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Articles by From the College

Coding Corner Question: Medical Chart Review of an Infliximab Infusion

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A 73-year-old female established patient with rheuma­toid arthritis affecting multiple joints and with positive rheumatoid factor returns to the office for an infliximab infusion. She denies any fevers, cough, dyspnea or concurrent illness. She has joint pain of 6 on the pain scale. She is on an NSAID, weekly methotrexate subcutaneous injections, folic acid and…

Joint Efforts: RheumPAC Facilitates Progress

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Advocacy and RheumPAC staff from the ACR and other medical specialty organizations gathered in Nashville this month to discuss the importance of making sure your members know the details of the work advocacy and the PAC are doing. Thus far, the ACR has had a very successful year in terms of its advocacy efforts. Following…

UnitedHealthcare Implementing Risk Adjustment Audit Program

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Beginning in June 2018, UnitedHealthcare (UHC) will implement their risk adjustment data validation (RADV) audit program. UHC states that through the mandatory requirement by the U.S. Department of Health and Human Services (HHS), Medicare Advantage health plans will be reviewed for supporting medical documentation to check for accurately reported patient data. UHC will send requests…

ACR/ARHP Members Call on Congress to Restore Patients’ Voices

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WASHINGTON, D.C.—The ACR hosted the 2018 Advocacy Leadership Conference in Washington, D.C., on May 16–17. Rheumatology professionals from around the country flew to our nation’s capitol to attend the conference, where advocates heard from key policymakers and spoke with lawmakers about the issues that affect the rheumatology community—and what ACR/ARHP members can do to influence policy….

Avoid Billing Risks for New vs. Established Patients

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When coding evaluation and management (E/M) services provided to a patient, one of the most persistent concerns is whether a patient is new or established to the practice. Although this may seem like a simple coding answer, the distinction is an important one, because it enables providers to appropriately bill and receive reimbursement correctly. E/M…

Rheumatology Coding Corner Answer: Billing for an Inflectra Infusion

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Take the challenge. CPT codes: 96413, 96415, 96375, Q5103x20, J1200 ICD-10: M07.9 Coding Rationale This procedure is billed with CPT code 96413 for the initial hour of the intravenous infusion and CPT code 96415 for each additional hour. The patient was given 50 mg of diphenhydramine prior to the infusion to prevent reactions and should…

Rheumatology Coding Corner Question: Billing for an Inflectra Infusion

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A 68-year-old female patient returns to the office for a second round of Inflectra (infliximab-dyyb) infusion for her rheumatoid arthritis with rheumatoid factor of multiple joints without organ or systems involvement. She reports pain, stiffness and swelling in her left and right knees and right elbow and rates the pain at a 9 on a…

ACR Praises Congress for Bill with Part B Fix, Therapy Caps Repeal

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The ACR praises Congressional leaders for passing the sweeping spending agreement, which includes a technical provision reversing a Centers for Medicare & Medicaid Services (CMS) policy that would have linked physicians’ quality payment adjustments to Medicare Part B drug costs starting in 2019. The ACR also applauds the inclusion of provisions that permanently repeal Medicare…

Funding Available for Community Practitioners from the Rheumatology Research Foundation

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Few opportunities exist for rheumatologists in community-based practice who, in addition to taking care of patients, want to test their own observations through research. Limited funding, time constraints and competition from larger academic medical centers are some of the barriers hindering clinical research in this setting. The Rheumatology Research Foundation is addressing this issue with…

Rheumatologists: Participate in the ABMS Certification Conversation

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The ACR continues to actively advocate for certification reform and recently testified to the Continuing Board Certification: Vision for the Future Commission. The Commission is leading a collaborative effort to assess the current state of continuing board certification, and to envision a framework that is relevant and meaningful to physicians, patients, hospitals and health systems….