Cigna recently announced that they will discontinue payment for consultation codes later this year. As of Oct. 19, 2019, the payer will implement a new policy on Evaluation and Management (R30) that will deny claims billed with CPT codes for consultation services as not valid. Impacted CPT codes are 99241, 99242, 99243, 99244, 99245, 99251,…
Coding Corner Answer: Interprofessional Consultations
Take the challenge. Answer: This is a two-part office visit scenario. The first part of the scenario illustrates the original new patient office visit, and the second portion is for the follow-up, interprofessional telephone consultation with the patient’s ophthalmologist. For the office visit … CPT: 99203 ICD-10: B30.8, M45.5, I73.00 The history was detailed, because…
Coding Corner Question: Interprofessional Consultations
A 68-year-old patient reports that her eyes have been itchy and red for approximately one month. She was treated with erythromycin gel on Jan. 10; while the itching did not stop, the redness resolved. She denies any matting and has not used any other type of eye drops. She states there has been no change…
CMS 2018 MIPS Performance Feedback, Final Score & Targeted Review Now Available
Your 2018 MIPS performance feedback and final score from the CMS are now available on the Quality Payment Program website. To learn more about performance feedback, view the frequently asked questions document from the CMS. The payment adjustment you will receive in 2020 is based on your score for the 2018 performance year. If you…
New Wins, Ongoing Challenges for ACR Insurance Subcommittee
Corrections to reimbursement system errors with Aetna and a Medicare contractor demonstrate the latest wins for all providers by the ACR’s Insurance Subcommittee. But the committee remains hard at work advocating for rheumatologists on several fronts.
Medicare Patient Costs Lower at Teaching Hospitals
NEW YORK (Reuters Health)—The overall 30-day costs of caring for Medicare patients are lower at teaching hospitals, according to data from the Medicare inpatient file. “We found it really interesting that the lower costs seen at major teaching hospitals was driven primarily by lower costs after discharge from the hospital,” Dr. Laura G. Burke from…
Coding Corner Answer: Are Brief Phone Calls with Patients Billable?
Take the challenge. Scenario B is billable and should be coded as G2012. The ICD-10 is M06.09. As of January 2019, the Centers for Medicare & Medicaid Services has allowed a new code to be billed for a brief communication for virtual check-in by a physician or a qualified healthcare professional who can provide an…
Coding Corner Question: Are Brief Phone Calls with Patients Billable?
Scenario A A 67-year-old, female Medicare patient diagnosed with rheumatoid arthritis, previously without rheumatoid factor, calls the rheumatologist’s office to get an update on the lab tests taken when she was last seen in the office two weeks before. The patient was tested for C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) and…
Coding Corner Question: How to Bill a Rituximab Infusion Visit?
A 66-year-old female patient returns for a second infusion of rituximab for her diagnosis of rheumatoid arthritis in multiple sites. She is rheumatoid factor positive. She says the pain in her knees, elbows and neck has slightly improved. She rates the severity of her pain at a 7 on a 10-point scale, which is an…
Coding Corner Answer: How to Bill a Rituximab Infusion Visit?
Take the challenge. CPT Codes: 96413, 96415 x 3, J9312 x 5, 96375, J2920 Diagnoses: M05.79 Coding Rationale As of Jan. 1, 2019, the Healthcare Common Procedure Coding System (HCPCS) code for rituximab was changed from J9310 rituximab 100 mg, to the new HCPCS code J9312 (injection, rituximab, 100 mg). According to a Verywell Health…
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