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,…
Rheumatology Coding Corner Question: Infusion Services for Skilled Nursing Facility Patient
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….
A Look at CPT Codes for Prolonged Services
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…
NGS Updates E/M Coding Requirements for Examination Component
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…
Rheumatology Coding Corner Answers: Eligibility Quiz
Take the challenge. B—Most employer insurance plans change on Jan. 1. Because of this, it is a best practice for medical office staff to ask if there is any change to a patient’s medical coverage. Even if the patient indicates there are no changes in coverage, staff should still request to review their insurance card….
Rheumatology Coding Corner Questions: Eligibility Quiz
An established patient is seen in the office for a scheduled visit with the rheumatologist at the start of the new year. What should the front desk staff do for all patients at the beginning of each year? Inform the patient that their co-pay is due prior to receiving treatment, and ask how they would…
Noridian Updates Tendon Injections Guidelines for Jurisdiction F
Effective May 22, 2017 Noridian has updated the Local Coverage Determination (LCD) coding guidelines for CPT procedures 20552, injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) and 20553, injection(s); single or multiple trigger point(s), 3 or more used to affect therapy for a pathological condition. Noridian states the goal of the updated diagnostic…
Rheumatology Coding Corner Question: Billing Infusion Procedure with JW Modifier
An 82-year-old female established patient diagnosed with ankylosing spondylitis in multiple joints returns to the office for her second infliximab infusion. She denies any fevers, cough or concurrent illness. Her joint pain is 7 on a scale of 1–10. She complains of achy pain in the cervical, lumbar and sacral regions of her spine. She…
Rheumatology Coding Corner Answer: Billing Infusion Procedure with JW Modifier
Take the challenge. CPT: 99214-25, 96413, 96375, 96361-59, J1745 x 4 J1745 JW* x 36, J1200 x1 ICD-10: M45.09, T50.995A, R06.02, E66.3, Z68.2 Rationale Modifier 25 is appropriate to use because it indicates the patient received a significant, separately identifiable E/M service on the same day as the infliximab infusion. This E/M service entailed the…
How to Bill Medicare Patients for Non-Covered Services
What do you do when you are presented with a patient who needs treatment but the patient’s insurance company will not pay for the services? Can you provide the services anyway? Who will pay for them? How do you collect payment for such services? If the patient consents to receive the services in spite of…
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