Coding Corner Question: Rheumatology Coding & Practice Quiz

1. A 45-year-old female patient with a diagnosis of primary osteoarthritis returns to the office for her second scheduled injection of sodium hyaluronate (Supartz). The nurse takes the patient’s vitals: weight is 185 lbs., height is 5’2”, and temperature is 98.2°F. The patient is prepped and given the injection. How should this encounter be coded?

1. 99211-25, 20610, J7321
2. 20610, J7321
3. 99211-25, 20611, J7321
4. None of the above

2. A 27-year-old female patient with a diagnosis of systemic lupus erythematous (SLE) returns to the office for her second belimumab infusion. The patient was last seen two weeks ago. The physician takes the patient’s vitals: weight is 120 lbs., temperature is 98°F, and blood pressure is 105/80. The infusion is started at 10:16 a.m. and completed at 11:05 a.m.; the dosage is 600 mg. How should this encounter be coded?

1. 99212-25, 96365, J0490 X 60
2. 96365, J0490 X 60
3. 99212-25, 96413, J0490 X 60
4. 96413, J0490 X 60

3. A 45-year-old man with a diagnosis of rheumatoid arthritis of multiple sites, rheumatoid factor positive, without organ or systems involvement, returns to the practice for his infliximab infusion. The practice does not verify that the patient’s medical coverage is still the same, because it has a prior authorization from the patient’s payer for 10 months. Is something incorrect with this scenario?

1. Yes
2. No

4. A practice receives notice of a Zone Program Integrity Contractor (ZPIC) audit. How should the practice handle this?

1. Put it to the side because the practice is dealing with other audits
2. Treat it like a regular audit, and send in requested documents
3. Give the notice immediately to the physician or practice manager
4. None of above

5. A practice hires someone or does business with a company that is on the Office of Inspector General’s (OIG) excluded list. What can happen to the practice as a result?

1. The practice can be fined and given a penalty
2. The practice can end up on the excluded list
3. The practice must fire the person or stop doing business with the company immediately
4. All of the above

Click here for the answer(s).