In August 2018, the Centers for Medicare and Medicaid Services (CMS) announced it would permit Medicare Advantage plans to use step therapy for Part B drugs, with a lookback period of just 108 days.1 On May 16, 2019, however, the CMS issued a final rule that extends the lookback period for Part B therapies to 365…
What Pharmacists Want Rheumatologists to Know
Involving pharmacists in the management of chronic diseases benefits patients, says Wendy Ramey, BSPharm, RPh, CSP, a clinical pharmacy specialist in rheumatology at the University of Kentucky, Lexington. She knows this personally. As someone with rheumatoid arthritis (RA), Ms. Ramey knows pharmacists can play an important role in patient education and encouraging adherence to medications….
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…
Email & Text in the World of HIPAA
The world we live in necessitates information be communicated in a quick and easy manner. This remains true in the healthcare setting. The ability to text or email staff and patients has become a priority for many healthcare entities. However, maintaining patient privacy and confidentiality is essential to ensure we meet compliance standards. Although emailing…
How to Address the Rheumatology Workforce Gap
The College’s principal journals have been telling the tale of workforce woe, exploring the reasons for our predicament and potential solutions for the long and short term.1,2 Among the medium-term remedies is increased use of advanced practice clinicians (APCs), as we collectively refer to nurse practitioners and physician assistants in rheumatology practices. Solutions Estimates of…
ACR Leaders to Meet with Members of Congress
On May 16, ACR and ARP leaders serving on the Board of Directors, Affiliate Society Council, Government Affairs Committee, Committee on Rheumatologic Care, RheumPAC and Insurance Subcommittee will go to Capitol Hill to advocate on behalf of the College’s membership and our patients. The group represents 31 states and the District of Columbia, and will…
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…
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