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An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Billing/Coding

CORC: The Uncomfortable Move from Fee for Service to Value

Doug White, MD  |  

ACR members are spread out across the U.S., but we all work in the same place: the land of fee for service. FFS, as it’s known to policy nerds, poses certain problems for cognitive subspecialists like rheumatologists. For instance, much of the work we do—calling providers and patients, coordinating care after hours—often isn’t compensated. And…

Rheumatology March Coding Corner Answer: Pediatric Rheumatology Consult

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Take the challenge. CPT: 99203 This encounter is coded as 99203, because it included: History—The history of present illness was extended. The review of systems was complete, and the past medical, family and social were documented. This makes the history comprehensive. Examination—Expanded detailed. Medical decision making—The diagnosis was a new problem with no additional workup…

Undercoding Is Not an Audit-Proof Strategy in Medical Documentation

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Overcoding is a common term used when discussing fraud and abuse in reporting procedures and services not supported by the actual work performed. Alternatively, undercoding—or failing to report the full extent of services or procedures provided—is an equally unsound practice and a compliance risk. In the world of quality reporting, undercoding can have damaging effects…

Clinical Documentation and Coding Boot Camp

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Coding properly and efficiently can have a profound effect on practice viability. ICD-10’s many changes, both ongoing and planned, have many physicians, coders and practice administrators confused, especially as the changes relate to clinical documentation improvement. To address this issue, a pre-symposium course on documentation and coding will be held in conjunction with the ACR’s…

Rheumatology Coding Corner Answer: Coding for a Knee Injection

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CPT: 20611-LT, J7325 X 1 ICD-9: 715.16—Osteoarthritis, localized, primary, lower leg ICD-10: M17.12—Unilateral primary osteoarthritis, left knee Note: When billing for 20611—Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa), with permanent recording and reporting, there must be a permanent photograph of the needle placement in the patient’s medical chart….

Rheumatology Coding Answer: Deconstructing Evaluation and Management Codes

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Take the challenge. Answers: B: No—Only the treating physician can take the HPI. The medical assistant is allowed to take the review of systems. If the documentation indicates the treating physician did not take the HPI, the insurance can deny the claim as not medically necessary. B: No—If the high-risk medication is not assessed and…

MACRA: More Points, Smarter Future

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As the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is implemented in January with new models for quality-based reimbursement payments, rheumatologists must seize control of how they will be paid now—and in the future. This message was stressed by speakers during Holy MACRA! How to Survive and Thrive in the Era of MACRA,…

3 Ways the ACR Helps Practices Thrive

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The ACR can be the first line of defense for rheumatologists when it comes to compliance efforts, quality control and oversight of physician billing and coding practices, says ACR Director of Practice Management Antanya Chung, CPC, CPC-I, CRHC, CCP. The ACR is focused on providing the support its members want and need. “We want to…