. Two…
Systemic sclerosis (SSc) is a disease characterized by immunologic abnormalities, microvascular involvement and tissue fibrosis. In previous studies, 10-year survival rates ranged from 50–84%. However, there are concerns that these studies, using prevalent cohorts, are underestimating mortality. “While the prognosis of many rheumatic diseases has improved with the availability of more effective and targeted therapies,…
Interest in viewing the nail capillaries dates to the late 17th century. Later research by Maurice Raynaud and others in the late 19th and early 20th century first established a direct link between the nailfold capillaries and certain medical conditions. Although underutilized in the past, with the advent of modern digital equipment and the validation…
Deborah Dyett Desir, MD, vividly remembers her first day as an undergraduate student at Harvard University, Boston. When her parents helped her move into the dorm, her mother, Betty, handed her a beautiful begonia. “My response was, ‘What on earth am I going to do with this plant?’” she says, recalling how she examined the…
Take the challenge. CPT codes 99358—prolonged evaluation and management (E/M) service before and/or after patient care; first hour 99359—each additional 30 minutes (list separately in addition to codes for prolonged service) Coding Rationale No—This scenario would not support the medical necessity to bill the prolonged service code(s). Keep in mind, the time that the supporting…