After 25 years, the American Medical Association (AMA) Current Procedural Terminology (CPT) office and outpatient evaluation and management (E/M) codes received a major overhaul. These changes, which went into effect Jan. 1, will help reduce administrative burden on providers and roll back some of the rigid requirements for E/M coding by simplifying the code selection…
The American Medical Association consists of two key groups: 1) the Relative Value Scale Update Committee (RUC), which oversees the annual updates to the physician work relative values, and 2) the Current Procedural Terminology (CPT) Editorial Panel, which assigns new or revised codes in the CPT book. The CPT Process Current Procedural Terminology (CPT) was…
To ensure adequate and appropriate reimbursement, rheumatologists must provide detailed information about their services to the people advocating on their behalf. With the proper information, advocates can then do the work necessary to secure the appropriate values for these services. These advocates are members of the Relative Value Update Committee (RUC), a volunteer committee of…
The rule for coding the drug administration’s CPT codes; coding an incident to patient correctly; billing for both a joint injection and aspiration; coding for five-trigger point injections in three different muscles; and the laboratory code for crystal identification by light microscopy lab
Office visits are considered evaluation and management codes (E/M) in the Current Procedural Terminology (CPT) manual and are a fundamental part of a rheumatologist’s day. There are two types of office visits: new patient and established patient.
New Patient vs. Established Patient Quiz 1. A 65-year-old female patient comes to see Dr. Raven at her new practice. The last time this patient saw Dr. Raven was eight weeks ago at her old practice. What type of patient visit is this? Established New 2. Dr. Smith joins a new practice and many of…
Take the challenge… 1. A: Established. Even though Dr. Raven is now practicing at a new location, the patient is considered an established patient because she received professional services from Dr. Raven within the past three years. The CPT manual defines a new patient as “one who has not received any professional services from the…
It is not unusual for rheumatologists to spend significant time during an office visit reviewing new and/or existing problems, modifying medications, counseling, and coordinating care, but is this additional time reimbursable?
Medically Unlikely Edits (MUEs) were launched on January 1, 2007 by the Centers for Medicare and Medicaid Services (CMS) to reduce the paid claims error rate for Medicare Part B claims. The function of MUEs is to detect and deny unlikely CMS claims for a Medicare patient on a single, 24-hour date of service on a prepayment basis. This is achieved by limiting the frequency of services provided by a physician or medical supply company.
July’s Coding Answer