A 68-year-old female Medicare patient with a diagnosis of primary osteoarthritis of the left knee returns to a practice for her third injection in a series of knee injections. She reports being able to resume her after-dinner walks, which last for 30–40 minutes at least twice weekly. She denies fevers or any rashes. She has…
Coding Corner Answers: Rheumatology Word Search
Take the challenge. Ultrasound guidance: There must be a permanent picture placed in the patient’s medical chart to meet the requirements of documentation guidelines. Arthrocentesis: This is the proper term for the withdrawal of fluid and/or injection of medication into a joint. If both the aspiration and injection are performed during the same encounter, only…
Coding Corner Questions: Rheumatology Word Search
Find the words/terms suggested by the following clues: What is the procedure conducted when a permanent picture is required for a joint injection? What is another name for a joint injection? What should be done when a patient returns for an infusion and a prior authorization has already been approved? On what body system is…
Common Issues That Lead to Claim Denials
In an already complicated reimbursement landscape, claims denials can potentially pose a serious issue to the financial revenue for rheumatology practices. Denials are not only highly prevalent in the healthcare environment, but also costly to appeal, which affects overall reimbursements. According to The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting…
ACR Leaders Discuss E/M Coding Changes, Step Therapy & More
CHICAGO—ACR leaders described a series of looming legislative and regulatory threats to rheumatologists and their patients—including the proposed collapsing of evaluation and management (E/M) coding and potential changes to step therapy rules—and urged everyone in the field to make their voices heard to quash the proposals. They also recounted recent victories in the policy realm…
2019 Changes to E/M Documentation
As of Jan. 1, 2019, the Centers for Medicare & Medicaid Services (CMS) will implement several coding and documentation policies to provide immediate burden reduction to providers. The 2019 Medicare Physician Fee Schedule Final Rule (MPFS) released Nov. 1, 2018, by the CMS contained significant changes to the Medicare Part B coding and documentation policies…
Coding Corner Answers: A Drug Administration Quiz
Take the challenge. C—This claim cannot be coded without querying the infusion nurse and physician. There must be documentation of the patient’s weight to document the correct dosage of the medication to be given to the patient. Also the start time and the completion time of the infusion must be documented to know which drug…
Coding Corner Questions: A Drug Administration Quiz
A 70–year-old female patient with rheumatoid arthritis affecting multiple joints who is rheumatoid-factor positive but without organ or system failure returns for her third infliximab infusion. She is scheduled to receive 500 mg of the drug. How should this encounter be coded? 96413, 96415, J1745 x 50; ICD 10: M05.79 96413, 96415, J1745 x 50;…
Improve Your Claim Submissions Process
Maintaining a health revenue cycle in a medical practice comes with myriad moving parts. Numerous external forces, such as economic conditions, government programs (e.g., the Zone Program Integrity Contractor [ZPIC], the Health Information Technology for Economic Clinical Health [HITECH]) and legislation passed under healthcare reform, mandate healthcare organizations to begin managing internal processes, such as…
Coding Corner Answer: Rheumatology Coding & Practice Quiz
Take the challenge. B or D—If it was not documented, it was not done is the motto of many coders. For those who follow this motto, the answer would be B. But there is another option for the coder and that is to query the physician about whether the injection was done with ultrasound guidance…
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