(Reuters)—Health insurer Aetna Inc said on Wednesday it will exit the 2018 Obamacare individual insurance market in Delaware and Nebraska – the two remaining states where it offered the plans. Aetna had already said it would exit the individual commercial market in Virginia and Iowa, after pulling out of several other states last year. Aetna…
Cracking, Popping Joints May Foretell Arthritis
(Reuters Health)—Grating, cracking or popping sounds around joints may predict future arthritis, especially in the knees, according to a recent U.S. study. Among thousands of people with no knee pain who were followed for three years, one quarter had noisy knees yet they made up three quarters of the cases of symptomatic knee arthritis that…
Republican Moves on Obamacare Cloud Insurers’ 2018 Plans
NEW YORK (Reuters)—U.S. Republicans may be moving ahead with a vote to repeal Obamacare, but the uncertainty about what a national health law may look like is clouding insurers’ decisions on whether to stay in the individual insurance market in 2018. Republicans do plan to vote on the U.S. House of Representatives bill, the American…
CMS Notifying Clinicians of Their MIPS Status
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…
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