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

Billing/Coding

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…

Rheumatology Coding Corner Answer: Joint Injection with Ultrasound Guidance, No Office Visit

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Take the challenge. CPT: 20611-RT, J1040, 89060 ICD-10: M17.11 Coding Rationale Keep in mind, no evaluation and management services are billed because there wasn’t a separate and/or significant reason, other than the knee injection, addressed during the visit. Note: Although the injection was performed via ultrasound guidance, CPT code 76942 should not be billed with…

Rheumatology Coding Corner Answer: Gout Visit for Established Patient

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CPT: 99213, 89060 ICD-10: M10.072 Coding Rationale This is an established out­patient visit. The encounter is coded as 99213 because it included: History—Expanded problem-focused history. The history of present illness was brief, the review of systems was extended and the past medical and social history was documented. Examination—Detailed. There were seven organ systems examined. This…