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Coding Corner Answer: To Bill or Not to Bill an Eval & Management Visit?

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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…

Coding Corner Question: To Bill or Not to Bill an Eval & Management Visit?

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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…

5 Ways to Improve Your Collaboration with Orthopedic Surgeons

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Rheumatologists and orthopedic surgeons must frequently collaborate to provide optimal patient care. Sometimes, they may even work at the same practice and form a care team for easy collaboration. Still, patient management from both specialties can be challenging, and specialists from both sides can learn from each other. How Crossover Starts Rheumatologists and orthopedic surgeons…

Figure 2: Renal Biopsy

The Classification & Diagnosis of Granulomatosis with Polyangiitis

Harry E. Subramanian, Ravi Sutaria, MD, & Fotios Koumpouras, MD  |  

Based on the classification system developed by the Chapel Hill Consensus Conference, anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis is defined as a necrotizing vasculitis involving small vessels that is associated with myeloperoxidase (MPO) ANCA or proteinase 3 (PR3) ANCA and displays minimal immune deposits. The mechanism behind the pathogenesis of ANCA-associated vasculitis is not fully…

Antiphospholipid Syndrome: The Risk of Travel at High Altitudes

Antiphospholipid Syndrome: The Risk of Travel at High Altitudes

Vaneet Kaur Sandhu, MD, & Kathleen Teves, MD  |  

Antiphospholipid syndrome (APS) is an autoimmune clotting disorder that may present catastrophically with multiple thromboses over a short period of time. In this article, we examine the case of a woman with undiagnosed APS whose first symptoms presented during a long-haul flight. A review of the literature on thrombosis at high altitudes and during long…

Lyme Arthritis Treatment Protocols Critical as Lyme Disease Spreads

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As Lyme disease and Lyme arthritis spread to new regions in North America, physicians may ned to become aware of their signs and symptoms. Allen C. Steere, MD, says “Lyme arthritis is more complicated to treat than other manifestations of the disease.” Here are some best practices for treating Lyme arthritis…

ACR Advocates for Access to Viscosupplementation for OA

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In several U.S. states, Blue Cross/Blue Shield and other insurers have dropped or are considering dropping coverage of hyaluronic acid injection—or viscosupplementation—for patients with knee osteoarthritis. The decision appears to be based on guidelines published by the American Academy of Orthopaedic Surgeons in 2013, which at that time specified that research had not found hyaluronic…

Don’t Rule Out Placebos for Osteoarthritis Pain Control

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CHICAGO—The placebo effect in treating pain in osteoarthritis (OA) should not be discounted, an expert said at the ACR State-of-the-Art Clinical Sym­posium in April. It’s especially important to accept the effect as real considering that trials of pain therapies in OA generate such high placebo effects (typically at least 40%) and that OA treatment options,…