Infusion Administration
Many offices are using Medical Assistants to infuse biologics under the direct supervision of a physician. It is very unclear whether or not this is under their scope of practice legally. My question...
View Article20611 Injection with calcium breakdown
I don't often bill for such injections so I thought I should ask the experts. Procedure: Ultrasound Guided Subacromial Subdeltoid Bursa Injection w/ tenotomy and Percutanious Needlain of Calcification...
View ArticleSubacromial Bursa & Glenohumeral Joint Injections
Has anyone billed a subacromial bursa and glenohumeral joint injection together? These are 2 seperate areas of the shoulder with 2 different reasons for the injection. It seems you should be able to...
View ArticleRheumatology 99214
I have a couple of Rheumatolgiest that see alot of RA patients. When they come in for a follow up they are wanting to bill level fours. If the patient is in stable condition and nothing is being...
View ArticleUltrasound Guided Injection as of 2015
Medicare coding I haven't been having an issue with- I know what their rules are. I have had problems with commercial insurance companies. Some deny the new codes, but only sometimes. I haven't been...
View Article96401 billed twice with J0717
Can anyone clarify if 96401 can be billed twice with J0717 (Cimzia), which is a Sub Q administered drug? It is given as two injections (left and rt side of abdomen). The manufacturer protocol says we...
View ArticleUltrasound for diagnostic
Can you tell me if a physician uses ultrasound for diagnostic and then decides based on findings to inject the joint that now includes the ultrasound is acceptable to charge the diagnostic ultrsound...
View Article20610 SI injection
Can this CPT be used for this anatonical site? I came across an LCD ( 31359) that says it is not appropriate to use this code for SI joint injection, rather use 27096. This code Injection procedure for...
View ArticleAlemtuzumab/ Lemtrada HCPCS code
I'm am wondering what code you are using for this drug prior to October 1st for Medicare patient in particular. We are having problems getting payment to even cover the cost of this. We have used J3590...
View ArticlePositive RF without RA
Hello: I'm looking for an ICD-10 code for patients that are seropositive (+RF) but does not actually have Rheumatoid Arthritis (RA). Thank you
View Articlerheumatology
I'm not sure if I agree with the CPT my Doctor chose for the patients procedure. The treatment was for trochanteric bursitis. The Doctor injected 40 mg of kenalog into the patients left trochanteric...
View Article20551 vs 20610
M Doctor is billing a 20551 and I do not agree with the procedure she chose. I think she should have billed a 20610 because she injected into the left trochanteric bursa. Her note indicates Patient...
View ArticleNail fold capillaroscopy
Could someone please advise if nail fold capillaroscopy is billable? I am unable to find a CPT code. If anyone has any information or links they could post, would be much appreciated! Thank you!
View Articledocumentation post ICD10 grace period
With the grace period for documentation/coding issues for ICD10 ending effective 10/1/2016---can someone please clarify for me if our physicians (rheumatologists) are also required to be very detailed...
View ArticleRA with positive or negative RF
Hi, I have a question that may seem silly but, if a patient has a negative Rheumatoid Factor and a positive Anti- CCP would you use M05.79 Rheumatoid arthritis with rheumatoid factor of multiple sites...
View Articletreatment due to adverse reaction to HEP B Vaccine
Hi All, So here is the scenario.... Patient is seen in Rheumatology dept. for Hep B vaccine. Patient has a adverse reaction and Diphenhydramine 25mg is administered Intramuscular. Hydrocortisone 100mg...
View ArticleIgG4 Dx Code?
Does anyone have a code they use for this DX? I guess it is a new DX and no official code yet? Shari
View ArticleRheum specialty test & CEUs
Planning on taking the AAPC specialty test for this, any advice? And any idea on where to get the specialty CEUs? That is the one reason I am hesitant to go for this....Any help would be appreciated!...
View ArticleDrug Waste for Simponi Aria-Need Help ASAP
Each vial is 50 mg. We only gave 138.18 mgs and we wasted 11.89 mgs. How do we report this as drug waste? Thanks.
View ArticleSpecimen Handling
Are any rheumatology practices billing for specimen handling (code 99000)? I know Medicare will not reimburse for this, but are any commercials? Thanks.
View ArticleBaylor Scott & White Appeals
Hiya, Community! Can you help me? I have a friend at a HIPAA-/PHI-compliant business associate company who is seeking a better way to contact the appeals department at Baylor Scott & White (BSW)...
View ArticleIncident to and Infusions
We are a rheumatology office and are getting ready to hire a nurse practitioner. I have conflicting information on if the nurse practitioner is allowed to supervise infusions if the doctor is not in...
View Articlequery
Hi, I am new coder in the field of Rheumatology...any one can help me to know the way for coding & billing? Is there any use of Modifier?
View ArticleCAC Member?
Does anyone know any of the carrier advisory committee (CAC) members for any of the MAC jurisdictions? Thank you.
View Article2 day infusions
We have a patient that was receiving Rituxan infusion and because of a reaction and other health issues, we had to infuse slower and were unable to complete the infusion same day. The doctor ordered...
View ArticleProlia injections
Does anyone bill for these J3490 & 96372? We are trying to determine the cost and reimbursement in our internal care clinic. Thanks, Alicia
View ArticleAdministration Code Needed cor J0490 Benlysta
I work at a Rheumatology Practice in Kansas. When billing Medicare for J0490 Benlysta IV Infusion would we bill 96413 or 96365? Thanks
View ArticleDictation requirements for intercostal nerve injections
I am in serious need of help! I am assisting with our Rheumatology clinic and even though I have a background in Ortho I am not too familiar with this procedure. I requested clarification from the...
View ArticleModifier for Specialty Pharmacy Infusion Drugs
Hi we have a list of drugs that have to be ordered through the patients specialty pharmacy therefore we cannot bill the drug to the insurance. Is there a modifier that we can put on the drug CPT so the...
View ArticleCRHC CEUs
Anybody a CRHC? Having trouble finding CEUs for this...any help would be appreciated. -Wendy K Gray, CPC, COBGC, COSC, CRHC
View Article20611 done by CMA
I am looking at this procedure for the first time, covering for someone. Is this within the Scope of Practice for a CMA? I looked on the CA Board for CMA and only injection is mentioned not ultrasound....
View ArticleM05.89 with D89.9 THEN M06.09 with D89.9
I just started coding Rheumatology and I have a dilemma. Some of my providers are putting M05.89 (Other rheumatoid arthritis with rheumatoid factor of multiple site) with D89.9 (Disorder involving the...
View ArticleDocumenting the use of CBD Oil
Could you please give me your opinions on the documentation of the use of CBD oil in a physician's office note in Texas, where the use of Marijuana is illegal? Should the physician stay neutral and not...
View ArticleOsteoporosis
Current DEXA indicates osteopenia as does the latest progress note. The physician wrote M81.0 for the diagnosis on the Prolia order. He is basing the osteoporosis dx on a DEXA from 2007. Our office is...
View ArticleIV Billing without Rheumatologist
Is it acceptable for a Rheumatologist to bill for infusions when he is not in the office/infusion center? The office will have another non-Rheumatologist physician in the office/infusion center when...
View Articleshoulder tendonitis arthrocentesis
Im trying to see if my doctor is coding correctly for a shoulder arthrocentesis. He is putting Shoulder Tendonitis arthrocentesis and choosing 20610. Is that correct or would 20605 be more appropriate?
View ArticleHAQ and Rapid3 article
Hi everyone. I am fairly new to rheumatology coding. My physician presented me with an article on The Health Assessment Questionnaire (HAQ) and Routine Assessment of patient index data 3 (RAPID3) and...
View ArticleRheumatology
I would appreciate all the help that I can get. What is the procedure code for Ultrasound guided injection for for retrocalcaneal bursitis that was injected with Depo Med 40mg? Thanks again for your...
View ArticleBenlysta Waste
Is anyone else having issues with BCBS recouping the reimbursement they receive for Benlysta waste? It is billed out correctly with the modifier JW on the waste. EviCore is a third party company that...
View ArticleInfusion signatures
I am looking for official guidelines that states whether or not a physician (who signed orders for infusion) needs to co sign the progress/procedure note of the infusion that was performed by RN
View ArticleActemra
Is anyone having problems with Medicare denying J3262 as a duplicate. We have 3 different vials that each have their own NDC # so when a patient receives 600 mg(1-200 mg vial and 1-400 mg vial) we bill...
View Article20610 with liquid nitrogen
My provider freezes the site prior to injection. Are we able to bill for the use of liquid nitrogen or is it included.
View ArticleModifier help
Does anyone know if there is a modifier that can be used when billing J0490 with 2 different NDC #'s such as J0490. TIA
View ArticleDuplicate NDC denials
Hello - I just recently starting coding for Rheumatology. We have a drug - Acterma; CPT J3262 that we bill with 2 different NDC #'s and units. An example is: we use 600 units and bill as 1 line with...
View ArticlePort Flush
We have a patient that has a port and needs to be flushed. We are going to start her on Benlysta, but she needs her port flushed while we wait on her labs. Any advise from others that have a patient or...
View Articlelabs data qualifications
So based on 3/9 ama revision for 2021 e/m guidelines, if my Rheumo MD orders a series of labs to determine correct dx code (cmp, cbc, essays, etc) & we bill for the lab. then i can count either as...
View ArticleAdmin HCPCS for Methotrexate
I am looking for the Medicare accepted HCPCS for administration of methotrexate in the clinic setting for RA. Patient brought own meds.
View ArticleMedicare Denials
I have a quick question.... I am getting Medicare denials for CPT 96365, that it's not billed with an appropriate code. We do not bill for "J" code as the patient receives the medications free from the...
View ArticleInfusions
For Rheumatology if a provider starts and infusion does he need to be present the whole time of the infusion? Or can a NP step in? I've been looking for guide lines but cant seem to find any.
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