According to the Centers for Medicare & Medicaid Services (CMS), the Medicare Administrative Contractors (MACs) that process Medicare Part B claims have begun informing providers of their participation status in the Merit-Based Incentive Payment System (MIPS). This information is coming in the form of hard-copy letters that started mailing in late April and will continue…
Institute for Clinical Economic Review Final Report on RA Treatments
On April 7, 2017, the Institute for Clinical and Economic Review (ICER) published its final report, titled, Targeted Immune Modulators for Rheumatoid Arthritis: Effectiveness & Value.1 The stated objective of the report was to assess the comparative clinical effectiveness of the targeted immune modulators (TIMs) used to treat patients with moderate to severe active rheumatoid…
Noridian Updates Tendon Injections Guidelines for Jurisdiction F
Effective May 22, 2017 Noridian has updated the Local Coverage Determination (LCD) coding guidelines for CPT procedures 20552, injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) and 20553, injection(s); single or multiple trigger point(s), 3 or more used to affect therapy for a pathological condition. Noridian states the goal of the updated diagnostic…
Data Tool: How to Design an EHR Algorithm to Identify SLE Patients
Electronic health records enable researchers to access significant amounts of patient data, but identifying subjects with a specific condition can be difficult. In a recent study, researchers successfully designed three algorithms to identify patients with SLE, incorporating multiple counts of the ICD-9 code, laboratory testing, medication data and keywords. In the future, these algorithms may successfully transfer to other systems to aid research…
Rheumatology Coding Corner Question: Billing Infusion Procedure with JW Modifier
An 82-year-old female established patient diagnosed with ankylosing spondylitis in multiple joints returns to the office for her second infliximab infusion. She denies any fevers, cough or concurrent illness. Her joint pain is 7 on a scale of 1–10. She complains of achy pain in the cervical, lumbar and sacral regions of her spine. She…
Rheumatology Coding Corner Answer: Billing Infusion Procedure with JW Modifier
Take the challenge. CPT: 99214-25, 96413, 96375, 96361-59, J1745 x 4 J1745 JW* x 36, J1200 x1 ICD-10: M45.09, T50.995A, R06.02, E66.3, Z68.2 Rationale Modifier 25 is appropriate to use because it indicates the patient received a significant, separately identifiable E/M service on the same day as the infliximab infusion. This E/M service entailed the…
ACR Advocates for Regulatory Relief and Flexibility for MACRA
The American College of Rheumatology (ACR) continues to provide feedback to the Centers for Medicare & Medicaid Services (CMS) about the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 on behalf of rheumatologists. The bipartisan bill repealed the Sustainable Growth Rate and transitioned Medicare from fee for service to a system…
Straightforward Approach Can Help Rheumatology Health Professionals Engage with Fibromyalgia Patients
“I have pain all over my body” is a challenging response after you’ve asked a new patient what brings them in for their visit. You immediately suspect that this patient has fibromyalgia. The prevalence of fibromyalgia in the U.S. is 5 million people, and it is among the most common conditions in many rheumatology practices….
How to Bill Medicare Patients for Non-Covered Services
What do you do when you are presented with a patient who needs treatment but the patient’s insurance company will not pay for the services? Can you provide the services anyway? Who will pay for them? How do you collect payment for such services? If the patient consents to receive the services in spite of…
Use Time Component When Coding Counseling, Coordination of Care Visits
Although there are seven components for the levels of evaluation and management (E/M) services, most encounter levels are coded on the basis of the history, examination and medical decision making (MDM), which are the key components extracted from documentation in the medical record. However, when counseling and coordination of care for a patient are the…
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