DOCSLIB.ORG

Health Evidence Review Commission's Value-Based Benefits Subcommittee

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Health Evidence Review Commission's Value-Based Benefits Subcommittee Health Evidence Review Commission's Value-based Benefits Subcommittee October 4, 2018 8:30 AM - 1:00 PM Clackamas Community College Wilsonville Training Center, Room 111-112 29373 SW Town Center Loop E, Wilsonville, Oregon, 97070 Section 1.0 Call to Order AGENDA VALUE-BASED BENEFITS SUBCOMMITTEE October 4, 2018 8:30am - 1:00pm Clackamas Community College 29373 SW Town Center Loop E, Wilsonville Training Center, Rooms 111-112 Wilsonville, Oregon A working lunch will be served at approximately 12:00 PM All times are approximate I. Call to Order, Roll Call, Approval of Minutes – Kevin Olson 8:30 AM II. Staff report – Ariel Smits, Cat Livingston, Darren Coffman 8:35 AM III. Straightforward/Consent agenda – Ariel Smits 8:45 AM A. Consent table B. S86 code review C. Coding issues for gender dysphoria IV. Previous discussion items 8:50 AM A. F39 Unspecified Mood Disorder B. Brow ptosis repair C. Blepharoplasty V. 2020 Biennial Review 9:30 AM A. Neonatal circumcision VI. New discussion items 10:00 AM A. Medical indications for circumcision B. Items carried over from August VBBS meeting A. Postpartum depression screening B. Cardiac MRI C. Allergy testing for eczema D. MRI Guided Focused Ultrasound (MRgFUS) E. Human donor breast milk F. SI joint dysfunction prioritization G. Testosterone hypofunction H. iStent for open angle glaucoma I. Humeral osteotomy for recurrent shoulder dislocation VII. Coverage guidances 12:00 PM A. CarioMEMs Health Evidence Review Commission (503) 373-1985 VIII. Public comment 12:55 PM IX. Adjournment – Kevin Olson 1:00 PM Health Evidence Review Commission (503) 373-1985 Value-based Benefits Subcommittee Recommendations Summary For Presentation to: Health Evidence Review Commission on August 9, 2018 For specific coding recommendations and guideline wording, please see the text of the 8/9/2018 VbBS minutes. RECOMMENDED CODE MOVEMENT (effective 10/1/2018 unless otherwise noted) • Add neuropsychological testing done by computer or technician to various covered mental health lines • Add 2019 ICD-10 codes to various covered and uncovered lines • Add acne fulminans to a covered line (effective January 1, 2019) • Add procedure codes for inserting drug eluting stents into coronary arteries to several heart disease lines • Add the procedure code for Eustachian tube inflation to an uncovered line • Makes the PET scan codes diagnostic and remove from lines; make the PET scan guideline into a diagnostic guideline • Add the code for prediabetes to Line 3 and recommend it be removed from the Diagnostic Procedures File. Add a series of temporary codes for the delivery of the Diabetes Prevention Program to Line 3. (effective January 1, 2019) • Move several developmental and speech delay codes to the dysfunction lines • Add the procedure code for nasal vestibular wall stenosis implants to an uncovered line • Add the procedure code for computer assisted musculoskeletal surgery to an uncovered line • Add procedure codes for insertion of buprenorphine implants to the substance disorder line (effective January 1, 2019) • Add the generic diagnosis code that can be used for adult human growth hormone deficiency to an uncovered line with a new coding specification that it is only on the uncovered line for that specific diagnosis (effective January 1, 2019) • Various straightforward coding and guideline note changes. RECOMMENDED GUIDELINE CHANGES (effective 10/1/2018 unless otherwise noted) • Edit the guideline for chemodenervation with botulinum toxin for chronic migraine to require medication overuse to be addressed and to modify the requirements for pharmacotherapies • Edit the severe inflammatory skin disease line to update the step therapy requirements for atopic dermatitis • Edit the guideline note on biomarker tests of cancer tissue • Add a new diagnostic guideline note on urine drug testing • Edit the guideline for breast reconstruction after mastectomy to indicate that revision surgery is only covered for medical, not cosmetic, indications • Delete the guidelines regarding implantable buprenorphine and enzyme replacement therapy (effective January 1, 2019) • Edit the human growth hormone guideline to remove the restrictions on types of childhood diseases that are covered for treatment (effective January 1, 2019) • Add a new guideline to clarify coverage for the treatment of prediabetes with the Diabetes Prevention Program when delivered by CDC-certified programs (effective January 1, 2019) Value-based Benefits Subcommittee Summary Recommendations, 8/9/2018 • Edit the guideline on overweight and obesity to make reference to the new Diabetes Prevention Program guideline (effective January 1, 2019) BIENNIAL REVIEW CHANGES (effective 1/1/2020) • Create a new line for severe acne which will be in the funded region, with a new guideline • Reorganize the burn lines from 4 lines into 3 VALUE-BASED BENEFITS SUBCOMMITTEE Clackamas Community College Wilsonville Training Center, Rooms 111-112 Wilsonville, Oregon August 9, 2018 8:00 AM – 1:00 PM Members Present: Kevin Olson, MD, Chair; Mark Gibson; Holly Jo Hodges, MD; Vern Saboe, DC; Gary Allen, DMD; Adriane Irwin, PharmD Members Absent: Susan Williams, MD Staff Present: Darren Coffman; Ariel Smits, MD, MPH; Cat Livingston, MD, MPH; Wally Shaffer, MD; Daphne Peck; Mark Altenhofen Also Attending: Napua Catriz (OHA); Adam Obley, MD (Center for Evidence-based Medicine); Dr. Julie Dhossche and Dr. Tracy Funk (OHSU); Carolyn Concion, NP; Rob Twillman (Academy of Integrative Pain Medicine); Karen Yeargain; Edith Agoff; Ginevra Liptan MD (Frida Center for Fibromyalgia); Allan Chino, PhD; Windy Sinclair; Shane Sinclair; Amara McCarthy; Kim Martin Thanislaus; Karl Probst; Patrick Starnes; Steven Hix; Zane Six; Laura A Dolph; Rick Schmitt; Amanda Siebe (Disables Americans for Change); Helen Turner; Kelly Howard; Leonard Ramey; Laura Stallard; BJ Cavnor (One in Four); Margaret Olmon and Laura Jeffcoat (Abbvie); Becky Harison (BioMartin); Deena Loughany and Jay Wurschev (DHS Child Welfare); Sara Gore (Millennium); David Balham (Genentech); David Barba. Roll Call/Minutes Approval/Staff Report The meeting was called to order at 8:00 am and roll was called. Minutes from the May 17, 2018 VbBS meeting were reviewed and approved. Staff noted that the minutes included in the meeting packet had some typos in the line placements for the HCPCS “C” code issue; these line numbers have been corrected. Smits brought the errata document to the attention of the subcommittee members. There were no comments or discussion. Topic: Straightforward/Consent Agenda Discussion: There was no discussion about the consent agenda items. Recommended Actions: 1) Add ICD-10 Z45.42 (Encounter for adjustment and management of neuropacemaker) to line 250 PARKINSON'S DISEASE 2) Remove ICD-10 N43.4 series (Spermatocele of epididymis) from line 327 FUNCTIONAL AND MECHANICAL DISORDERS OF THE GENITOURINARY SYSTEM INCLUDING BLADDER OUTLET OBSTRUCTION 3) Add G0270-G0271 (Medical nutrition therapy) to line 320 OBESITY IN ADULTS AND CHILDREN; OVERWEIGHT STATUS IN ADULTS WITH CARDIOVASCULAR RISK FACTORS Value-based Benefits Subcommittee Minutes, 8/9/2018 Page 3 4) Add H0023 (Behavioral health outreach service (planned approach to reach a targeted population)) to line 4 SUBSTANCE USE DISORDER 5) Add N18.5 (Chronic kidney disease, stage 5) to line 59 END STAGE RENAL DISEASE 1) Remove N18.5 from line 339 CHRONIC KIDNEY DISEASE 6) Add 50389 (Removal of nephrostomy tube, requiring fluoroscopic guidance), 50432 (Placement of nephrostomy catheter, percutaneous), 50435 (Exchange nephrostomy catheter, percutaneous) and 50695 (Placement of ureteral stent, percutaneous) to line 25 VESICOURETERAL REFLUX 7) Add 11004 (Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum), 11006 (Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia, perineum and abdominal wall, with or without fascial closure), 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less), 13131-1313 (Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia), 15004-15005 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar) and 55150 (Resection of scrotum) to line 47 DEEP ABSCESSES, INCLUDING APPENDICITIS AND PERIORBITAL ABSCESS 8) Add 57420-57421 (Colposcopy of the entire vagina, with cervix if present) to line 25 DYSPLASIA OF CERVIX AND CERVICAL CARCINOMA IN SITU, CERVICAL CONDYLOMA 9) Add 49020 (Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, open), 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst)) and 49406-49407 (Image-guided fluid collection drainage by catheter) to line 51 ACUTE PELVIC INFLAMMATORY DISEASE 10) Revise Guideline Note 148 as shown in Appendix A 11) Modify GN173 as shown in Appendix A MOTION: To approve the recommendations stated in the consent agenda. CARRIES 6-0. Topic: Behavioral Health Advisory Panel report Discussion: Smits reviewed the summary documents. There was no discussion regarding the general recommendations. There was discussion regarding the recommendations about a guideline for ICD-10 F39 (Unspecified mood [affective] disorder). Hodges felt that adopting the proposed guideline would make the exceptions process more streamlined. Gibson felt that the relative lack of use for more than a few visits did not require the adoption
Load more

Recommended publications
  • Guide to Pediatric Urology and Surgery in Clinical Practice Prasad P
    Guide to Pediatric Urology and Surgery in Clinical Practice Prasad P. Godbole • Martin A. Koyle Duncan T. Wilcox (Editors) Guide to Pediatric Urology and Surgery in Clinical Practice Editors Prasad P. Godbole Martin A. Koyle Department of Pediatric Surgery Department of Urology and Urology and Pediatrics Sheffield Children’s Hospital University of Washington Sheffield, UK and Department of Urology Duncan T. Wilcox and Pediatrics Department of Pediatric Urology Seattle Children’s Hospital Denver Children’s Hospital Seattle, WA University of Colorado at Denver USA Denver, CO USA ISBN 978-1-84996-365-7 e-ISBN 978-1-84996-366-4 DOI 10.1007/978-1-84996-366-4 Springer Dordrecht Heidelberg London New York British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Control Number: 2010933607 © Springer-Verlag London Limited 2011 Apart from any fair dealing for the purposes of research or private study, or criti- cism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use.
    [Show full text]
  • Hypospadias Repair in Adults Are the Results Different in Comparison with Children? Identification of Prognostic Factors
    HYPOSPADIAS REPAIR IN ADULTS ARE THE RESULTS DIFFERENT IN COMPARISON WITH CHILDREN? IDENTIFICATION OF PROGNOSTIC FACTORS Lander Heyerick Student number: 01306014 Supervisor(s): Prof. dr. Piet Hoebeke, Dr. Anne-Françoise Spinoit A dissertation submitted to Ghent University in partial fulfilment of the requirements for the degree of Master of Medicine in Medicine Academic year: 2017 – 2018 HYPOSPADIAS REPAIR IN ADULTS ARE THE RESULTS DIFFERENT IN COMPARISON WITH CHILDREN? IDENTIFICATION OF PROGNOSTIC FACTORS Lander Heyerick Student number: 01306014 Supervisor(s): Prof. dr. Piet Hoebeke, Dr. Anne-Françoise Spinoit A dissertation submitted to Ghent University in partial fulfilment of the requirements for the degree of Master of Medicine in Medicine Academic year: 2017 – 2018 Deze pagina is niet beschikbaar omdat ze persoonsgegevens bevat. Universiteitsbibliotheek Gent, 2021. This page is not available because it contains personal information. Ghent Universit , Librar , 2021. Preface This dissertation is a result of a prosperous collaboration between Prof. dr. Piet Hoebeke, Dr. Anne-Françoise Spinoit and myself. For the last year and a half, I got the opportunity to enrich myself in a very fascinating discipline in medicine. Therefore, I would like to thank Prof. dr. Piet Hoebeke to give me the opportunity to conduct research in this field of medicine. Special thanks go to Dr. Anne-Françoise Spinoit: without her, I would not have been able to write this thesis. I could always ask the questions I got, she was willing to invest a lot of time in this research topic, but most of all she were a very pleasant person to work with. I would also like to thank all of the members of ‘het Kenniskot’: during my research period, they were always able to create an enjoyable environment to work in.
    [Show full text]
  • I.8.5 Circumcision 203
    I.8.5 Circumcision 203 volume disease (prophylactic lymphadenectomy) has a I.8.4.6 survival benefit compared to the delayed treatment of Results of Treatment clinically involved nodes. The improved survival for It is usually possible to provide good local control for some patients must be balanced with considerable penile cancer by all approaches for early disease (Ta– morbidity of lymphadenectomy. Tumour grade does T2), but for more advanced disease surgery is usually have some prognostic significance. This probably re- the preferred option. flects the propensity of poorly differentiated tumours The survival figures of penile cancer are summa- to metastasize, but it should not be forgotten that well- rized in Table I.8.10. differentiated tumours also metastasize. Table I.8.10. Survival figures for penile cancer. Percentages are I.8.4.8 mean 5-year survivals from various reported studies Prevention Treatment Survival (%) at tumour stage As has been described previously, early circumcision I II III IV can prevent the development of penile cancer, but re- Surgery6542270 cent epidemiological studies from Scandinavia have Radiotherapy 68 51 21 5 suggested that good hygiene associated with improved Adapted from Gillenwater J, Howards S, Grayhack J, Mitchell socioeconomic status can lead to a decreased incidence ME (2001) Adult and Pediatric Urology, 4th edn. Lippincott, of this disease. Wilkins & Williams, Philadelphia, p. 1990 I.8.4.9 I.8.4.7 Other Prognosis An increased incidence of cervical and vulval cancer As can be seen in the preceding section, patients with has been demonstrated in partners of patients with pe- localized disease have a good prognosis; however, nile cancer.
    [Show full text]
  • Approved Surgical Procedures
    UNION MEDICAL BENEFITS SOCIETY LTD APPROVED SURGICAL PROCEDURES The following list of surgical procedures should be read in conjunction with your policy document. If you are intending to have one of the listed procedures, please call our surgical team on 0800 600 666 so we can guide you through the prior approval process. If a surgical procedure is not listed below, it will not be covered unless UniMed decides, in its sole discretion, to offer cover. CARDIAC GENERAL • Pericardiotomy Breast • Pericardiocentesis • Breast Cyst Aspiration or Needle Biopsy • Drainage of Pericaridal Effusion • Breast Biopsy • Coronary Artery Bypass (using vein or artery) • Core Biopsy of Breast • Open Repair of Atrial Septal Defect (ASD) • Excision Accessary Breast Tissue • Valvuloplasty • Mastectomy • Aortic/ Mitral Valve Replacement via Sternotomy • Sentinel Node Biopsy with/without Axillary Dissection • Pulmonary Valve Replacement via Sternotomy • Breast Microdochotomy • Tricuspid Valve Replacement via Sternotomy • Balloon Valvuloplasty – Mitral/ Aortic Reconstruction Post Mastectomy • Pacemaker Surgery – Initial Implantation (Excluding the Cost • Breast/ Nipple Reconstruction of the Pacemaker) • Nipple Areolar Tattoo • Removal of Sternal Wire • Maze Arrhythmia Surgery Gastrointestinal • Removal & Rewiring of Sternal Wire • Anal Sphincterotomy • Maze Arrhythmia Surgery (Standalone procedure) • Simple Repair of Anal Fistula – Special approval only • Maze Procedure – Thoracoscopic • Anal Fistula Repair with Mucosal Advancement Flap • Bentall’s Procedure (includes
    [Show full text]
  • Health Evidence Review Commission
    Health Evidence Review Commission October 4, 2018 1:00 PM - 4:30 PM Clackamas Community College Wilsonville Training Center, Room 111-112 29373 SW Town Center Loop E, Wilsonville, Oregon, 97070 Section 1.0 Call to Order AGENDA HEALTH EVIDENCE REVIEW COMMISSION Wilsonville Training Center, Rooms 111-112 29353 SW Town Center Loop E Wilsonville, Oregon 97070 October 4, 2018 1:30-4:30 pm (All agenda items are subject to change and times listed are approximate) Action # Time Item Presenter Item 1 1:30 PM Call to order Kevin Olson 2 1:35 PM Approval of minutes (8/9/18) Kevin Olson X 3 1:40 PM Director’s report Darren Coffman Ariel Smits 4 1:50 PM Value-based Benefits Subcommittee report X Cat Livingston Single fraction radiotherapy for palliation of bone metastases Adam Obley 5 2:20 PM X • Coverage guidance Wally Shaffer • Prioritized List changes CardioMEMS for heart failure monitoring Adam Obley 6 3:15 PM • Coverage guidance X • Prioritized List changes Cat Livingston 7 4:15 PM Other Business Darren Coffman Next steps 8 4:20 PM • Schedule next meeting – Nov. 8, 2018 Kevin Olson Wilsonville Training Center, rooms 111-112 9 4:30 PM Adjournment Kevin Olson Note: Public comment will be taken on each topic per HERC policy at the time at which that topic is discussed. MINUTES HEALTH EVIDENCE REVIEW COMMISSION Clackamas Community College Wilsonville Training Center, Rooms 111-112 Wilsonville, Oregon August 9, 2018 Members Present: Kevin Olson, MD, Chair; Holly Jo Hodges, MD, Vice-Chair; Mark Gibson; Leda Garside, RN, MBA (by phone); Angela Senders, ND; Gary Allen, DMD; Leslie Sutton; Adriane Irwin, PharmD; Lynnea Lindsey, PhD.
    [Show full text]
  • Steroid Treatment for Recurrent Epididymitis Secondary to Idiopathic Urethritis and Urethrovasal Reflux
    56 Case Report Steroid Treatment for Recurrent Epididymitis Secondary to Idiopathic Urethritis and Urethrovasal Reflux G. K. Ninan1 Preethi Bhishma1 Ramnik Patel1 1 Department of Paediatric Urology, Children’s Hospital, University Address for correspondence G. K. Ninan, FRCSG, FRCSI, FRCS Ed, FRCS Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary (Paed Surg), Department of Paediatric Urology, Children’sHospital, Square, Leicester, United Kingdom University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Road, Leicester LE1 5WW, United Kingdom Eur J Pediatr Surg Rep 2013;1:56–59. (e-mail: [email protected]). Abstract We describe a case of recurrent left-sided epididymitis secondary to severe idiopathic Keywords posterior urethritis extending to left seminal vesicle and vas deference with associated ► idiopathic urethritis urethrovasal reflux (UVR). Cystourethroscopy and micturating cystourethrogram were ► urethrovasal reflux essential for the diagnosis. Following cystourethroscopy, intravesical, and urethral ► urethro-ejaculatory instillation of topical steroid triamcinolone, patient had a full recovery. Idiopathic reflux urethritis in association with veru montentitis, utriculitis leading to left-sided UVR, ► acute scrotum inflammation of the seminal vesicle, and vas deference causing secondary epididymitis ► recurrent is rare. We report the first such rare case presenting as recurrent acute scrotum and epididymitis response to innovative treatment we used. ► topical steroid triamcinolone Introduction scrotal exploration that revealed no obvious abnormality. Left hydatid of Morgagni was excised and left orchidopexy was Nonspecific urethritis in children is rare and mild disease.1,2 performed. He was given trimethoprim for 5 days, but he Adolescent urethritis in most cases is self-limiting.3 To our continued to have dysuria and left scrotal pain knowledge, this is the first case in which an ascending postoperatively.
    [Show full text]
  • Dorsal Slit Preputioplasty for Phimosis: a Prepuce Conserving Surgery
    International Surgery Journal Arora BK et al. Int Surg J. 2016 Aug;3(3):1543-1546 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 DOI: http://dx.doi.org/10.18203/2349-2902.isj20162744 Research Article Dorsal slit preputioplasty for phimosis: a prepuce conserving surgery Bhavinder K. Arora1*, Rachit Arora2, Akshit Arora2 1 Department of Surgery, Pt BD Sharma PGIMS, Rohtak, Haryana, India 2MBBS Student, VMMC and Safdarjung Hospital, New Delhi, India Received: 26 May 2016 Accepted: 02 July 2016 *Correspondence: Dr. Bhavinder K. Arora, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Phimosis is narrowing of prepuce leading to non-retraction behind glans penis. Phimosis is physiological in majority of patients. Pathological phimosis gives rise to symptoms of urinary tract infection and balanoposthitis. Most of patients with phimosis are subjected to circumcision. Instead of circumcision, a conservative surgical approach preputioplasty can be done as a prepuce salvage procedure. Methods: Patients suffering from urinary tract symptoms and persistent narrowing of phimotic ring and recurrent balanoposthitis were subjected to this prepuce salvage surgery. The dorsal slit preputioplasty was performed in these patients. Results: All patients were operated under local anaesthesia in outpatient department. The mean operative time was 10 minutes. No major complication was seen in any of these patients. Oedema of prepuce, haematoma and mild inflammation was noticed in a small number of patients.
    [Show full text]
  • Hypospadias Repair in Adults Are the Results Different in Comparison with Children? Identification of Prognostic Factors
    HYPOSPADIAS REPAIR IN ADULTS ARE THE RESULTS DIFFERENT IN COMPARISON WITH CHILDREN? IDENTIFICATION OF PROGNOSTIC FACTORS Lander Heyerick Student number: 01306014 Supervisor(s): Prof. dr. Piet Hoebeke, Dr. Anne-Françoise Spinoit A dissertation submitted to Ghent University in partial fulfilment of the requirements for the degree of Master of Medicine in Medicine Academic year: 2017 – 2018 Preface This dissertation is a result of a prosperous collaboration between Prof. dr. Piet Hoebeke, Dr. Anne-Françoise Spinoit and myself. For the last year and a half, I got the opportunity to enrich myself in a very fascinating discipline in medicine. Therefore, I would like to thank Prof. dr. Piet Hoebeke to give me the opportunity to conduct research in this field of medicine. Special thanks go to Dr. Anne-Françoise Spinoit: without her, I would not have been able to write this thesis. I could always ask the questions I got, she was willing to invest a lot of time in this research topic, but most of all she were a very pleasant person to work with. I would also like to thank all of the members of ‘het Kenniskot’: during my research period, they were always able to create an enjoyable environment to work in. I would also like to thank my parents for creating a safe haven in which I am able to achieve my goals: not only for this dissertation, but for all other aspects of my education, you were always there to support me, to make everything more agreeable for me so that I could focus on my studies.
    [Show full text]
  • Female Genital Mutilation and Male Circumcision: Toward an Autonomy-Basedethical Framework’ (2015) 5(1) Medicolegal and Bioethics 89
    Almenn hegningarlög (bann við umskurði drengja) 114. mál, 148. lögg'afarþing 2017-2018. Dear Esteemed Madam or Sir, I have read with interest about the proposed circumcision ban in Iceland. The law, ethics, and policy of male and female genital cutting are my main academic areas of expertise, and I thought I might provide a few resources that may be helpful in your governmental deliberations. I am Research Fellow at the Uehiro Centre for Practical Ethics at the University of Oxford and Associate Director of the Yale-Hastings Program in Ethics and Health Policy at Yale University and The Hastings Center. First, I am attaching an analysis of a recent court decision in England, in the matter of B and G, which classified male circumcision as a 'significant harm' but then tried to rescue the distinciton between it and female genital cutting by appealing to alleged health benefits and a distinction between religion and 'mere' culture. Since this will be a common objection to the proposed Icelandic law, I hope you will find this analysis especially helpful. In the essay, recently published in the Medical Law Review by Oxford University Press, I argue that the supposed distinctions concerning health and religion are not grounded in fact, but rather stereotypes about the two forms of genital cutting. That therefore, I conclude, if non-therapeutic female genital cutting is unlawful, then so must be non- therapeutic male genital cutting. This argument is explored further in the attached second essay, "In Defence of Genital Autonomy for Children," published by the Journal of Medical Ethics.
    [Show full text]
  • Anesthesiology
    ANESTHESIOLOGY MEDICAL PROCEDURE FEE € GENERAL 1) In case of Two or More Operations on the Same Patient, the Main Operation will be charged in its total plus 1/2 of each Anesthesia 2) If for any reason an Operation lasts longer than two (2) hours, then the Anesthesiologist's Fee is set at 120 Euro / hour, starting from the beginning of the Anesthesia 3) If the Anesthesiologist's Presence is deemed necessary for the administration of conscious sedation to the patient or for their monitoring, the fee is automatically set at 120 Euro / hour 4) Out-of-surgery Anesthesia / Hr-Radiology, First Aid, Endoscopy GASTROENTEROLOGY Esophagogastroduodenoscopy 94 Esophagogastroduodenoscopy with CLO Test 94 Total colonoscopy 94 Endoscopic Upper and Lower Digestive System Polypectomy 132 Endoscopic Removal of a Foreign Body 132 Esophageal varices Sclerotherapy - 1st Session 132 Banding of Esophageal Varicose Treatment- 1st Session 150 Dilatation of Esophagus Achalasia 150 Esophageal dilatation 132 Hemorrhoids Treatment Per Session 94 ERCP 132 PLASTIC SURGERY (a) Unilateral Cleft Lip 200 (b) Bilateral Cleft Lip 300 a) Cleft Palate 350 b) Complete cleft 410 Syndactyly 170 a) Face skin micronizing 170 b) Face Lift 350 (a) Blepharoplasty 200 (b) Otoplasty 200 (c) Complete rhinoplasty 200 (d) Abdominoplasty 350 e) Thigh lift 220 Gynecomastia 170 a) Augmentation Mammoplasty 200 (b) Reduction Mammoplasty 350 LIPOSUCTION (a) Hips 190 (b) Thighs 190 (c) abdomen 190 OTORHINOLARYNGOLOGY EAR Radical Mastoid Trepanation 235 Tympanoplasty 254 Myringoplasty 188 Myringotomy
    [Show full text]
  • Circumcision Information Sheet
    Dr Danielle Delaney FRACS (Urol) Adult and Paediatric Urological Surgeon Provider number: 231152VL 6 Carter St, Cammeray NSW 2062 P: 02 8920 1161 F: 02 8208 9846 E: [email protected] Circumcision What is a circumcision? A circumcision is an operation to remove your foreskin which is the skin that coves the sensitive head (glans) of your penis. Worldwide, circumcisions are most commonly performed for religious or cultural reasons. Circumcisions are usually recommended only for the following medical reasons: Persistent tightening of the foreskin (phimosis), where you are unable to pull back the foreskin. Generally ointments and gentle self-retraction are tried prior to circumcision. Balanitis OR Balanoposthitis (infection of the foreskin and head of the penis), especially if recurring despite good hygiene and treatment with antibiotics. Recurrent urinary tract infections, especially in boys under the age of 12 months (ten-fold risk reduction). Balanitis xerotica obliterans (BXO), which is an uncommon condition where the foreskin becomes thickened and white, making it difficult to pull back. BXO can cause the opening of our urethra (tube that carries urine and semen to the tip of your penis) to narrow affecting you urine flow. Pain during sex from a tight or non-retractile foreskin. Are there any alternatives to circumcision? For phimosis or recurrent balanitis, topical steroid ointment and gentle foreskin retraction is usually tried first (50-80% successful) and a circumcision recommended if unsuccessful. If BXO is suspected, a circumcision is the only dependable way to cure the condition. For other conditions, a dorsal split operation or a preputioplasty may be recommended.
    [Show full text]
  • A Comparative Study of Management of Phimosis by Preputioplasty and Circumcision
    136 New Indian Journal of Surgery Original Research Article Volume 9 Number 2, March - April 2018 DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9218.5 A Comparative Study of Management of Phimosis By Preputioplasty and Circumcision Bhushan Shaha, Rohit Virmanib, Kandarpa Akhilc, Nagendra Yadavd, Harshad Gawadee, Shahji Chavanf aProfessor and HOU b,c,d,eResident fProfessor and HOD, Department of General Surgery, Dr. D.Y. Patil Medical College and Research Centre, Pimpri, Pune, Dr D.Y. Patil Vidyapeeth, Pune, Maharastra 411018, India. Abstract Introduction Introduction: Phimosis is defined as a condition in Phimosis is defined as a condition in which the which the prepuce cannot be retracted over the glans prepuce cannot be retracted over the glans penis. The penis, usually treated by circumcision. A minimal term “phimosis” is derived from Greek word meaning surgical techniques have been proposed “closure”. It can be physiological, as happens in preputioplasty for prepucial relief to avoid infancy and childhood, or pathologic. Physiological circumcision. AIMS/Objectives: Prospective phimosis is most common in patients up to 3 years of Comparative Study Of Management Of Phimosis By age, but it often extends up to pre pubertal age group. Techniques Of Circumcision And Preputioplasty in Pathological phimosis results from inflammatory relation to: Bleeding, Injury to urethral meatus. Injury or traumatic injury to the prepuce resulting in an to glans, Post op swelling of glans / prepuce, Time acquired inelastic scar that prevents retraction [1]. taken for the procedure,Time taken for complete Forceful disruption of physiologic adhesions between healing, Post operative results. Methods: It is a glans and prepuce in infants encourages pathologic prospective comparative study in which 100 patients phimosis.
    [Show full text]