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Billing/Coding

Rheumatology Coding Corner Answer: RA Follow-Up with Imaging

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Take the challenge. CPT codes: 99214, 71045, 86580 ICD-10: M05.79, R05, R06.2 History—Detailed: The history of present illness (HPI) was extended; the review of systems (ROS) was extended; and the past medical, family and social history (PFSH) were documented. All three components of the HPI, ROS and PFSH are needed to achieve the detailed history…

Rheumatology Coding Corner Question: RA Follow-Up with Imaging

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History A 39-year-old woman returns for follow-up for her rheumatoid arthritis. She has positive rheumatoid factor, but no organ or systemic involvement. She has joint swelling and pain in her left hand, right elbow and right knee. Her pain is at an 8 on a 10-point scale. She states the pain is worse in the…

Rheumatology Coding Corner Answer: Follow-Up Knee Injection

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Take the challenge. CPT codes: 20611-LT, 20611-RT, J7326x2 or 20611, 20611-50, J7326x2 ICD-10: M17.0 Coding Rationale CPT Codes: 20610-LT, J7325x16 ICD-10 Code: M17.12 This claim is rejected by the insurance carrier because the injection was outside of the preauthorization window that ended on Oct. 31. Most insurance carriers enforce their preauthorization dates for procedures. In…

Rheumatology Coding Corner Question: Follow-Up Knee Injection

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On Nov. 4, a 55-year-old female patient presents to the office for a follow-up visit for injection of the left knee for osteoarthritis. This is her third of three injections that were preauthorized through Oct. 31. She reports pain and swelling in her left knee and rates the pain at an 8 on a 10-point…

Anthem Cancels Planned Modifier 25 Cuts

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Anthem, a Blue Cross Blue Shield company that operates in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, Virginia and Wisconsin, has decided not to move forward with a policy that would have resulted in decreased reimbursement for evaluation and management (E/M) services when billed with modifier 25. As reported…

Rheumatology Coding Corner Answer: Bilateral Knee Injections

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Take the challenge. CPT codes: 20611-LT, 20611-RT, J7326x2 or 20611, 20611-50, J7326x2 ICD-10: M17.0 Coding Rationale The CPT code 20611 is for an arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee or subacromial bursa with ultrasound guidance, with permanent recording and reporting). The code is billed twice because this was a…

Rheumatology Coding Corner Question: Bilateral Knee Injections

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A 68-year-old male patient returns to the office for his scheduled bilateral knee injections for primary osteoarthritis. The patient rates the pain in his right knee at an 8 on a scale of 10, and the pain in his left knee at a 7. He was in the office a week before, but the practice…

2018 CPT Coding Updates

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Each year the American Medical Association’s CPT code manual is revised to delete codes and/or guidelines, and to add or revise codes to reflect current technologies, techniques and services. Medicare and all other payers are switching to the new 2018 CPT codes for X-rays of the chest. The original codes for a chest X-ray were…

Medicare Access & CHIP Reauthorization Act Preparation Tips

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The ABCs of MACRA The transition year under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is at an end. MACRA repealed the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS) and replaced it with a value-driven payment system. The new approach to payment is called the…