An 82-year-old female established patient diagnosed with ankylosing spondylitis in multiple joints returns to the office for her second infliximab infusion. She denies any fevers, cough or concurrent illness. Her joint pain is 7 on a scale of 1–10. She complains of achy pain in the cervical, lumbar and sacral regions of her spine. She…
Take the challenge. CPT: 99214-25, 96413, 96375, 96361-59, J1745 x 4 J1745 JW* x 36, J1200 x1 ICD-10: M45.09, T50.995A, R06.02, E66.3, Z68.2 Rationale Modifier 25 is appropriate to use because it indicates the patient received a significant, separately identifiable E/M service on the same day as the infliximab infusion. This E/M service entailed the…
Systemic lupus erythematosus (SLE) is a heterogeneous disease associated with multiple acute or chronic cutaneous manifestations, including the relatively rare category of bullous lupus. The development of vesiculo-bullous lesions may be associated with a high morbidity, hence they warrant an urgent investigation, including a skin biopsy to identify the diagnosis and initiate prompt treatment. With…
Brodalumab Approved for Plaque Psoriasis The U.S. Food and Drug Administration has approved brodalumab, a monoclonal antibody that targets interleukin 17 (IL‑17).1,2 Brodalumab (Siliq) was approved for treating moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy and have failed to respond to, or have lost response to, other…
WASHINGTON, D.C.—Challenges abound for the manufacturing of biosimilar drugs—from their sheer size compared with small molecule drugs to the unknowable proprietary aspects of the originator drugs—an expert said at the 2016 ACR/ARHP Annual Meeting in a session titled Immunology Update: Biologic Agents: From Nature to Protein Engineering to Biosimilars. Above all, because biosimilars are copies…
The year 2015 brought the end of the much-maligned Sustainable Growth Rate (SGR), sometimes known as the “doc fix.” The SGR established limits on Medicare reimbursement for physicians, and each year, physicians and those lobbying on their behalf were forced to stave off drastic cuts to their payments. “The SGR was Congress’s attempt to control…
The American College of Rheumatology (ACR) continues to provide feedback to the Centers for Medicare & Medicaid Services (CMS) about the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 on behalf of rheumatologists. The bipartisan bill repealed the Sustainable Growth Rate and transitioned Medicare from fee for service to a system…
On May 11, ACR leaders will fly to Capitol Hill to meet with Congressional leaders on behalf of ACR and ARHP members. With so many pressing policy issues facing the medical community this year, we hope that you, too, will let your members of Congress know where you stand on the following issues: Support Medical…
On March 22, 2017, Ewa Olech, MD, testified at a hearing before the Nevada State Assembly to voice support for A.B. 245, a bill governing biologic medications and biosimilar substitution in that state. She spoke on behalf of the Rheumatology Association of Nevada (RAN), as its president and founder. The bill establishes guidelines regarding biosimilars and requires…
Editor’s note: This blog by Dr. Worthing originally appeared on the ACR’s Advocacy Listserv. Here’s a perspective on the current climate in which your government affairs team works. As you read this list of observations, imagine you’re a lawmaker and try to find where the ACR’s agenda fits into the current landscape: Washington is highly…