Non active patient dating
Highlights include the following (Notable change from 2012 to 2015 guidelines: Instead of switching from one anti-TNF biologic to another anti-TNF biologic because of continued activity, it is recommended to change first to a non-TNF biologic)In RA patients with untreated chronic hepatitis B virus (HBV) infection, as well as those with treated chronic HBV disease of Child-Pugh class B and higher, biologic agents are not recommended.Since 1996 the Medicare NCCI procedure to procedure (PTP) edits have been assigned to either the Column One/Column Two Correct Coding edit file or the Mutually Exclusive edit file based on the criterion for each edit.After this date, it will only be necessary to search the Column One/Column Two Correct Coding edit file for active or previously deleted edits.Effective April 1, 2012, CMS will no longer publish a Mutually Exclusive edit file on its website for either practitioner or outpatient hospital services since all active and deleted edits will appear in the single Column One/Column Two Correct Coding edit file on each website.Medication-based therapies comprise several classes of agents, including nonsteroidal anti-inflammatory drugs (NSAIDs), nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs), immunosuppressants, and corticosteroids.Early therapy with DMARDs has become the standard of care, in that it is capable not only of retarding disease progression more efficiently than later treatment but also, potentially, of inducing more remissions.The Mutually Exclusive edit file included edits where two procedures could not be performed at the same patient encounter because the two procedures were mutually exclusive based on anatomic, temporal, or gender considerations.All other edits were assigned to the Column One/Column Two Correct Coding edit file.
However, some of the medications used in treating RA can have adverse effects on the fetus and may have to be discontinued several months before conception is planned.
Alternate approaches to the principles and practices described in this document acceptable provided they are supported by adequate justification.
Alternate approaches should be discussed in advance with the relevant program area to avoid the possible finding that applicable statutory or regulatory requirements have not been met.
There are important changes to these files described below.
In order to simplify the use of PTP edit files, CMS consolidated the two edit files into the Column One/Column Two Correct Coding edit file.