Major changes to office and outpatient evaluation and management codes 99201–99205 and 99211–99215 will take effect Jan. 1, 2021.
Coding Corner Answers: Rheumatology Word Search
Take the challenge. Answers Biosimilars Methotrexate Time Presenting problem Ultrasound guidance International Classification of Diseases Current Procedural Terminology Trigger points Osteoporosis Osteoarthritis
Coding Corner Questions: Rheumatology Word Search
Questions What type of drug is interchangeable with an FDA-approved biologic? What drug is used in conjunction with infliximab, unless the patient cannot tolerate it? What can be used as a key element in an evaluation and management (E/M) service, along with the history, exam and medical decision making? What drives the level of an…
2019 MIPS Reporting via RISE: Are You Ready?
It’s time to prepare for 2019 MIPS reporting via the Rheumatology Informatics System for Effectiveness (RISE) registry, and the ACR is here to help. To ensure you’re ready to submit your data to the Centers for Medicare & Medicaid Services (CMS), RISE users should take the following steps: Review your data in the dashboard; Make…
Reimbursement Options for Services Without Direct Patient Contact
Beginning in October 2019, two major commercial payers, UnitedHealthcare and Cigna, discontinued payment for consultation services. The CPT codes affected include 99241–99245 and 99251–99255. The payers have instructed providers to instead bill the non-consultative evaluation and management (E/M) codes that best describe the services performed. If the non-face-to-face service goes beyond the usual time a…
Coding Corner Answers: Navigating Medicare’s Online Resources
Take the challenge. 1. A—Internet-only manuals Before appealing the request for an overpayment or appealing a denial, providers and staff should first verify the claim was coded and billed correctly. Second, staff should review the internet-only manuals website, which includes operating instructions, policies and procedures that cover CMS policies based on statutes, regulations, guidelines, models…
Coding Corner Questions: Navigating Medicare’s Online Resources
A practice receives an overpayment request from the Centers for Medicare & Medicaid Services (CMS) for not meeting medical necessity related to a biologic infusion. In which instructional guideline can the coding and billing staff find the necessary information on the CMS website to handle this request? Internet-only manuals National Correct Coding Initiative Medically Unlikely…
Coding Corner Answer: An Insurance Billing Quiz
Take the challenge. A—The commercial insurance coverage is primary in this situation. Medicare should be billed secondarily because it will not become primary until after the first 30 months of ESRD Medicare entitlement. After that, Medicare will be primary no matter the patient’s employment status. C—Unless the patient has a qualifying condition, such as ESRD,…
Coding Corner Question: An Insurance Billing Quiz
A 55-year-old male patient diagnosed with generalized osteoarthritis and diagnosed with end stage renal failure (ESRD) 20 months previously presents to the office to see the rheumatologist. The patient has a commercial insurance plan and Medicare. Which carrier is primary for this visit? Commercial insurance carrier Medicare You do not know because it is not…
ACR Leads Coalition Opposing Cigna’s Elimination of Consultation Codes
In a letter co-signed by other Cognitive Specialty Coalition organizations, the ACR is requesting at least a one-year delay to better coordinate payer changes with recent federal initiatives.
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