I have been tongue-tied, of late. When I was a medical student, I was told not to turn the physical examination into an aerobic workout. This sage piece of advice was imparted by my physical examination preceptor, who had watched me perform a complete examination on a hapless volunteer. At the time, I thought of…
Camelot allegedly existed once upon a time in South Wales. The name was evoked again in the 1960s, but perhaps it is also applicable to the character of rheumatology in the halcyon days of the 1970s and 80s. That’s not to belittle the world we now live in, with so many treatment options for our…
For most rheumatologists, the key elements of the physical exam—inspection, palpation, percussion and auscultation—have long been second nature, but a fifth modality has grown in importance with respect to making the correct diagnosis: ultrasound. From evaluating for Doppler signal and additional findings indicative of synovitis to identifying bony erosions, chondrocalcinosis, tophi and other articular and…
ATLANTA—Two ways to investigate injuries to the upper extremities are by in-depth physical examinations and ultrasound. In a Clinical Practice session at the 2019 ACR/ARP Annual Meeting, Anatomy: Correlating Physical Exam and Ultrasound in Common Sports Injuries of the Upper Extremity, Carlin Senter, MD, FACP, associate professor of primary care sports medicine at the University…
Many, if not all, rheumatologists seek to grow as clinicians so they can provide consistently exceptional care to patients and serve as role models for colleagues and trainees. In this series, Lessons from a Master Clinician, we compile insights from clinicians who have achieved a level of distinction in the field of rheumatology. Gail Kerr,…
The adage frequently cited in healthcare settings, “If it isn’t documented, it wasn’t done,” still rings true for the key components required in a patient’s medical record. The note in the medical record must sufficiently describe all of the services furnished to patients on a specific date. The essential requirements to appropriately bill a claim…
Take the challenge. CPT: 99214-25, 96413, 96415 x 1, J1745 x 35 ICD-10: M07.68, K51.80 Billing Overview It is appropriate to bill for an E/M visit for this day of service along with the infusion procedure. Modifier 25 should be appended to the E/M, indicating that the patient received a significant, separately identifiable E/M service…
A 12-year-old male established patient with inflammatory bowel disease with associated juvenile spondyloarthropathy returns to the office for a follow-up visit for his infliximab infusion. The patient reports moderate pain in his right hip after walking for extended periods of time or after sports activities. He denies any other joint pain and denies any joint…
“Do you seriously want me to stand on my tiptoes?” my gruff 68-year-old patient at the VA Rheumatology Clinic asked, incredulous. “I came with a walker. I think you very well know, doc, that if I get on my tippy-toes, then I’m going to fall flat on my face.” He had a point, one that…
A rheumatologist stresses the need for more thorough exams in the context of one patient’s hospital admission for stroke