Did you know a laboratory can perform one of two different tests when a provider orders an HLA-B27 blood test? The ACR Insurance Subcommittee has received several complaints regarding commercial payer coverage for these tests, depending on which methodology the lab employs. To avoid administrative burden, members should familiarize themselves with lab practices and payer…
CMS Says U.S. Health Spending to Rise 5.5% Per Year over Next Decade
(Reuters)—U.S. health spending is expected to grow at an average rate of 5.5% every year from 2018 over the next decade and will reach nearly $6 trillion by 2027 as more people become eligible for Medicare, a government health agency said on Wednesday. Rising income levels, better employment rate and more people enrolling for Medicare,…
Coding Corner Answer: A Quiz on Modifiers
Take the challenge. 1. A—Modifier -25 is defined as a significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. It is to be placed on the E/M visit only because it attests to the payer there is…
Coding Corner Question: A Quiz on Modifiers
Which modifier is used when there is a separate and/or identifiable reason to bill for both an evaluation and management code and a procedure code? -25 -24 -51 -59 Which modifier is used to indicate that bilateral procedures were done on a patient? -50 -LT/RT Both a and b None of the above A 68–year-old…
7 Smartphone Tools for Rheumatologists
CHICAGO—Suleman Bhana, MD, a rheumatologist at New York-based Crystal Run Healthcare, calls himself a “technology nerd,” but judging by his review of tech tools at the 2018 ACR/ARHP Annual Meeting, you don’t have to geek out to embrace technology in your rheumatology practice. You just have to like simplicity and saving money. “We have a…
Possible MIPS Errors in 2019 Payment Adjustment
Recently, the Centers for Medicare and Medicaid Services (CMS) discovered an error in the implementation of the 2019 Merit-Based Incentive Payment System (MIPS) payment adjustment. It incorrectly applies adjustments to payments for Medicare Part B drugs and other non-physician services billed by physicians. Adjustments to affected claims will occur in the near future. According to the…
Update & Changes to the OIG Work Plan
Early last fall, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its OIG Work Plan for fiscal year 2018–2019, which is a two-year framework for the audits, inspections, evaluations and investigative activities planned in support of its vision, mission, and strategic goals and objectives to maintain HHS program integrity….
Coding Corner Answers: Billing for Joint Injection within a Series
Take the challenge. CPT: 20611-LT, J7325-EJ ICD-10: M17.12, E66.01, Z68.41 Coding/Billing Rationale No evaluation and management (E/M) code was added because there was no significant and/or separate identifiable reason for an E/M service to be billed with this scheduled visit for her series of injections. The joint injection was billed with ultrasound guidance due to…
Coding Corner Question: Billing for Joint Injection within a Series
A 68-year-old female Medicare patient with a diagnosis of primary osteoarthritis of the left knee returns to a practice for her third injection in a series of knee injections. She reports being able to resume her after-dinner walks, which last for 30–40 minutes at least twice weekly. She denies fevers or any rashes. She has…
Rheumatology Clinics Add Pharmacists to Care Teams, See Benefits
CHICAGO—Could the addition of a pharmacist to rheumatology care teams improve patient satisfaction, decrease staff burnout or reduce medication-related problems? Three panelists in Integrating Pharmacists into the Workforce, a session at the 2018 ACR/ARHP Annual Meeting, shared positive experiences with this interdisciplinary care model. Less Burnout, More Satisfaction Ten years ago, the Arthritis Treatment Center…
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