The complexity add-on code is appropriate to bill for an evaluation and management visit related to a transient or temporary problem when there is an established relationship for ongoing longitudinal care, even if the ongoing care is unrelated to the transient problem being treated.
Community Practice Rheumatology Is Challenging, But Rewarding, Too
Community practice rheumatology may be a less-followed path within the specialty, and it brings with it certain challenges. However, it also offers rewards, such as autonomy and deep relationships with patients. The Rheumatologist recently interviewed three community practice rheumatologists from around the U.S. to find out about their approaches to patient management, staffing and other…
ACR Advocates with Payers Against Insufficient Reimbursement for Biosimilars
The ACR is engaging with payers regarding formulary requirements that would leave practices underwater when treating patients with rheumatic diseases.
Ask Congress to Support Complexity Add-on Code
Implementation of the G2211 add-on code for evaluation and management services is included in the CY 2024 Medicare Physician Fee Schedule, barring further delays. Ask your lawmakers to support timely implementation and patient access to complex care.
After Pushback, Cigna Delays Modifier 25 Policy Changes
After significant pushback from the AMA, ACR and other medical societies, Cigna has delayed implementation of changes to its modifier 25 reimbursement policy, originally scheduled to take effect May 25.
Key Facts on Billing Drug Wastage
The ACR has compiled guidelines and tips on how to use the JW modifier and correctly bill Medicare for discarded drugs and biologicals. This modifier can be applied only to unused amounts from a single-dose vial or package.
ACR Proposes New ICD-10 Code to Capture ‘Pre-RA’
On Sept. 13, the ACR and Kevin D. Deane, MD, PhD, presented a proposal to create a new clinical code to recognize a condition in which an individual may exhibit rheumatoid arthritis-related autoantibodies without clinical presentation.
September Updates from the ACR Insurance Subcommittee
In recent months, the ISC has engaged with payers to reduce administrative burden on practices and continues to advocate to the CMS for the use of complex administration codes for biologics.
Ethics Forum: Billing, Burnout and Protected Non-Clinical Time
It’s 11 a.m. on a Wednesday. You see a new patient in your fellow’s clinic with impressive physical findings, including a prominent skin rash and deforming arthritis. The patient has been to many doctors and is frustrated that her condition remains undiagnosed and untreated. You thoroughly examine the patient, present her case to your attending…
Cigna Delays Modifier 25 Policy Change for Evaluation & Management Services
Cigna will not move forward with changes to their reimbursement policy for evaluation and management (E/M) codes submitted with modifier 25 as originally scheduled.
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