Obesity is a well-known risk factor for knee osteoarthritis (OA), but data regarding the association of body composition (fat and muscle mass) with the risk of knee OA are lacking. Thus, it is not clear whether the effects of BMI, typically interpreted as effects of obesity, are truly due to excess adiposity rather than to overall loading due to the combined weight of body mass. Misra et al. undertook this study to examine the longitudinal association of body composition categories based on fat and muscle mass with the risk of incident knee OA…
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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…
Case Report: Coccidioides Immitis Infects a Patient’s Vascular Graft
A 76-year-old Caucasian male with a history of abdominal aortic aneurysm repair five years earlier presented with three months duration of worsening periumbilical abdominal pain associated with nausea, non-bloody emesis, decreased appetite, fatigue and a 40 lb. weight loss. He denied having fever, chills, night sweats, temporal headaches, vision loss, chest pain, shortness of breath and…
Case Report: Lymphocytic Vasculitis of the Central Nervous System
Vasculitis is a group of chronic inflammatory diseases in which the blood vessel is the target of an immune reaction. They can be secondary to connective tissue disease, idiopathic or due to infection, neoplasm or drugs.1 Primary angiitis of the central nervous system (PACNS) is a rare syndrome characterized by inflammatory cell infiltration and necrosis…
Patients with Prediabetes May Be Predisposed to Arthritis
New research from the CDC shows that approximately one-third of U.S. adults with prediabetes also have arthritis, which can prevent physical activity in these patients, thereby, making it more likely they will develop type 2 diabetes…
Tips for Using Digital Health Tools
CHICAGO—Approximately 200,000 health apps are available through major app stores. Some offer real benefits, said Brennan Spiegel, MD, MSHS, director of health services research at Cedars-Sinai Health System, Los Angeles, Calif. But most, he told attendees at the 2018 ACR/ARHP Annual Meeting, are “rubbish.” “They do one or two things only—and generally not well,” he…
VA Study Tracks Biologics Usage, Finds Dramatic Patient-Age Difference
Patients under the care of the U.S. Veterans Affairs who were older, non-white and had more comorbidities were less frequently given biologic initiation therapy to treat their rheumatoid arthritis (RA), according to a recent study. Researchers sought to identify predictors of greater use of biologic therapies, as well as factors associated with persistent use of…
New PsA Guideline Released
The ACR & the National Psoriasis Foundation (NPF) have published a joint Guideline for the Treatment of Psoriatic Arthritis (PsA). The guideline will serve as an aid to practitioners managing active PsA in patients.
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