If you speak to any advocate for rheumatology, each of us has an “Aha! moment,” when we learned the importance of advocacy. My own came a dozen years ago. I was meeting with a legislative aide to a local congressman who was a senior member of the committee overseeing Medicare. He introduced himself as the…
The Medical Decision Making (MDM) of an evaluation and management (E/M) visit is one of the three components of determining the level of a patient’s visit. But the MDM can sometimes be the most difficult component, as this is where the provider’s thought process is quantified in deciding the correct level of E/M service. In the…
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,…
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…
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….
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…
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…
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…
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…
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:…