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),…
I am a few weeks post-retirement. Having written thank you notes and completed urgent home projects, I swing in a hammock at our currently fire-threatened cabin north of Winthrop, Wash., and reflect. I feel like a young boy while freely flipping pages of a hand-scribed picture book, The Principles of Uncertainty, by Maira Kalman. She…
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….
Take the challenge. CPT: 20611-LT, J7325 X 1 ICD-9: 715.16—Osteoarthritis, localized, primary, lower leg ICD-10: M17.12—Unilateral pri- mary osteoarthritis, left knee Note: When billing for 20611—Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa), with permanent recording and reporting, there must be a permanent photograph of the needle placement in…
Coding for a Knee Injection A 68-year-old female patient with primary osteoarthritis of the left knee returns to the office for her scheduled hyaluronan injection. The patient reports that her knee is a little tender, but on a scale of 1–10, it is a 4. She is stiff in the morning for 10–20 minutes. The…
In an age of constant change and regulations, one thing remains the same in coding and billing: If it’s not documented, it wasn’t done. This is the main rule for documentation. Good documentation is and always has been the foundation of accurately capturing a provider’s work and the patient’s condition, management and treatment. Introduced by…
A new survey of more than 3,600 adults living with rheumatoid arthritis (RA) shows that a patient’s perception of their disease and treatment, as well as their relationship with their healthcare professional, can positively impact the management of their disease. The RA NarRAtive survey, created and sponsored by Pfizer, is part of an international initiative…
Co-morbidities in patients with rheumatoid arthritis and related autoimmune diseases often warrant a multidisciplinary approach to treatment. When it comes to inflammatory and fibrotic lung conditions in these patients, collaboration between pulmonary/critical care specialists and rheumatologists is essential, say two rheumatologists recently interviewed by The Rheumatologist. Both followed their rheumatology fellowship training with additional fellowships…
Rheumatic diseases, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and vasculitis, can affect the body in many ways, but perhaps the most serious is the increased risk of heart disease for many patients. As the risk of atherosclerosis in autoimmune disease patients gains increased attention, rheumatologists and cardiologists are collaborating more often to…
Methotrexate has long been a cornerstone of therapy in rheumatoid arthritis. Two new, injectable methotrexate products may help some RA patients for whom oral methotrexate is not as effective or causes adverse effects. Rasuvo and Otrexup are prefilled, auto-injection devices that allow patients to give themselves subcutaneous injections of methotrexate without having to use a…