We look forward to seeing you there! |
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ASIPP has been actively addressing recent coverage issues through letter correspondence to various agencies. The issues and letters include the following:
AIM published new guidelines effective 04/09/2023. Owned by Anthem, Inc (ANTM), the AIM guidelines are utilized by multiple insurers. ASIPP has addressed the guidelines with a comment letter on the guidelines for Appropriate Use Criteria: Interventional Pain Management. Our comments were related to paravertebral facet joint injection/medial branch nerve block/neurolysis/therapeutic facet joint interventions.
We are requesting LCD reconsideration requests to all of the Medicare Contractors for the LCD covering Facet Joint Interventions for Pain Management.
ASIPP immediate past president, Amol Soin, sent a letter to Cigna on February 7 addressing their Medical Policy Update on Peripheral Nerve Block Procedures (for trigeminal and occipital neuralgia) which considering them experimental, investigational, or unproven, with an efficacy date of April 18th, 2023. In the letter, we ask that the policy update restricting the use of peripheral nerve blocks be re-evaluated and modified. We recommended that these procedures continue to be covered and we find the characterization of these procedures to be experimental or investigational to be inaccurate.
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Novitas and First Coast Services have not issued their policies nor have they participated in multijurisdictional committee and have not issued a policy.
You can use this algorithmic approach whenever you see your patients by utilizing these checklists for each patient prior to performing epidural steroid injections and facet joint interventions.
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Why OIG Did This Audit
To address inappropriate billing for and overuse of epidural steroid injections, 10 of the 12 Medicare Administrative Contractors' (MACs') jurisdictions developed coverage limitations, through Local Coverage Determinations (LCDs), for epidural steroid injection sessions. These coverage limitations allow for physicians to be reimbursed for a maximum number of epidural steroid injection sessions in a 6-month or a 12-month period.
Prior Office of Inspector General audits found that Medicare did not always pay physicians for spinal facet-joint denervation and injection sessions in accordance with Federal requirements.
Our objective was to determine whether Medicare paid physicians for epidural steroid injection sessions in accordance with Medicare requirements.
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Get enough sleep, stop prior authorization, and share your story with colleagues
What if the electronic health record (EHR) said to doctors working late: "Hey, it's 11 p.m. Do you really have to respond to that email tonight or can it wait until the morning? You need your sleep so you don't burn out."
Sending a gentle electronic nudge like that directly to physicians still on their charts and answering patient emails late at night was among several suggestions for preventing physician exhaustion offered during a webinar on Thursday hosted by the American Medical Association (AMA) as part of its ongoing efforts to combat the problem.
"This has been a tough 3 years for our profession, and many drivers of burnout remain," said AMA President Jack Resneck Jr., MD, the moderator of the webinar, which was entitled "#FightingForDocs: AMA Recovery Plan Webinar on Addressing Physician Burnout."
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In August 2021, at the height of the COVID Delta variant, a male patient in his early 50s visited the family medicine practice of Jacqui O'Kane, DO, at South Georgia Medical Center.
"He complained of upper respiratory symptoms," said O'Kane. "Specifically, he had a dry cough, fever, headache, and malaise." She was concerned that he might have COVID or influenza.
"When I recommended testing for COVID or flu, his tone changed from troubled to indignant," she recalled. "'Don't you dare test me!' he said. 'Just give me ivermectin.'"
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ABIPP Part I; ABIPP Path - Combined DCCPM/CSM virtual exam; ABIPP Competency Exam in IPM; ABIPP Competency Exam in Regenerative Medicine
ABIPP Part II; ABIPP Competency Exam - Practical Portion; ABIPP Regenerative Medicine Competency Exam - Practical Portion
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A closer look at the mathematics of aging
In an article in The Atlantic from 2014, noted bioethicist and oncologist Ezekiel Emanuel, MD, PhD, wrote that he will refuse all medical interventions including antibiotics and vaccinations after age 75. The logic of his position is likely out of concern over a loss of autonomy and dignity associated with aging. Dying younger is intended to preserve one's legacy to be remembered as vital and not decrepit.
Emanuel is now 65. Interest exists in the durability of his 2014 claim. Recently, Helen Rumbelow of The Times of London asked Emanuel if he wanted a quick illness to decide his fate because it would take bravery to withstand a long treatment or take his own life. To this query Emanuel replied, "Well, I think it's bravery to say no to interventions where the majority of people would say yes." Words like bravery seem to appeal to both Rumbelow and Emanuel, but perhaps bravery is less about personal character and more about how we describe the actions of people bad at math. Nevertheless, Emanuel may not be wrong that America might be a bad place to grow old. Let's explore these ideas.
To unpack Emanuel's claim, it is fair to start with the likely origin of what might be special about age 75. Why pick this age over all other ages? According to the CDC, U.S. life expectancy peaked (78.9 years) in 2014 and subsequently decreased significantly for 3 consecutive years, reaching 78.6 years in 2017. In 2020, the number fell further to 77.28, and just over 76 in 2021. COVID-19 and drug overdoses are the biggest reasons for the decline. Life expectancy represents the average age of death of a population starting at a particular point in time. However, average age at time of death is a number that warrants further explanation. It is possible to have an average age of death that represents a smaller portion of an entire population. If, for example, infant and childhood mortality is high, that might skew the average death age down. If a person survives infancy and childhood, they may live a long life. Emanuel selected 75 so I imagine he had something close to current U.S. life expectancy as his target.
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- ASIPP Members Only Site Information - |
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To log in for the first time you will need to click “forgot password” at the bottom of the login window.
- Check your email and then log in as directed.
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If you have problems logging into your account, click here.
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Pain Medicine Case Reports (PMCR) and Editor-in-Chief Alaa Abd-Elsayed, MD, PhD would like to invite you to submit case reports and case series to the PMCR journal. Your article will be published free of charge.
Open access journals are freely available online for immediate worldwide open access to the full text of published articles. There is no subscription fee for open access journals. Open access journals are no different from traditional subscription-based journals: they undergo the same peer-review and quality control as any other scholarly journal.
Interested in becoming a member of the PMCR Editorial Board?
Editorial board members are asked to review 2-6 manuscripts per year. Please submit your most up-to-date CV to sgold@asipp.org for consideration.
For more information or to submit your articles, click here.
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| CASE REPORT |
Christopher L. Robinson, MD, PhD, Stephanie Wahab, MD, and Viet Cai, MD
Abstract
BACKGROUND: Delayed hypersensitivity reactions to an iodinated radiologic contrast are a form of hypersensitivity reactions that occurs anywhere from one hour up to 10 days after exposure to the causative agent.
CASE REPORT: We present a case of a 54-year-old woman with a history of a single minor reaction to an intravenous iodinated contrast consisting of only abdominal pain who developed a maculopapular exanthema 7 days after exposure to iohexol, an iodinated radiological contrast, during a lumbar epidural steroid injection. The patient was later treated with topical betamethasone with resolution of cutaneous symptoms within 2 weeks. The patient then underwent patch testing, which revealed a positive result for palladium (II) chloride; to date, there has been no documented association in the literature between palladium (II) chloride and iohexol.
CONCLUSION: DHRs to an iodinated radiologic contrast can range from cutaneous manifestations to lethal presentations, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, with the most common form being a maculopapular exanthema as experienced by our patient. Testing can be performed to determine the causative agent of the DHR and to find an alternative agent if a radiologic contrast is required. Caution must be taken if using an alternative contrast agent as there is significant cross-reactivity to other iodinated radiologic contrasts.
KEY WORDS: Delayed hypersensitivity reaction, iodinated contrast, maculopapular exanthema, palladium, case report
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| RETROSPECTIVE STUDY |
Fanguo Lin, MD, Yuye Zhang, MD, Xiaomei Song, BS, Yanping Niu, MD, Peng Su, MD, Jun Hua, PhD, and Yongming Sun, PhD
Abstract
BACKGROUND: Osteoporotic vertebral compression fractures (OVCF) are common. A few patients with thoracic vertebral fracture show pain in the bilateral rib region but not at the fracture site. The point of specific tenderness in the rib region cannot be located. It is not clear whether percutaneous kyphoplasty (PKP) can relieve the pain in the bilateral rib region in these patients.
OBJECTIVE: To check whether PKP can alleviate the rib region pain in thoracic vertebral fracture patients without local pain at the fractured vertebra.
STUDY DESIGN: Retrospective study.
SETTING: The study was carried out at a university hospital.
METHODS: We performed a retrospective analysis of thoracic vertebral fracture patients admitted to our hospital for PKP surgery between January 2018 and June 2022. The main clinical manifestations of these patients were pain in the bilateral rib region but no local tenderness and percussion pain at the fractured vertebra. CT and MRI examinations of the thoracic vertebrae were performed after admission. PKP was performed under general anesthesia after no surgical contraindication. Visual analog scale (VAS) scores and heights of the anterior, middle, and posterior edges of the fractured vertebra before the surgery, one day after surgery, and one month after surgery were compared. Also, the Cobb angles formed by the upper and lower endplate of the fractured vertebra before the surgery, one day after surgery, and one month after surgery were compared.
RESULTS: A total of 50 patients were included in this study (3 men and 47 women, with an average age of 72.46 ± 8.15 years), of which 7 patients had 2 segmental fractures, so a total of 57 vertebrae were included. The VAS scores on day one and one month after the surgery were significantly lower than that before the surgery. The heights of the anterior, middle, and posterior edges of the fractured vertebra on day one after the surgery were significantly higher than those before the surgery. The Cobb angle of the fractured vertebra on day one after the surgery was lower than that before the surgery. The vertebrae of 23 patients were examined using x-ray one month after the surgery. The heights of the anterior, middle, and posterior edges of the fractured vertebra one month after the surgery were also significantly higher than those before the surgery but significantly lower than those one day after the surgery. Also, the Cobb angle of the fractured vertebra one month after the surgery was significantly lower than that before the surgery.
LIMITATIONS: This was a retrospective study, which may be prone to selection and recall bias. Single-center non-controlled studies may also introduce bias.
CONCLUSION: The exact location of the pain in the rib region caused by thoracic fracture cannot be identified usually. PKP can alleviate the rib region pain caused by the thoracic fracture.
KEY WORDS: Percutaneous kyphoplasty, rib region pain, osteoporosis, thoracic vertebra, compression fractures, local pain
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| RETROSPECTIVE STUDY |
Shih-Chieh Yang, MD, Hui-Mei Huang, MS, Te-Feng Yeh, PhD, Ching-Hui Shen, MD, Chieh-Liang Wu, MD, Yun-Jui Hsieh, MD, Chih-Cheng Wu, MD, PhD, and Chih-Jen Hung, MD
Abstract
BACKGROUND: Pain assessments are an important aspect of health care quality because the high prevalence of pain in inpatients may contribute to complications. Several studies revealed a gap in the pain intensity evaluated by nurses (PEN) and patients (PEP). The aim of the present study was to analyze the correlation and agreement between pain assessments conducted by nurses and patients, and to determine patients at high risk of misestimated pain.
OBJECTIVES: To compare the difference of pain intensity between the questionnaires conducted by additional assessors and electronic records by nursing staff.
STUDY DESIGN: A retrospective study.
SETTING: A medical center in Taichung, Taiwan.
METHODS: We approached 1,034 patients admitted from January 1, 2018 to December 31, 2018 in our hospital. We compared the assessments of pain intensity using questionnaires conducted by additional assessors with those entered into electronic records by nursing staff. Continuous data were reported as the mean (± standard deviation). The analysis of agreement and correlation were performed by kappa statistics or weighted kappa statistics, and correlation (Spearman rank correlation method).
RESULTS: Among the 1,034 patients, 307 patients were excluded. Thus, the final analysis included 686 patients. Patients’ median pain intensity was 5 in PEP and 1 in PEN. The patients’ pain intensity was underestimated (PEN < PEP) in 539 patients (78.6%), matched (PEN = PEP) in 126 patients (18.3%), and overestimated (PEN > PEP) in 21 patients (3.1%). The surgical interventions (chi squared = 7.996, and P = 0.018) and pain in the past 24 hours (chi squared = 17.776, and P < 0.001) led to a significant difference.
LIMITATIONS: The limitation of the study was the single-center and retrospective design.
CONCLUSIONS: The gap in pain assessments between inpatients and nurses is an important issue in daily practice. The underestimations of pain were more common than overestimations (78.6% vs 3.1%). Surgical interventions and persistent pain lasting over 24 hours were high risk factors for underestimation, but patients’ gender, receiving anesthesia, type of anesthesia, and patient-controlled analgesia did not contribute significantly to differences in pain estimation.
KEY WORDS: Pain, assessment, correlation, agreement
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ASIPP is now in collaboration with Curi Medical Liability Program
Since this malpractice insurance program officially launched in November 2018, ASIPP has signed up hundreds of providers with an average savings of 30%. This is professional liability insurance tailored to our specialty and will stand up for us and defend our practices.
Curi is a full-service advisory firm that serves physicians and their practices. Their valued advice is grounded in your priorities and elevated in your outcomes. They are driven by a deep understanding of your specific circumstances in medicine, business, and life. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary risk management CME activities, visit our website.
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ASIPP® has formed a partnership with Henry Schein and PedsPal, a national GPO that has a successful history of negotiating better prices on medical supplies and creating value-added services for independent physicians. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you experience today.
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ASIPP® is now offering our members the benefit of a unique revenue cycle management/ billing service.
We have received a tremendous amount of interest in the ASIPP® billing and coding program.
Click here to learn more about the negotiated rate for practices and more!
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up-to-date news related to you, your practice, and your patients!
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