RheumWATCH Archives


Read the RheumWATCH archives on topics such as rheumatology advocacy, policy updates, insurance advocacy, and practice management.


ICD-10 Transition Today

ICD-10 Practice Pearls

The ACR has compiled six easy steps to help your practice navigate the ICD-10 transition:

  1. Download the top 50 rheumatology codes and the sample superbill as quick reference guides from the ICD-10 page.
  2. Create a cheat sheet with key coding guidelines for laterality and anatomical site (i.e., “1” is for the right side and “2” is for the left side).
  3. Make a list of key vendors and payers with contact information for easier access to communicate quickly on issues.
  4. Continue to monitor documentation requirements, as this is vital to coding from the correct family of codes (e.g., services for osteoarthritis with bilateral involvement should include anatomical site, as the family of codes are different):
    • M16.0—Bilateral primary osteoarthritis of hip
    • M17.0—Bilateral primary osteoarthritis of knee
    • M18.0—Bilateral primary osteoarthritis of first carpometacarpal joint
  5. Monitor accounts receivable, and track adjustment charges and collections closely for rejections and denials.
  6. Stay calm!

Because communications will be vital to the transition to the new code set, it is recommended to have a point person on staff to be a spokesperson in this capacity and to handle all ICD-10 questions or issues that may arise in the practice. The goal is to send out correct claims the first time, and it is a good idea to have your ICD-10 staff review and scrub all claims before sending out a final bill, saving a lot of time on the back end. Also, remember that documentation is the key to coding specificity—this will be the key to applying a valid code from the correct family of codes in ICD-10.

The ACR is here as a resource to members and their staff during the transition to ICD-10. All questions should be sent to practice@rheumatology.org, or directly contact Melesia Tillman, CPC, CPC-I, CRHC, CHA, at 404-633-3777 ext. 820 mtillman@rheumatology.org or Antanya Chung, CPC, CPC-I, CRHC, CCP, at 404-633-3777 ext. 818 achung@rheumatology.org.

ACR Urges Changes to Physician Fee Schedule

The American College of Rheumatology recently submitted comments to CMS on the 2015 Medicare Physician Fee Schedule Proposed Rule. The ACR’s comment letter addresses concerns related to the following provisions:

  • Evaluation and Management (E/M) Codes; Improving Payment Accuracy for Care Management Services
  • Changes to Chronic Care Management Payment/New Code Recommendations
  • MACRA Provisions
  • Potential Expansion of Comprehensive Primary Care Initiative
  • Appropriate Use Criteria for Advanced Diagnostic Imaging Services
  • Telehealth Initiatives
  • Potentially Misvalued Codes
  • Open Payments Data
  • Medicare Opt-Out
  • Biosimilars Reimbursement/Part B Drugs
  • PQRS/Measures Set
  • Physician Compare and Physician Compare Benchmark
  • Electronic Health Records/Meaningful Use
  • Value-Based Modifier
  • Stark Law/Self-Referral Updates
  • Incident-to Changes/Billing Physician as the Supervising Physician and Ancillary Personnel

Rheumatologists provide ongoing care for Medicare beneficiaries with complex chronic and acute conditions that require expertise beyond that of primary care providers. The ACR believes the viability of providing this care for Medicare beneficiaries must be protected.

The ACR is very concerned that workforce shortages may become more acute because of the increasing population of Medicare beneficiaries who will need rheumatology care and the influx of patients resulting from the Affordable Care Act.

If the expertise rheumatologists and other cognitive specialists bring to their patients is not valued appropriately, then the numbers of rheumatologists and other cognitive specialists will be inadequate to meet the growing demands for these services, restricting Medicare beneficiaries’ access to appropriate healthcare.

Read the full comment letter >

PQRS and QRUR Reports Released; Informal Review Period Open Now

All rheumatologists should view PQRS and QRUR reports to know how they are doing with patient outcomes and cost information that will be used to calculate the Value-Based Modifier adjustments. Last month, CMS released the 2014 Quality and Resource Use Reports (QRURs) and the 2014 Physician Quality Reporting System (PQRS) Feedback Reports. 2016 PQRS and Value Modifier (VM) payment adjustments are based on this 2014 reporting.

For groups with 10 or more PQRS-eligible professionals that are subject to the 2016 VM, the QRUR shows how the VM will affect Medicare’s 2016 payments to physicians. VM cost and quality scores will also be provided in the QRURs for other practices, even though they are not yet subject to the VM. If physicians or group practices feel an incentive payment or penalty was performed in error, they must file an Informal Review by November 9, 2015.

How to Access the Reports and File an Informal Review

In order to access the portal to review reports and/or file an Informal Review, an EIDM account is required. CMS transitioned the portal from the Individual Access to CMS Computer Services (IACS) to the Enterprise Identity Management System (EIDM) on July 13, 2015. The IACS system is now retired, but current PQRS and VM IACS users, their data, and roles have moved to EIDM, which is accessible from the portion of the CMS Enterprise Portal. The EIDM system provides a way for business partners to apply for, obtain approval for, and receive a single user ID for accessing multiple CMS applications.

For more information on 2014 feedback reports and how to request them, see How to Obtain a QRUR. Contact ACR staff at mgueye@rheumatology.org with questions or if you need assistance.

Message from the CORC Chair

Ready, set, go…today marks a historic milestone in the U.S. healthcare system, as we all have braced ourselves for the transition from using ICD-9-CM to ICD-10-CM for claims billed to insurers. This means that all HIPAA-covered entities are required to report all diagnostic codes in the ICD-10 format. Unlike previous billing and coding policy modifications, which allowed a transition period of overlapping old and new billing parameters, there will be no gradual change from ICD-9 to ICD-10. All services provided prior to October 1 will need to report ICD-9 codes, and services rendered today and moving forward will require all diagnostic codes submitted to payers in the ICD-10 format for processing and payment.

While it is true that the ICD-10 code set has more than 68,000 codes, we should not fear, as in reality we will be using a small subset of the new codes. The ACR coding staff has helped decipher the 50 most commonly used rheumatology codes as a supplementary tool to the official ICD-10 manual. The crosswalk lists the former ICD-9 codes with the corresponding ICD-10 format, along with key coding guidelines and conventions, and can be downloaded from the ICD-10 page.

The ACR advocacy team was successful in their tireless efforts on a safe harbor period, which CMS agreed to with a 12-month reprieve to not deny any Part B claims, as long as the provider uses a valid code from the right family/category of codes. As for other insurers, most of the commercial carriers have indicated that they are fully capable of processing in the ICD-10 format and expect providers to bill to the highest level of specificity as directed by the ICD-10 manual. Thus, it is vital for everyone in the practice to understand the coding guidelines and apply the most valid diagnosis code to your claim to minimize any negative impact on your practice’s financial and operational metrics.

Additionally, although we have made the move to ICD-10, we recognize that there is still a worldwide movement to implement ICD-11. The Committee on Rheumatologic Care, along with the Government Affairs Committee, is closely monitoring the modifications from CMS and the World Health Organization.

There are several steps you can take to ensure coding success with ICD-10-CM:

  • All providers should be familiar with the basic ICD-10 coding parameters.
  • Ensure documentation in patient medical records includes all necessary information needed for anatomical site and laterality.
  • Understand all the coding instructions for specificity in certain conditions. For example, all chronic gout claims require a seventh character extension and will need to specify with or without tophus to code to the highest level of specificity.

Keep in mind that the implementation of ICD-10 will not change reporting CPT procedure codes, HCPCS drug codes, or CPT/HCPCS modifiers for physician services. While ICD-10 codes have expanded detail and specificity in laterality for most rheumatic and musculoskeletal conditions, carriers have indicated that providers should continue billing with CPT modifiers for laterality.

We are here for you. The ACR practice management and coding staff will have a triage and call center to help members with minor ICD-10 coding problems or errors. ACR staff have developed a stronger communication and collaboration platform to keep better track of any ICD-10 implementation issues and coding errors. For faster response to questions or concerns, members should send questions to practice@rheumatology.org and the insurance / coding listserve, or contact the coding staff directly at 404-633-3777.

In addition, visit the ICD-10 page often for all ICD-10 FAQs and coding updates on guidelines and conventions.

Douglas White, MD
Chair, Committee on Rheumatologic Care