Billing/Coding

Rheumatology Coding Corner Question: Prolonged Service without Direct Patient Contact, Part 2

From the College | October 18, 2017

An established, 66-year-old male patient is seen in the office for a follow-up visit for his fibromyalgia. The physician makes the decision to prescribe venlafaxine for anxiety and depression, and gabapentin for nerve pain. After the visit, the physician informs his medical assistant (MA) to contact the patient’s insurance carrier because venlafaxine requires a prior…

Tips to Manage, Prevent Medical Billing Claim Denials

From the College | October 16, 2017

Physicians are increasingly fighting multiple forces in running a practice, and one of the most common barriers to effective revenue cycle management is frequent medical billing and claim denials. An insurance company’s denial for services places a significant strain on the financial process of the practice, which affects the bottom line. According to the Medical…

Rheumatology Coding Corner Answer: New Patient Prolonged Service Without Direct Patient Contact, Part 1

From the College | September 19, 2017

Take the Challenge. ICD-10 Codes R76.1—Raised antibody titer L20.8—Other atopic dermatitis R20.2—Paresthesia of skin R20.1—Hypoesthesia of skin CPT Codes 99358 and 99359 Rationale The Centers for Medicare & Medicaid Services (CMS) typically does not allow separate payment for physician services that do not require face-to-face time with a patient, but as of Jan. 1, 2017,…

Rheumatology Coding Corner Question: New Patient Prolonged Service Without Direct Patient Contact, Part 1

From the College | September 17, 2017

A 67-year-old female patient from New York with a long history of fatigue, joint and muscle pain, rash and fevers is scheduled to see the rheumatologist in five days. She is referred to the rheumatologist by her primary care physician (PCP) for possible diagnosis of lupus erythematosus. The patient requested her medical records from her…

ACR Opposes UnitedHealthCare’s Move to End Consultation Reimbursement

Carina Stanton | September 6, 2017

Effective for claims with dates of service on or after Oct. 1, 2017, UnitedHealthCare (UHC) plans to no longer reimburse consultation services represented by CPT codes 99241–99245 and 99251–99255. In lieu of a consultation services procedure code, UHC says it will “reimburse the appropriate evaluation and management (E/M) procedure code which describes the office visit,…

Rheumatology Coding Corner Answer: Coding for Incident-to Services

From the College | August 15, 2017

Take the challenge. CPT codes: 99214-25, 20610-RT, J1030x1 Diagnoses: M05.79, M25.561 This is an established patient visit with an established diagnosis, along with a new diagnosis, which would have to be billed under the PA’s National Provider Number (NPI) and reimbursed at 85% of the fee schedule. Keep in mind that to qualify as an…

Rheumatology Coding Corner Question: Coding for Incident-to Services

From the College | August 13, 2017

A 66-year-old woman returns to the office for a follow-up visit. She is seen by the physician assistant (PA) for her rheumatoid arthritis. She is experiencing burning pain in her right knee, and she reports that after going for her morning walk, she rates the pain at a 6 on a scale of 10. She…

Rheumatology Coding Corner Question: Established Patient Office Visit with Acute Gout

From the College | July 15, 2017

A 66-year-old female patient returns to the office complaining of swelling and a burning pain in her right first toe. She rates the pain level at a 9 out of 10. She currently takes an over-the-counter non-steroidal anti-inflammatory drug (NSAID), but it has done little to alleviate the pain. This is her second episode this…

Rheumatology Coding Corner Answer: Established Patient Office Visit with Acute Gout

From the College | July 15, 2017

Take the challenge. CPT: 99214-25, 89060, 20600-RT ICD-10: M10.271, T50.2X5A, I10 This is an established outpatient visit. This encounter is coded as 99213, because it included: History—Detailed: The history of present illness is extended, the review of systems is extended, and the past medical and social histories are documented. Examination—Detailed: Seven organ systems are examined….

How to Document a Patient’s Medical History

From the College | July 13, 2017

The levels of service within an evaluation and management (E/M) visit are based on the documentation of key components, which include history, physical examination and medical decision making. The history component is comparable to telling a story and should include a beginning and some form of development to adequately describe the patient’s presenting problem. To…