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…
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2 Medical Schools Work to Improve Rheumatology Learning
CHICAGO—The pre-clinical rheumatology curriculum at the University of North Carolina (UNC) School of Medicine, Chapel Hill, used to consist mainly of portions of a musculoskeletal course, with up to only three instructional hours, and not always with a rheumatologist in the room with students. Systemic autoimmune diseases were never fully discussed in any of the…
These 3 Tough Cases from the 2018 Thieves Market Underscore Need for Clinical Diligence
CHICAGO—In the Thieves Market session at the 2018 ACR/ARHP Annual Meeting, rheumatologists from around the country presented a slate of challenging cases that emphasized the importance of clinical persistence and attention to detail, and the need to consider diagnoses that might not be common or obvious. Three of them are summarized below. (Look for more…
Why & How Our Biologic Drug Discussion with Patients Should Evolve
As we turn the corner on the second decade of biologic use for rheumatic disorders, a reappraisal of approach in our communication with patients is due. In practice, the impact these agents have on patients’ lives justifies the friction rheumatologists face when connecting patients to them. You can understand why older rheumatologists who apprenticed on…
Cancer-Associated Myositis: A Case Report & Review of the Literature
Since it was first reported in 1916, a correlation between inflammatory myopathies and cancer has been noted in several studies. Population studies have confirmed this relationship, and the phrase cancer-associated myopathy has entered the vernacular. Over the past decade, research efforts have shifted toward revealing associations between autoantibodies and clinical phenotypes. One subset of auto-antigens…
OA Patient-Reported Outcomes Positive for Intra-Articular Injection
In a recent Phase 2 clinical trial, patient-perceived pain and function measures improved with SM04690, an injectable, disease-modifying osteoarthritis treatment currently in development…
Rheumatology Advocacy in 2019
A belated Happy New Year to my fellow advocates! Here’s your first update for 2019 on what the rheumatology community should know is going on in Washington, D.C., right now. Current Climate On Jan. 3, the 116th Congress gaveled into session with Democrats in control of the House of Representatives and Republicans still the majority in the…
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…
How to Proceed When Kids Present with Joint Pain but Normal Exams
CHICAGO—When it comes to correctly diagnosing joint pain in children, “things take time,” said Michael L. Miller, MD, quoting Danish physicist and poet Piet Hein. Children with pain but normal physical examinations may need to return to the clinic for repeat evaluation over several months. “I often tell parents that laboratory tests may help in…
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