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

Billing/Coding

Rheumatology Coding Corner Question: Sacroiliac Injection with Office Visit

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Coding for SI Injections with Office Visit A female patient previously diagnosed with sacroiliitis and ankylosing spondylitis returns to the office for a follow-up visit. The patient reports her lower back has been stiff and swollen for the past couple of weeks. She is currently on celecoxib and ranitidine, and mentions that she had some…

Rheumatology Coding Corner Answer: Sacroiliac Injection with Office Visit

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CPT codes: 99214-25, 27096, J3301 x1 ICD-9: 720.2, 720.0, 787.02 ICD-10: M46.1*, M45.9*, R11.0 This encounter is coded as 99214 because it includes: Detailed history; Comprehensive examination—eight systems counted; and Medical decision making—moderate complexity (established problem, new problem with no additional workup; new prescription drug ordered). Keep in mind, the CT guidance is an inclusive…

Rheumatology Community Applauds CMS Guidance Providing ICD-10 “Safe Harbor” Period, Encourages Further Action to Ensure Responsible Transition

American College of Rheumatology  |  

ATLANTA, Ga.—The American College of Rheumatology (ACR) today praised the Centers for Medicare and Medicaid Services (CMS) for issuing new guidance to provide a 12-month “safe harbor” period for physicians following the Oct. 1 implementation of the ICD-10 code set. The ACR has led legislative and grassroots efforts to responsibly address the transition to the…

Rheumatology Coding Corner Answer: Trigger Point Injections for Fibromyalgia

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Take the challenge. CPT codes: 99213-25, 20553, 73120/LT Diagnosis: ICD-9 7291 ICD-10 M79.7 Coding for trigger-point injections continues to create a lot of confusion on proper coding guidelines. Keep in mind, two CPT4 codes can be used for trigger-point procedures: 20552—Injection(s); single or multiple trigger point(s), one or two muscle(s); and 20553—Single or multiple trigger…

2015 ACR/ARHP Annual Meeting to Offer Coding, Practice Management Sessions

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At this year’s ACR/ARHP Annual Meeting in San Francisco, you can take advantage of a variety of sessions designed to address pressing concerns in practice management today. Practice managers, clinicians, office staff and others will enjoy and benefit from hands-on practical sessions and informative panel discussions by top content experts in the field. Here are…

Medicare Incident-to Billing Rules, Pitfalls

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In today’s busy rheumatology practices, the services of nurse practitioners, physician assistants, occupational therapists and clinical nurse specialists are a great asset for patient flow, as well as increased revenue. As the growth of nonphysician providers (NPPs) in rheumatology practices has evolved, it has become increasingly important to understand the incident-to rules and avoid the…

Rheumatology Coding Corner Question: Knee Osteoarthritis

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Incident-to Billing Case Scenario A 51-year-old female patient returns for a follow-up visit with a physician assistant (PA) for unilateral primary osteoarthritis of her right knee. She had an intraarticular corticosteroid injection of her right knee six weeks prior to her visit. She reports significant improvement in her knee pain and stiffness, and states the…

Rheumatology Coding Corner Answer: Knee Osteoarthritis

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Diagnoses: ICD-9 715.16, 528.02, E943.8 ICD-10 M17.11, K12.32, T39.395A This was an established patient visit with a new diagnosis. Because the PA sought out the physician to address the new problem and document the assessment and treatment, the visit can still be billed as incident-to. Note: The physician initiated the plan of care for treatment…