K481

PDF page 330 / A202

CONSULTATIONS AND VISITS
RHEUMATOLOGY (48)
   Rheumatoid arthritis management by a specialist
   Definition/Required elements of service
     This is the service rendered by a specialist in Rheumatology who is most responsible for
     providing ongoing management of a patient with rheumatoid arthritis. This service includes all
     services related to the coordination, provision and documentation of ongoing management,
     including documentation of all medical record requirements, using a planned care approach.
 K481 Rheumatoid arthritis management by a specialist ..................           85.35
     Payment rules:
     1.K481 is limited to a maximum of one service per patient per 12 month period.
     2.K481 is only eligible for payment if the physician has rendered a minimum of three
       consultations/assessments to the patient in the 12 month period for which K481 is claimed.
     3.K481 is only eligible for payment when the physician has treated greater than 100 patients
       with rheumatoid arthritis for the 12 month period for which K481 is claimed.
     4.K481 is only eligible for payment to a physician in the following specialties: Rheumatology
       (48)
     Medical record requirements:
     K481 is only eligible for payment when the following information is recorded in the patient’s
     permanent medical record for the previous 12 month period:
     1.Measurement of tender joint count;
     2.Measurement of swollen joint count;
     3.Physician and patient global assessment of disease activity;
     4.Patient pain score;
     5.Patient assessment of function (e.g. HAQ [Health Assessment Questionnaire] or SF36 [Short
       Form 36]);
     6.Measurement of acute phase reactant (ESR or CRP); and
     7.Calculation and recording of a pooled measure of RA disease activity (DAS-28 [Disease
       Activity Score 28], SDAI [Simplified Disease Activity Index], or CDAI [Clinical Disease Activity
       Index].
     Claims submission instructions:
     Claims for K481 should only be submitted when the required elements of the service have
     been completed for the 12 month period for which K481 is claimed.

Master, record 3018. Record Layout PDF, page 1.

K48120260401999999990000000000000000000000000008535000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.