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Neurophysiologic Testing and Monitoring
UnitedHealthcare® Commercial Medical Policy Neurophysiologic Testing and Monitoring Policy Number: 2021T0493Z Effective Date: January 1, 2021 Instructions for Use Table of Contents Page Community Plan Policy Coverage Rationale ........................................................................... 1 • Neurophysiologic Testing and Monitoring Applicable Codes .............................................................................. 2 Description of Services ..................................................................... 4 Medicare Advantage Coverage Summary Clinical Evidence ............................................................................... 6 • Neurophysiological Studies U.S. Food and Drug Administration ..............................................16 References .......................................................................................18 Policy History/Revision Information..............................................21 Instructions for Use .........................................................................22 Coverage Rationale Nerve Conduction Studies The following are proven and medically necessary: • Nerve conduction studies with or without late responses (e.g., F-wave and H-reflex tests) and neuromuscular junction testing when performed in conjunction with needle electromyography for any of the following known or suspected disorders: o Peripheral neuropathy/polyneuropathy (e.g., inherited, metabolic, traumatic, entrapment syndromes) o Plexopathy o Neuromuscular junction disorders (e.g., -
Septoplasty, Rhinoplasty, Septorhinoplasty, Turbinoplasty Or
Septoplasty, Rhinoplasty, Septorhinoplasty, 4 Turbinoplasty or Turbinectomy CPAP • If you have obstructive sleep apnea and use CPAP, please speak with your surgeon about how to use it after surgery. Follow-up • Your follow-up visit with the surgeon is about 1 to 2 weeks after Septoplasty, Rhinoplasty, Septorhinoplasty, surgery. You will need to call for an appointment. Turbinoplasty or Turbinectomy • During this visit any nasal packing or stents will be removed. Who can I call if I have questions? For a healthy recovery after surgery, please follow these instructions. • If you have any questions, please contact your surgeon’s office. Septoplasty is a repair of the nasal septum. You may have • For urgent questions after hours, please call the Otolaryngologist some packing up your nose or splints which stay in for – Head & Neck (ENT) surgeon on call at 905-521-5030. 7 to 14 days. They will be removed at your follow up visit. When do I need medical help? Rhinoplasty is a repair of the nasal bones. You will have a small splint or plaster on your nose. • If you have a fever 38.5°C (101.3°F) or higher. • If you have pain not relieved by medication. Septorhinoplasty is a repair of the nasal septum and the nasal bone. You will have a small splint or plaster cast on • If you have a hot or inflamed nose, or pus draining from your nose, your nose. or an odour from your nose. • If you have an increase in bleeding from your nose or on Turbinoplasty surgery reduces the size of the turbinates in your dressing. -
CPT® New Codes 2019: Biopsy, Skin
Billing and Coding Update Alexander Miller, M.D. AAD Representative to the AMA CPT Advisory Committee New Skin Biopsy CPT® Codes It’s all about the Technique! SPEAKER: Alexander Miller, M.D. AAD Representative to the AMA -CPT Advisory Committee Chair AAD Health Care Finance Committee Arriving on January 1, 2019 New and Restructured Biopsy Codes Tangential biopsy Punch Biopsy Incisional Biopsy How Did We Get Here? CMS CY 2016 Biopsy codes (11100, 11101 identified as potentially mis-valued; high expenditure RUC Survey sent to AAD Members Specialty survey results are the only tool available to support code values Challenging survey results Survey revealed bimodal data distribution; CPT Codes 11100, 11101 referred to CPT for respondents were valuing different procedures restructuring Rationale for New Codes 11100; 11101 • Previous skin biopsy codes did not distinguish between the different biopsy techniques that were being used CPT Recommended technique specification in new biopsy codes • Will also provide for reimbursement commensurate with the technique used How Did We Get Here? • CPT Editorial Panel deleted 11100; 11101 February 2017 • 6 New codes created based on technique utilized • Each technique: primary code and add-on code March 2017 • RUC survey sent to AAD members April 2017 • Survey results presented to the RUC Biopsy Codes Effective Jan., 1, 2019 • Integumentary biopsy codes 11755 Biopsy of nail unit (plate, bed, matrix, hyponychium, proximal and lateral nail folds 11100, 11101 have been deleted 30100 Biopsy, intranasal • New -
Ct Maxillofacial with Contrast Protocol
Ct Maxillofacial With Contrast Protocol Untrue Blaine ferment retrally and encouragingly, she nogged her Narva jeweling smokelessly. Unsaluted Zak scollop: he bards his self-sacrifice lordly and trichotomously. Eliott companions perdurably. In contrast both ultra-low dose protocols that combined a larger voxel. Although some elements on maxillofacial lesions in protocol change was limited in addition, protocols were reported are extremely thin slices. Contact us see it kills thyroid functions, which are related disorders such as they safe. CT The American College of Radiology with regret than. If the protocol is changed by one then our radiologists to condition more suitable. PRACTICE PARAMETER CT American College of Radiology. Assume that ct? Separate requests for concurrent imaging of the arteries and the veins in separate head are inappropriate. You have had an hour prior to maxillofacial fibrosarcoma using special room, protocol is no additional effects research to help your details. Patient lead a candidate for curative surgery. No citing articles found no other precautions can be stored in your email address ct maxillofacial radiology facilities may affect your contrast ct with maxillofacial lesions. Pillows may est will usually, with maxillofacial ct with persistent dysesthesia as radiation. It personnel also used to narrate at blood vessels and lymph nodes in the abdomen. RESULTS Compared with the reference dose protocol with FBP the. MRI lumbar spine pain and without IV contrast is best appropriate; CT lumbar spine system or without IV contrast can be performed if MRI is contraindicated. Ordered CT exams under ARA protocols For any coding. Studies by maxillofacial with other. -
Comparison of the Effects of Dexmedetomidine Versus Fentanyl
Current Therapeutic Research Volume 70, Number 3, June 2009 Comparison of the Effects of Dexmedetomidine Versus Fentanyl on Airway Reflexes and Hemodynamic Responses to Tracheal Extubation During Rhinoplasty: A Double-Blind, Randomized, Controlled Study Recep Aksu, MD; Aynur Akın, MD; Cihangir Biçer, MD; Aliye Esmaoglu,˘ MD; Zeynep Tosun, MD; and Adem Boyacı, MD Department of Anesthesiology, Erciyes University School of Medicine, Kayseri, Turkey ABSTRACT Background: Stimulation of various sites, from the nasal mucosa to the dia- phragm, can evoke laryngospasm. To reduce airway reflexes, tracheal extubation should be performed while the patient is deeply anesthetized or with drugs that do not depress ventilation. However, tracheal extubation during rhinoplasty may be dif- ficult because of the aspiration of blood and the possibility of laryngospasm. Dexmede- tomidine and fentanyl both have sedative and analgesic effects, but dexmedetomidine has been reported to induce sedation without affecting respiratory status. Objective: The aim of this study was to compare the effects of dexmedetomi- dine and fentanyl on airway reflexes and hemodynamic responses to tracheal extuba- tion in patients undergoing rhinoplasty. Methods: This double-blind, randomized, controlled study was conducted at the Erciyes University Medical Center, Kayseri, Turkey. Patients classified as Ameri- can Society of Anesthesiologists physical status I or II who were undergoing elective rhinoplasty between January 2007 and June 2007 with general anesthesia were eli- gible for study entry. Using a sealed-envelope method, the patients were randomly divided into 2 groups (20 patients per group). Five minutes before extubation, pa- tients received either dexmedetomidine 0.5 μg/kg in 100 mL of isotonic saline or fentanyl 1 μg/kg in 100 mL of isotonic saline intravenously. -
High Number of Endometrial Polyps Is a Strong Predictor of Recurrence: findings of a Prospective Cohort Study in Reproductive-Age Women
ORIGINAL ARTICLE: GYNECOLOGY AND MENOPAUSE High number of endometrial polyps is a strong predictor of recurrence: findings of a prospective cohort study in reproductive-age women Fang Gu, M.D.,a Huanxiao Zhang, M.D.,b Simin Ruan, M.D.,c Jiamin Li, M.D.,d Xinyan Liu, M.D.,a Yanwen Xu, M.D.,a,e and Canquan Zhou, M.D.a,e a Center for Reproductive Medicine, Department of Obstetrics and Gynecology, b Division of Gynecology, Department of Obstetrics and Gynecology, and c Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University; d Department of Obstetrics and Gynecology, Second Affiliated Hospital of Guangzhou Medical College; and e Key Laboratory of Reproductive Medicine of Guangdong Province, Guangzhou, People's Republic of China Objective: To compare the incidence of recurrence between a cohort with a high number (R6) of endometrial polyps (EPs) and a single- EP cohort among reproductive-age patients after polypectomy. Design: Prospective observational cohort study. Setting: Single university center. Patient(s): Premenopausal women who underwent hysteroscopic endometrial polypectomy were recruited. Intervention(s): Patients underwent a transvaginal ultrasound scan every 3 months after polypectomy to detect EP recurrence. Kaplan- Meier and Cox regression models were used to compare the risk of recurrence between the two cohorts and analyze the potential risk factors for EP recurrence. Main Outcome Measure(s): EP recurrence rate. Result(s): The study enrolled 101 cases with a high number of EP and 81 cases with a single EP. All baseline parameters were similar except that the high number of EP cohort had a slightly lower mean age than the single EP cohort (33.5 [range 30.0–39.0] vs. -
Rhinoplasty and Septorhinoplasty These Services May Or May Not Be Covered by Your Healthpartners Plan
Rhinoplasty and septorhinoplasty These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. Administrative Process Prior authorization is not required for: • Septoplasty • Surgical repair of vestibular stenosis • Rhinoplasty, when it is done to repair a nasal deformity caused by cleft lip/ cleft palate Prior authorization is required for: • Rhinoplasty for any indication other than cleft lip/ cleft palate • Septorhinoplasty Coverage Rhinoplasty is not covered for cosmetic reasons to improve the appearance of the member, but may be covered subject to the criteria listed below and per your plan documents. The service and all related charges for cosmetic services are member responsibility. Indications that are covered 1. Primary rhinoplasty (30400, 30410) may be considered medically necessary when all of the following are met: A. There is anatomical displacement of the nasal bone(s), septum, or other structural abnormality resulting in mechanical nasal airway obstruction, and B. Documentation shows that the obstructive symptoms have not responded to at least 3 months of conservative medical management, including but not limited to nasal steroids or immunotherapy, and C. Photos clearly document the structural abnormality as the primary cause of the nasal airway obstruction, and D. Documentation includes a physician statement regarding why a septoplasty would not resolve the airway obstruction. 2. Secondary rhinoplasty (30430, 30435, 30450) may be considered medically necessary when: A. The secondary rhinoplasty is needed to treat a complication/defect that was caused by a previous surgery (when the previous surgery was not cosmetic), and B. -
Coding Billing
CodingCoding&Billing FEBRUARY 2020 Quarterly Editor’s Letter Welcome to the February issue of the ATS Coding and Billing Quarterly. There are several important updates about the final Medicare rules for 2020 that will be important for pulmonary, critical care and sleep providers. Additionally, there is discussion of E/M documentation rules that will be coming in 2021 that practices might need some time to prepare for, and as always, we will answer coding, billing and regulatory compliance questions submitted from ATS members. If you are looking for a more interactive way to learn about the 2020 Medicare final rules, there is a webinar on the ATS website that covers key parts of the Medicare final rules. But before we get to all this important information, I have a request for your help. EDITOR ATS Needs Your Help – Recent Invoices for Bronchoscopes and PFT Lab ALAN L. PLUMMER, MD Spirometers ATS RUC Advisor TheA TS is looking for invoices for recently purchased bronchoscopes and ADVISORY BOARD MEMBERS: PFT lab spirometer. These invoices will be used by theA TS to present practice KEVIN KOVITZ, MD expense cost equipment to CMS to help establish appropriate reimbursement Chair, ATS Clinical Practice Committee rates for physician services using this equipment. KATINA NICOLACAKIS, MD Member, ATS Clinical Practice Committee • Invoices should not include education or service contract as those ATS Alternate RUC Advisorr are overhead and cannot be considered by CMS for this portion of the STEPHEN P. HOFFMANN, MD Member, ATS Clinical Practice Committee formula and payment rates. ATS CPT Advisor • Invoices can be up to five years old. -
Rhinoplasty ARTICLE by PHILIP WILKES, CST/CFA
Rhinoplasty ARTICLE BY PHILIP WILKES, CST/CFA hinoplasty is plastic become lodged in children's noses.3 glabella, laterally with the maxilla, surgery of the nose Fortunately, the art and science of inferiorly with the upper lateral car- for reconstructive, rhinoplasty in the hands of a skilled tilages, and posteriorly with the eth- restorative, or cos- surgical team offers positive alter- moid bone? metic purposes. The natives. The nasal septum is formed by procedure of rhmo- Three general types of rhino- the ethmoid (perpendicular plate) plasty had its beginnings in India plasty will be discussed in this arti- and vomer bones (see Figure 5). The around 800 B.c.,as an ancient art cle. They include partial, complete, cartilaginous part is formed by sep- performed by Koomas Potters.' and finesse rhinoplasties. tal and vomeronasal cartilages. The Crimes were often punished by the anterior portion consists of the amputation of the offender's nose, Anatomy and Physiology of the medial crus of the greater alar carti- creating a market for prosthetic sub- Nose lages, called the columella nasi? stitutes. The skill of the Koomas The nose is the olfactory organ that The vestibule is the cave-like area enabled them to supply this need. In projects from the center of the face modem times, rhinoplasty has and warms, filters, and moistens air developed into a high-technology on the way to the respiratory tract. procedure that combines art with Someone breathing only through the latest scientific advancements.' the mouth delivers a bolus of air During rhinoplastic procedures, with each breath. The components surgeons can change the shape and of the nose allow a thin flow of air size of the nose to improve physical to reach the lungs, which is a more appearance or breathing. -
Thoracentesis
The new england journal of medicine videos in clinical medicine Thoracentesis Todd W. Thomsen, M.D., Jennifer DeLaPena, M.D., and Gary S. Setnik, M.D. INDICATIONS From the Department of Emergency Medi- Thoracentesis is a valuable diagnostic procedure in a patient with pleural effusion cine, Mount Auburn Hospital, Cambridge, of unknown causation. Analysis of the pleural fluid will allow its categorization as MA (T.W.T., G.S.S.); the Department of Emergency Medicine, Beth Israel Deacon- either a transudate (a product of unbalanced hydrostatic forces) or an exudate (a ess Medical Center, Boston (J.D.); and the product of increased capillary permeability or lymphatic obstruction) (Table 1). If Division of Emergency Medicine, Harvard the effusion seems to have an obvious source (e.g., in an afebrile patient with con- Medical School, Boston (T.W.T., J.D., G.S.S.). Address reprint requests to Dr. Thomsen gestive heart failure and bilateral pleural effusions), diagnostic thoracentesis may at the Department of Emergency Medi- be deferred while the underlying process is treated. The need for the procedure cine, Mount Auburn Hospital, 330 Mount should be reconsidered if there is no appropriate response to therapy.1 Auburn St., Cambridge, MA 02238, or at [email protected]. Thoracentesis, as a therapeutic procedure, may dramatically reduce respiratory distress in patients presenting with large effusions. N Engl J Med 2006;355:e16. Copyright © 2006 Massachusetts Medical Society. CONTRAINDICATIONS There are limited data on the safety of thoracentesis -
CME Anatomy of Aging Face
Published online: 2020-01-15 Free full text on www.ijps.org CME Anatomy of aging face Rakesh Khazanchi, Aditya Aggarwal, Manoj Johar1 Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi - 110 060, 1Fortis Hospital, Noida, UP, India Address for correspondence: Dr. Rakesh Khazanchi, Department of Plastic and Cosmetic Surgery, Sir Ganga Ram Hospital, New Delhi - 110 060, India. E-mail: [email protected] ejuvenation of the face is evolving into a common deposition in regions of body called ‘depots’ procedure in India. This may be attempted by f) Fascial and ligament laxity Reither surgical or non surgical means. Surgical g) Shrinkage of glandular tissue (Salivary glands) rejuvenation of face includes a large variety of procedures h) Skeletal resorption to revert the changes of aging. In the past, face lift operation was done to simply lift the sagging skin rather Facial soft tissues are arranged in concentric layers. than shaping the face. However it often ended up in Skin is the outermost layer and then the basic building giving the patient an ‘operated on’ look producing tight blocks-fat, superficial fascia also known as superficial appearing face. The surgeons have now learnt that aging musculoaponeurotic system (SMAS), deep fascia and the process is a complex process that involves soft tissues as periosteum that covers the facial skeleton. Interspersed well as skeleton of face and is not just sagging of skin. in these layers are vessels, nerves, facial muscles and Therefore in order to get a good result after surgical retaining ligaments. Knowledge of these layers allows facial rejuvenation, it is paramount to understand these the surgeon to dissect in a given anatomic plane without anatomical structures and the effect of aging process on damaging important structures. -
Study Guide Medical Terminology by Thea Liza Batan About the Author
Study Guide Medical Terminology By Thea Liza Batan About the Author Thea Liza Batan earned a Master of Science in Nursing Administration in 2007 from Xavier University in Cincinnati, Ohio. She has worked as a staff nurse, nurse instructor, and level department head. She currently works as a simulation coordinator and a free- lance writer specializing in nursing and healthcare. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text shouldn’t be regarded as affecting the validity of any trademark or service mark. Copyright © 2017 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America CONTENTS INSTRUCTIONS 1 READING ASSIGNMENTS 3 LESSON 1: THE FUNDAMENTALS OF MEDICAL TERMINOLOGY 5 LESSON 2: DIAGNOSIS, INTERVENTION, AND HUMAN BODY TERMS 28 LESSON 3: MUSCULOSKELETAL, CIRCULATORY, AND RESPIRATORY SYSTEM TERMS 44 LESSON 4: DIGESTIVE, URINARY, AND REPRODUCTIVE SYSTEM TERMS 69 LESSON 5: INTEGUMENTARY, NERVOUS, AND ENDOCRINE S YSTEM TERMS 96 SELF-CHECK ANSWERS 134 © PENN FOSTER, INC. 2017 MEDICAL TERMINOLOGY PAGE III Contents INSTRUCTIONS INTRODUCTION Welcome to your course on medical terminology. You’re taking this course because you’re most likely interested in pursuing a health and science career, which entails proficiencyincommunicatingwithhealthcareprofessionalssuchasphysicians,nurses, or dentists.