Maintaining a health revenue cycle in a medical practice comes with myriad moving parts. Numerous external forces, such as economic conditions, government programs (e.g., the Zone Program Integrity Contractor [ZPIC], the Health Information Technology for Economic Clinical Health [HITECH]) and legislation passed under healthcare reform, mandate healthcare organizations to begin managing internal processes, such as…
Systemic lupus erythematosus (SLE) is a leading cause of death among young women, according to an August 2018 study in Arthritis & Rheumatology.1 To help determine where SLE ranks among causes of death, Eric Y. Yen, MD, and Ram Raj Singh, MD, conducted a population-based study using nationwide mortality counts for all female residents of…
Take the challenge. CPT codes: 99203/99243 ICD-10: M25.521, M25.522, M25.561, M25.562 History—Comprehensive: The history of present illness is extended, the review of systems is complete, and the past medical, family and social history are documented. All three of the HPI, ROS and PFSH are needed to achieve the history level as comprehensive. Examination—Detailed: This level…
Take the challenge. Scenario 1 is the correct answer. Although documentation of both scenarios supports a Level 4 visit, only one supports the medical necessity to code an evaluation and management (E/M) visit on the same day with a procedure. Scenario 1 supports the need for a separate E/M visit, because a new problem was…
Scenario 1 History: A 45-year-old male patient with sero-negative rheumatoid arthritis affecting multiple sites, but with no organ or systems involvement, comes for a follow-up visit. The patient reports swelling of the left knee with throbbing left knee pain. He rates the severity of his pain at an 8 on a 10-point scale. The pain…
Take the challenge. CPT codes: 96413, 96415, 96375, J1745x30, J1200x1 Diagnosis ICD-10: M05.79 With the total infusion time of two hours and 13 minutes, CPT code 96413 is used to code for the first hour of the infusion and 96415 for the additional hour. The infusion would have to be 31 minutes into the next…
Take the challenge. CPT codes: 96413, 96415, 96375, Q5103x20, J1200 ICD-10: M07.9 Coding Rationale This procedure is billed with CPT code 96413 for the initial hour of the intravenous infusion and CPT code 96415 for each additional hour. The patient was given 50 mg of diphenhydramine prior to the infusion to prevent reactions and should…
Take the challenge. CPT codes: 99214, 71045, 86580 ICD-10: M05.79, R05, R06.2 History—Detailed: The history of present illness (HPI) was extended; the review of systems (ROS) was extended; and the past medical, family and social history (PFSH) were documented. All three components of the HPI, ROS and PFSH are needed to achieve the detailed history…
Take the challenge. CPT codes: 20611-LT, 20611-RT, J7326x2 or 20611, 20611-50, J7326x2 ICD-10: M17.0 Coding Rationale CPT Codes: 20610-LT, J7325x16 ICD-10 Code: M17.12 This claim is rejected by the insurance carrier because the injection was outside of the preauthorization window that ended on Oct. 31. Most insurance carriers enforce their preauthorization dates for procedures. In…
The ACR Practice Management Department actively works to provide valuable, accessible resources addressing practice issues on a local and national level to rheumatologists and their staff. Our trained professionals are devoted to providing the most up-to-date tools and resources to help improve practice efficiency while meeting the myriad compliance obligations of the ever-changing healthcare landscape….