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…
Time Plays an Important Role in Selecting the Best Services Billing Code
The evaluation and management (E/M) code set in the American Medical Association’s Current Procedural Terminology (CPT) book lists descriptors, as well as typical times for patient visits. These times are averages of how long it takes a physician to complete all components of a visit at each level. Because the specific times identified in the…
Value for Service: ACR Update on RUC & CPT Activities
The American Medical Association (AMA) Relative Value Update Committee (RUC) and Current Procedural Terminology (CPT) meet three times a year to keep the CPT code set up to date and review resource costs for physicians. The two-step meetings of the CPT Editorial Panel and the RUC allow physicians to provide direct input to the Centers…
Closed Case? ACR Fights CMS Proposed Changes for E/M Reimbursement
When the Centers for Medicare and Medicaid Services (CMS) proposed coding and documentation changes to consolidate evaluation and management (E/M) services last fall, the ACR was among many specialist societies actively involved in advocating against the proposed ruling. The changes to E/M coding were part of a larger initiative to reduce the documentation burden on…
Coding Corner Question: Use Level 3 or 4 for RA/Gout Patient?
A 60-year-old man returns for a follow-up related to his diagnoses of rheumatoid arthritis and chronic gout of his right ankle and foot, without tophi. He reports the gout flares have subsided in his ankle. He takes 450 mg of allopurinol daily. He has rheumatoid factor-positive rheumatoid arthritis, which previously affected multiple sites, without organ…
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