Take the challenge. CPT: 99213, 96413, 96415 x1, J1745 x 20* ICD-10: M05.09 This encounter is coded as 99213 because: History—The history of present illness is extended. The review of systems is detailed, and two of the three past, family, social history were documented, which makes the history level detailed. Exam—There are four systems examined,…
Articles by From the College
Highlights from the Second Annual ACR Division Directors’ Conference
The second annual ACR Division Directors’ Conference took place in Chicago on March 10–11. The conference opened with a presentation on the use of the ACR’s Rheumatology Informatics System for Effectiveness (RISE) Registry in academic medical centers by Salahuddin “Dino” Kazi, MD, from UT Southwestern Medical Center, and Jinoos Yazdany, MD, MPH, from the University of California…
Rheumatology Coding Corner Question: Infusion Services for Skilled Nursing Facility Patient
An 83-year-old established female patient who resides in a skilled nursing facility (SNF) and is diagnosed with rheumatoid arthritis with rheumatoid factor in multiple joints returns to the office for her first infliximab infusion. She denies fevers, cough, dyspnea or concurrent illness, but has joint pain and swelling in both elbows and her left wrist….
Rheumatology Research Foundation Funding Enables Potential Treatment Advancements
Investigators at Brigham and Women’s Hospital recently discovered a novel subset of peripheral helper T cells (TPH) that drive rheumatoid arthritis (RA) inflammation. Originally published in the February issue of Nature, findings from this study provided bedrock knowledge for developing new RA therapies. Now, with funding from the Rheumatology Research Foundation, investigators are expanding on…
A Look at CPT Codes for Prolonged Services
In the 2017 Medicare physician fee schedule, the CMS officially activated CPT codes 99358 and 99359 as reimbursable codes for non-face-to-face prolonged services performed in the office or outpatient setting, hospital or nursing facility by physicians or other qualified health practitioners (not clinical staff). The CPT codes are defined as 99358: Prolonged evaluation and management service…
NGS Updates E/M Coding Requirements for Examination Component
Effective for dates of service on and after July 1, 2017, the National Government Services (NGS), the Medicare administrative contractor for Jurisdictions 6 and K, will require providers in their region to adhere to new evaluation and management (E/M) services expectations for the expanded problem-focused and detailed CPT examination components. The new requirement adds specificity…
ACR Leaders & Volunteers Take the Issues to the Decision Makers
On May 11, ACR leaders representing the Board of Directors, Affiliate Society Council, Government Affairs Committee (GAC), Committee on Rheumatologic Care, RheumPAC Committee and Insurance Subcommittee went to Capitol Hill to advocate on behalf of the ACR/ARHP membership and our patients. The group, which represents 27 states and the District of Columbia, conducted meetings in…
How MACRA Has Affected Physician Compliance
In recent years, providers and practice groups have been worrying about Meaningful Use (MU) and gaining knowledge on using certified electronic health record (EHR) technology to avoid payment penalties, earn incentives and increase practice efficiency. Now, with the release of the final rule for MACRA payment reform, physicians will have two options for payment paths:…
Rheumatology Coding Corner Answers: Eligibility Quiz
Take the challenge. B—Most employer insurance plans change on Jan. 1. Because of this, it is a best practice for medical office staff to ask if there is any change to a patient’s medical coverage. Even if the patient indicates there are no changes in coverage, staff should still request to review their insurance card….
Rheumatology Coding Corner Questions: Eligibility Quiz
An established patient is seen in the office for a scheduled visit with the rheumatologist at the start of the new year. What should the front desk staff do for all patients at the beginning of each year? Inform the patient that their co-pay is due prior to receiving treatment, and ask how they would…
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