The ACR has been at the forefront of helping rheumatologists meet practice demands, including federal reporting requirements. The first registry that helped meet these requirements was the Rheumatology Clinical Registry (RCR), and it facilitated quality reporting, but required manual entry of required data. More recently, ACR has contracted with FIGmd to create a tool that…
Ethics Forum: Unexpected Ethical Issues in Private Practice, Clinical Research
Ethical issues that arise in the average rheumatology practice and in clinical research are often straightforward. The AMA Code of Medical Ethics and the Office Practice and Procedures Manual offer useful information.1 In research, the Protocol and Investigators Agreement spells out who you can enroll and how the trial must be conducted. But still—even when…
Rheumatology Coding Corner Answer: Physical Examination with Infliximab Infusion
Take the challenge. CPT: 99214-25, 96413, 96415 x 1, J1745 x 35 ICD-10: M07.68, K51.80 Billing Overview It is appropriate to bill for an E/M visit for this day of service along with the infusion procedure. Modifier 25 should be appended to the E/M, indicating that the patient received a significant, separately identifiable E/M service…
Rheumatology Coding Corner Question: Physical Examination with Infliximab Infusion
A 12-year-old male established patient with inflammatory bowel disease with associated juvenile spondyloarthropathy returns to the office for a follow-up visit for his infliximab infusion. The patient reports moderate pain in his right hip after walking for extended periods of time or after sports activities. He denies any other joint pain and denies any joint…
Medicare Sets Standards for Overpayments Received by Physicians, Healthcare Providers
In February 2016, the Centers for Medicare & Medicaid Services (CMS) published the final rule on Medicare Reporting and Returning of Self-Identified Overpayments. This final rule from CMS has now established official policy for timely reporting and returning of Medicare overpayments received by healthcare providers, with a goal to provide clear requirements for reporting and…
Why Rheumatologists Should Focus on Patients’ Cardiovascular Health
Baseball is a great sport. It’s fascinating to watch the evolving duel between pitcher and batter. As the former employs their remarkably powerful and versatile rotator cuff and forearm flexor muscles to hurl blazing pitches, the latter engages their exceptionally honed hand–eye neural link to make contact with the ball. Baseball is the ultimate summertime…
How Rheumatologists Can Plan for Extended Work Absences
Sometimes, life calls for you to be out of the office for a length of time. Whether the absence is planned or not, it’s important to consider the best actions to take given the circumstances to ensure patients are cared for during your absence. Alexa Meara, MD, clinical instructor and rheumatologist, The Ohio State University…
Rheumatology Coding Corner Answer: Office Visit with DEXA Scan
Take the challenge. CPT: 99213-25, 77085 ICD-10: Diagnosis M81.0, Z79.52 The encounter is coded as 9913 as follows: History—The history of the present illness was extended. The review of systems was complete, and the past medical history was documented. This makes the history detailed. Examination—The examination was expanded problem focused. Medical decision making—The diagnosis was…
Avoid the Trap of Balance Billing
It is no secret that payers and providers have conflict as it relates to reimbursement rates for medical services, and there is another stakeholder, the patient, that plays an important role in the financial impact of healthcare reimbursement. Usually, patients are faced with unforeseen bills from their providers due to an unpaid portion of a…
Rheumatology Coding Corner Question: Office Visit with DEXA Scan
A 67-year-old female patient with Medicare returns to the office for a follow-up of her age-related osteoporosis. She states she has an achy pain in her left hip that lasts for 30–40 minutes in the morning. Currently, she has taken ibandronate sodium and alendronate sodium for the past year, and her pain level is a…
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