Approximately 10 years ago, the Office of Inspector General (OIG) issued its first guidance on compliance as it relates to federal mandates for physician practices. Although taking the necessary steps can be a daunting task in an era of complex rules and heightened regulations, there are key areas of government-mandated compliance requirements that practices should…
Different parts of Medicare cover different services. For outpatient prescription drugs, Medicare has two distinct programs with a maze of complex policies. Most physicians along with Medicare patients, retail pharmacies, Medicare drug plans as well as Medicare Advantage health plans continuously struggle with navigating Medicare drug coverage under Part B and Part D. There are…
The ACR advocates on behalf of rheumatologists, rheumatology health professionals and the rheumatology community through involvement in federal and state legislation and regulatory action, participation in hearings and education of lawmakers on issues important to rheumatologists, health professionals and patients. Through robust federal and state advocacy programs, the ACR engages lawmakers and informs them of…
What is the ICD-10 guideline to code for osteoporosis without a current pathological fracture? There is no rule. Code for the osteoporosis, and code for the pathological fracture. Code for the osteoporosis from the M81._ category, and code for the history of a pathological fracture. None of the above is correct. How many characters are…
Take the challenge. C—The guideline for coding from category M81._ is that an additional code is needed if the physician has knowledge that the patent had a past pathological fracture. The code for personal history of (healed) pathological fracture is Z87.310. B—Osteoporosis with a current pathologic fracture is one of the few ICD-10 codes that…
It’s easier than ever to become a part of advocacy efforts at the federal and state levels. Visit the ACR’s new Legislative Action Center to send a personalized message to your lawmakers, asking them to give patients access to treatments, to provide funding for biomedical research and to prevent insurer practices from interfering with treatment…
Nearly 150 of the Rheumatology Research Foundation’s most generous supporters gathered in November during the 2015 ACR/ARHP Annual Meeting for the Donors of Merit recognition event. In celebration of the Foundation’s 30th Anniversary in 2015, the event reflected on the journey to advance treatments and improve patient care. The Foundation’s president, David Karp, MD, PhD,…
The Lupus Initiative (TLI) of the American College of Rheumatology (ACR) continues its work to reduce the health disparities for people with lupus through multiple, national-level, grant-funded projects, targeting primary care physicians with lupus education to increase appropriate rheumatology referrals and—when necessary, appropriate and effective—distance-managed care. Since 2009, the ACR has received funding through the…
Take the challenge. M10.072—Acute gout has an Excludes 1 note of chronic gout (M1A.-). This means that acute gout and chronic gout cannot be coded for the same encounter, as the codes are mutually exclusive. M45.6—The patient is diagnosed with ankylosing spondylitis of the lumbar region. M81.8—Other osteoporosis without current pathological fracture. M79.622—The patient has…
It has been two months since the implementation of ICD-10, so everyone has gotten a feel for the new code set. Let’s see how well you are doing in your diagnosis coding for rheumatology-specific conditions. A 55-year-old female patient presents for a follow-up visit of idiopathic chronic gout of multiple joints without tophi. She complains…