Medical Coding and Billing Specialist

Total Page:16

File Type:pdf, Size:1020Kb

Medical Coding and Billing Specialist Medical Coding and Billing Specialist Instruction Pack 3 Lessons 21-30 ® Explore the possibilities ® 0205502LB03A-13 Medical Coding and Billing Specialist Instruction Pack 3 Lesson 21—Solving Problems with Insurance Carriers, Providers and Patients Lesson 22—Coding and Billing Resources Lesson 23—ICD-9-CM Coding Introduction Lesson 24—ICD-9-CM Coding—From Infections to Blood Diseases Lesson 25—ICD-9-CM Coding—From Mental Disorders to Circulatory System Lesson 26—ICD-9-CM Coding—From Respiratory System to Complications of Pregnancy Lesson 27 —ICD-9-CM Coding—From Diseases of the Skin to Conditions in the Perinatal Period Lesson 28—ICD-9-CM Coding—From Symptoms to Complications Lesson 29—V Codes, E Codes and ICD-9-CM Coding Practicum Lesson 30—The Future of Health Care Medical Coding and Billing Specialist No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, for any purpose, without the express written permission of U.S. Career Institute. Copyright © 2012-2013, Weston Distance Learning, Inc. All Rights Reserved. 0205502LB03A-13 Acknowledgments Author Katy Little Editorial Staff Trish Bowen Katy Little Leslie Ballentine Elizabeth Munson Bridget Tisthammer Kathy DeVault Georgia Chaney Brenda Blomberg Stephanie MacLeod Chris Jones Sue Bentley Carrie Williams Joyce Jeckewicz Jessica Tuttle Design/Layout Connie Hunsader Sandy Petersen D. Brent Hauseman FOR MORE INFORMATION CONTACT: U.S. Career Institute Fort Collins, CO 80525 • 1-800-347-7899 www.uscareerinstitute.edu 0205502LB03A-13 Table of Contents Table of Contents Lesson 21—Solving Problems with Insurance Carriers, Providers and Patients Step 1 Learning Objectives for Lesson 21 ...........................................................1 Step 2 Lesson Preview ..........................................................................................1 Step 3 Dealing With Insurance Problems ...........................................................2 Step 4 Following Through on Insurance Problems .............................................3 Resubmitting a Paper Claim ....................................................................3 Resubmitting an Electronic Claim ...........................................................5 Sending a Tracer .......................................................................................5 Filing a Narrative Explanation ................................................................7 Appeals ...................................................................................................... 8 The Insurance Commissioner .................................................................10 Rejected Versus Denied Claims ............................................................. 10 Step 5 Practice Exercise 21-1 .............................................................................11 Step 6 Review Practice Exercise 21-1 ................................................................11 Step 7 Billing Patients ....................................................................................... 11 Step 8 Credit .......................................................................................................12 Your Credit Report ..................................................................................13 Step 9 Delinquent Accounts ...............................................................................15 Handling Returned Checks .................................................................... 15 Handling Nonpayment ........................................................................... 16 Step 10 Collection Agencies ................................................................................. 18 Using Collection Agencies ...................................................................... 18 Step 11 Small Claims Court ................................................................................ 19 Filing a Claim ..........................................................................................19 Collecting a Judgment ............................................................................ 20 Step 12 Solving Patient Problems ....................................................................... 20 Step 13 Solving Problems With Providers .......................................................... 22 Step 14 Professional Liability Insurance ............................................................ 22 Step 15 How Does Compliance Affect Medical Coders and Billers? ..................23 Elements of Compliance ......................................................................... 23 Step 16 Practice Exercise 21-2 .............................................................................25 Step 17 Review Practice Exercise 21-2 ................................................................26 Step 18 Lesson Summary .....................................................................................26 Business Forms for a Medical Coding and Billing Specialist ...............27 Step 19 Mail-in Quiz 21 ....................................................................................... 40 Mail-in Quiz 21 ....................................................................................... 40 0205502LB03A-13 i Medical Coding and Billing Specialist Lesson 22—Coding and Billing Resources Step 1 Learning Objectives for Lesson 22 ...........................................................1 Step 2 Lesson Preview ..........................................................................................1 Step 3 Associations for Professional Coders and Billers .................................... 2 Step 4 Credentialing .............................................................................................5 Step 5 Practice Exercise 22-1 ...............................................................................8 Step 6 Review Practice Exercise 22-1 ..................................................................9 Step 7 Coding and Billing Resources ...................................................................9 Step 8 Practice Exercise 22-2 .............................................................................15 Step 9 Review Practice Exercise 22-2 ................................................................15 Step 10 Lesson Summary .....................................................................................15 Step 11 Mail-in Quiz 22 ....................................................................................... 16 Mail-in Quiz 22 ....................................................................................... 16 Endnotes .................................................................................................. 19 Lesson 23—ICD-9-CM Coding Introduction Step 1 Learning Objectives for Lesson 23 ...........................................................1 Step 2 Lesson Preview ..........................................................................................1 Step 3 History of the International Classifi cation of Diseases .......................... 2 The WHO ...................................................................................................3 ICD-9-CM .................................................................................................. 3 Step 4 Why Code? ................................................................................................. 4 Step 5 ICD-10 ....................................................................................................... 5 Impact for Coders ......................................................................................6 Step 6 ICD-9-CM vs. ICD-10-CM ........................................................................ 6 Step 7 Practice Exercise 23-1 ...............................................................................7 Step 8 Review Practice Exercise 23-1 ..................................................................8 Step 9 Organization of Volume 2, Alphabetic Index to Diseases ICD-9-CM...... 8 Main Terms ............................................................................................. 9 Subterms ................................................................................................. 10 Step 10 Organization of Volume 1, Tabular List ................................................ 12 Step 11 Practice Exercise 23-2 .............................................................................15 Step 12 Review Practice Exercise 23-2 ................................................................16 Step 13 Introduction to Coding Guidelines .........................................................16 Cross-reference Terms ...........................................................................18 Step 14 Practice Exercise 23-3 .............................................................................28 Step 15 Review Practice Exercise 23-3 ................................................................29 Step 16 ICD-9-CM Terminology .......................................................................... 29 ii 0205502LB03A-13 Table of Contents Step 17 The Appendices ....................................................................................... 31 Appendix A—Morphology of Neoplasms ................................................31 Appendix B—Glossary of Mental Disorders ..........................................31 Appendix C—Classifi cation of Drugs by AHFS List .............................31 Appendix D—Industrial Accidents According
Recommended publications
  • 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
    [Show full text]
  • Sensitive Teeth.Qxp
    Sensitive teeth may be a warning of more serious problems Do You Have Sensitive Teeth? If you have a common problem called “sensitive teeth,” a sip of iced tea or a cup of hot cocoa, the sudden intake of cold air or pressure from your toothbrush may be painful. Sensitive teeth can be experienced at any age as a momentary slight twinge to long-term severe discomfort. It is important to consult your dentist because sensitive teeth may be an early warning sign of more serious dental problems. Understanding Tooth Structure. What Causes Sensitive Teeth? To better understand how sensitivity There can be many causes for sensitive develops, we need to consider the teeth. Cavities, fractured teeth, worn tooth composition of tooth structure. The crown- enamel, cracked teeth, exposed tooth root, the part of the tooth that is most visible- gum recession or periodontal disease may has a tough, protective jacket of enamel, be causing the problem. which is an extremely strong substance. Below the gum line, a layer of cementum Periodontal disease is an infection of the protects the tooth root. Underneath the gums and bone that support the teeth. If left enamel and cementum is dentin. untreated, it can progress until bone and other supporting tissues are destroyed. This Dentin is a part of the tooth that contains can leave the root surfaces of teeth exposed tiny tubes. When dentin loses its and may lead to tooth sensitivity. protective covering and is exposed, these small tubes permit heat, cold, Brushing incorrectly or too aggressively may certain types of foods or pressure to injure your gums and can also cause tooth stimulate nerves and cells inside of roots to be exposed.
    [Show full text]
  • ANMC Specialty Clinic Services
    Cardiology Dermatology Diabetes Endocrinology Ear, Nose and Throat (ENT) Gastroenterology General Medicine General Surgery HIV/Early Intervention Services Infectious Disease Liver Clinic Neurology Neurosurgery/Comprehensive Pain Management Oncology Ophthalmology Orthopedics Orthopedics – Back and Spine Podiatry Pulmonology Rheumatology Urology Cardiology • Cardiology • Adult transthoracic echocardiography • Ambulatory electrocardiology monitor interpretation • Cardioversion, electrical, elective • Central line placement and venous angiography • ECG interpretation, including signal average ECG • Infusion and management of Gp IIb/IIIa agents and thrombolytic agents and antithrombotic agents • Insertion and management of central venous catheters, pulmonary artery catheters, and arterial lines • Insertion and management of automatic implantable cardiac defibrillators • Insertion of permanent pacemaker, including single/dual chamber and biventricular • Interpretation of results of noninvasive testing relevant to arrhythmia diagnoses and treatment • Hemodynamic monitoring with balloon flotation devices • Non-invasive hemodynamic monitoring • Perform history and physical exam • Pericardiocentesis • Placement of temporary transvenous pacemaker • Pacemaker programming/reprogramming and interrogation • Stress echocardiography (exercise and pharmacologic stress) • Tilt table testing • Transcutaneous external pacemaker placement • Transthoracic 2D echocardiography, Doppler, and color flow Dermatology • Chemical face peels • Cryosurgery • Diagnosis
    [Show full text]
  • Dental Cementum Reviewed: Development, Structure, Composition, Regeneration and Potential Functions
    Braz J Oral Sci. January/March 2005 - Vol.4 - Number 12 Dental cementum reviewed: development, structure, composition, regeneration and potential functions Patricia Furtado Gonçalves 1 Enilson Antonio Sallum 1 Abstract Antonio Wilson Sallum 1 This article reviews developmental and structural characteristics of Márcio Zaffalon Casati 1 cementum, a unique avascular mineralized tissue covering the root Sérgio de Toledo 1 surface that forms the interface between root dentin and periodontal Francisco Humberto Nociti Junior 1 ligament. Besides describing the types of cementum and 1 Dept. of Prosthodontics and Periodontics, cementogenesis, attention is given to recent advances in scientific Division of Periodontics, School of Dentistry understanding of the molecular and cellular aspects of the formation at Piracicaba - UNICAMP, Piracicaba, São and regeneration of cementum. The understanding of the mechanisms Paulo, Brazil. involved in the dynamic of this tissue should allow for the development of new treatment strategies concerning the approach of the root surface affected by periodontal disease and periodontal regeneration techniques. Received for publication: October 01, 2004 Key Words: Accepted: December 17, 2004 dental cementum, review Correspondence to: Francisco H. Nociti Jr. Av. Limeira 901 - Caixa Postal: 052 - CEP: 13414-903 - Piracicaba - S.P. - Brazil Tel: ++ 55 19 34125298 Fax: ++ 55 19 3412 5218 E-mail: [email protected] 651 Braz J Oral Sci. 4(12): 651-658 Dental cementum reviewed: development, structure, composition, regeneration and potential functions Introduction junction (Figure 1). The areas and location of acellular Cementum is an avascular mineralized tissue covering the afibrillar cementum vary from tooth to tooth and along the entire root surface. Due to its intermediary position, forming cementoenamel junction of the same tooth6-9.
    [Show full text]
  • The Cementum: Its Role in Periodontal Health and Disease*
    THE JOURNAL OF PERIODONTOLOGY JULY, NINETEEN HUNDRED SIXTY ONE The Cementum: Its Role In Periodontal Health and Disease* by DONALD A. KERR, D.D.S., M.S.,** Ann Arbor, Michigan HE cementum is a specialized calcified tissue of mesenchymal origin which provides for the attachment of the periodontal fibers to the surface of the Troot. It consists of 45 to 50 per cent inorganic material and 50 to 55 per cent organic material with the inorganic material in a hydroxyl apatite structure. The primary cementum is formed initially by appositional growth from the dental sac and later from the periodontal membrane under the influence of cementoblasts. It is formed in laminated layers with the incorporation of Sharpey's fibers into a fibrillar matrix which undergoes calcification. Cementum deposition is a Continuous process throughout life with new cementum being deposited over the old cemental surface. Cementum is formed by the organiza• tion of collagen fibrils which are cemented together by a matrix produced by the polymerization of mucopolysaccharides. This material is designated as cementoid and becomes mature cementum upon calcification. The significance of the continuous deposition of cementum has received various interpretations. 1. Continuous deposition of cementum is necessary for the reattachment of periodontal fibers which have been destroyed or which require reorientation due to change in position of teeth. It is logical that there should be a continuous deposition of cementum because it is doubtful that the initial fibers are retained throughout the life of the tooth, and therefore new fibers must be continually formed and attached by new cementum.
    [Show full text]
  • A Clinical and Histological Study of Radiofrequency-Assisted Liposuction (RFAL) Mediated Skin Tightening and Cellulite Improvement ——RFAL for Skin Tightening
    Journal of Cosmetics, Dermatological Sciences and Applications, 2011, 1, 36-42 doi:10.4236/jcdsa.2011.12006 Published Online June 2011 (http://www.SciRP.org/journal/jcdsa) A Clinical and Histological Study of Radiofrequency-Assisted Liposuction (RFAL) Mediated Skin Tightening and Cellulite Improvement ——RFAL for Skin Tightening Marc Divaris1, Sylvie Boisnic2, Marie-Christine Branchet2, Malcolm D. Paul3 1Plastic and Maxillo-Facial Surgery, University of Pitie Salpetiere, Paris, France; 2Institution GREDECO, Paris, France; 3Department of Surgery, Aesthetic and PlasticSurgery Institute, University of California, Irvine, USA. Email: [email protected] Received May 1st, 2011; revised May 27th, 2011; accepted June 6th, 2011. ABSTRACT Background: A novel Radiofrequency-Assisted Liposuction (RFAL) technology was evaluated clinically. Parallel origi- nal histological studies were conducted to substantiate the technology’s efficacy in skin tightening, and cellulite im- provement. Methods: BodyTiteTM system, utilizing the RFAL technology, was used for treating patients on abdomen, hips, flanks and arms. Clinical results were measured on 53 patients up to 6 months follow-up. Histological and bio- chemical studies were conducted on 10 donors by using a unique GREDECO model of skin fragments cultured under survival conditions. Fragments from RFAL treated and control areas were examined immediately and after 10 days in culture, representing long-term results. Skin fragments from patients with cellulite were also examined. Results: Grad- ual improvement in circumference reduction (3.9 - 4.9 cm) and linear contraction (8% - 38%) was observed until the third month. These results stabilized at 6 months. No adverse events were recorded. Results were graded as excellent by most patients, including the satisfaction from minimal pain, bleeding, and downtime.
    [Show full text]
  • Co™™I™™Ee Opinion
    The American College of Obstetricians and Gynecologists WOMEN’S HEALTH CARE PHYSICIANS COMMITTEE OPINION Number 673 • September 2016 (Replaces Committee Opinion No. 345, October 2006) Committee on Gynecologic Practice This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice and the American Society for Colposcopy and Cervical Pathology (ASCCP) in collaboration with committee member Ngozi Wexler, MD, MPH, and ASCCP members and experts Hope K. Haefner, MD, Herschel W. Lawson, MD, and Colleen K. Stockdale, MD, MS. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Persistent Vulvar Pain ABSTRACT: Persistent vulvar pain is a complex disorder that frequently is frustrating to the patient and the clinician. It can be difficult to treat and rapid resolution is unusual, even with appropriate therapy. Vulvar pain can be caused by a specific disorder or it can be idiopathic. Idiopathic vulvar pain is classified as vulvodynia. Although optimal treatment remains unclear, consider an individualized, multidisciplinary approach to address all physical and emotional aspects possibly attributable to vulvodynia. Specialists who may need to be involved include sexual counselors, clinical psychologists, physical therapists, and pain specialists. Patients may perceive this approach to mean the practitioner does not believe their pain is “real”; thus, it is important to begin any treatment approach with a detailed discussion, including an explanation of the diagnosis and determination of realistic treatment goals. Future research should aim at evaluating a multimodal approach in the treatment of vulvodynia, along with more research on the etiologies of vulvodynia.
    [Show full text]
  • Sensitive Teeth Sensitive Teeth Can Be Treated
    FOR THE DENTAL PATIENT ... TREATMENT Sensitive teeth Sensitive teeth can be treated. Depending on the cause, your dentist may suggest that you try Causes and treatment desensitizing toothpaste, which contains com- pounds that help block sensation traveling from the tooth surface to the nerve. Desensitizing f a taste of ice cream or a sip of coffee is toothpaste usually requires several applications sometimes painful or if brushing or flossing before the sensitivity is reduced. When choosing makes you wince occasionally, you may toothpaste or any other dental care products, look have a common problem called “sensitive for those that display the American Dental Asso- teeth.” Some of the causes include tooth ciation’s Seal of Acceptance—your assurance that Idecay, a cracked tooth, worn tooth enamel, worn products have met ADA criteria for safety and fillings and tooth roots that are exposed as a effectiveness. result of aggressive tooth brushing, gum recession If the desensitizing toothpaste does not ease and periodontal (gum) disease. your discomfort, your dentist may suggest in- office treatments. A fluoride gel or special desen- SYMPTOMS OF SENSITIVE TEETH sitizing agents may be applied to the sensitive A layer of enamel, the strongest substance in the areas of the affected teeth. When these measures body, protects the crowns of healthy teeth. A layer do not correct the problem, your dentist may rec- called cementum protects the tooth root under the ommend other treatments, such as a filling, a gum line. Underneath the enamel and the crown, an inlay or bonding to correct a flaw or cementum is dentin, a part of the tooth that is decay that results in sensitivity.
    [Show full text]
  • Sensitive Teeth May Be A
    Sensitive Teeth May Be a Warning of More Serious bcbsfepdental.com Problems Sensitive teeth can be experienced at any age, with different levels of pain. When a sip of iced tea, a cup of hot cocoa, or the sudden intake of cold air or pressure from your toothbrush causes pain you may have a common problem called “sensitive teeth.” Sensitive teeth can be experienced at any age as a momentary slight twinge to long-term severe discomfort. It is important to consult with your dentist because sensitive teeth may be an early warning sign of more serious dental problems. Tooth Structure To better understand how sensitivity develops, we need to consider the composition of tooth structure. The crown — the part of the tooth that is most visible — has a tough, protective jacket of enamel, which is an extremely strong substance. Below the gum line, a layer of cementum Do I Need to See My Dentist? protects the tooth root. Underneath the enamel and If you have sensitive teeth, consult your cementum is dentin which contains tiny tubes. When dentin dentist to get a diagnostic evaluation. loses its protective covering (enamel or cementum) from This will determine the extent of the cracks or decay the small dentinal tubules become exposed problem and the treatment. Your permitting heat, cold, certain types of foods or pressure to dentist will evaluate your oral behavior stimulate nerves and cells inside of the tooth. This causes and recommend products that will best teeth to be sensitive producing occasional discomfort. serve you. Causes Dentists can provide mouthguards to minimize the impact of tooth grinding Sensitive teeth can be caused by cavities, fractures (cracked that is the result of clenching or tooth), worn tooth enamel, exposed tooth root, gum bruxing.
    [Show full text]
  • Peri-Implantitis Regenerative Therapy: a Review
    biology Review Peri-Implantitis Regenerative Therapy: A Review Lorenzo Mordini 1,* , Ningyuan Sun 1, Naiwen Chang 1, John-Paul De Guzman 1, Luigi Generali 2 and Ugo Consolo 2 1 Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA 02111, USA; [email protected] (N.S.); [email protected] (N.C.); [email protected] (J.-P.D.G.) 2 Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, 41124 Modena, Italy; [email protected] (L.G.); [email protected] (U.C.) * Correspondence: [email protected] Simple Summary: Regenerative therapies are one of the options to treat peri-implantitis diseases that cause peri-implant bone loss. This review reports classic and current literature to describe the available knowledge on regenerative peri-implant techniques. Abstract: The surgical techniques available to clinicians to treat peri-implant diseases can be divided into resective and regenerative. Peri-implant diseases are inflammatory conditions affecting the soft and hard tissues around dental implants. Despite the large number of investigations aimed at identifying the best approach to treat these conditions, there is still no universally recognized protocol to solve these complications successfully and predictably. This review will focus on the regenerative treatment of peri-implant osseous defects in order to provide some evidence that can aid clinicians in the approach to peri-implant disease treatment. Keywords: peri-implant disease; peri-implant mucositis; peri-implantitis; re-osseointegration; regen- Citation: Mordini, L.; Sun, N.; Chang, erative therapy N.; De Guzman, J.-P.; Generali, L.; Consolo, U.
    [Show full text]
  • Age Estimation Using Cementum
    European Journal of Molecular & Clinical Medicine ISSN 2515-8260 Volume 07, Issue 01, 2020 AGE ESTIMATION USING CEMENTUM - A REVIEW Sundar R1, Gifrine Jayaraj2, Gayathri R3 1Saveetha Dental college and hospitals, Saveetha Institute of Medical and Technical science, Chennai, India 2Reader, Department of oral pathology, Saveetha Dental college and hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, India 3Assistant Professor, Department of Biochemistry, Saveetha Dental college and hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, India [email protected] [email protected] 3gayathri.sdc@saveetha ABSTRACT Cementum is a surface layer which is seen below the radicular dentin. It is near to the neck region of the tooth and thick at the root apex. It is formed by the cells known as cementoblast. Cementum helps the tooth to be attached to the periodontal ligament and alveolar bone through the sharpey’s fibre. Cementum helps in the repair and regeneration of damaged teeth. It has a high anti-absorption capacity. Age estimation using cementum technique is reliable to the teeth which is not affected by periodontal disease. Combined method of biological age estimation had high correlation when compared to public symphysis morphology and similar error were found among both the methodsThe literature search on age estimation using cementum as carried out for papers published from google scholar and pubmed with the intention of retrieving all original reports that were relevant to it. This review helps to provide deeper understanding about age estimation using cementum which benefits the dentist and forensic department. KEYWORDS: Age estimation, Cementum annulations, Cementum thickness INTRODUCTION Cementum is a surface layer present in the teeth which is seen below the dentin in the root area.
    [Show full text]
  • Slide Courtesy of Jeff North, MD
    3/17/2017 Basic Dermatology Procedures Basic Dermatology Procedures for the Non‐dermatologist • Liquid Nitrogen • Skin Biopsies Lindy P. Fox, MD • Electrocautery Associate Professor Director, Hospital Consultation Service Department of Dermatology University of California, San Francisco [email protected] I have no conflicts of interest to disclose 1 Liquid Nitrogen Cryosurgery 1 3/17/2017 Liquid Nitrogen Cryosurgery Liquid Nitrogen Cryosurgery Principles • Indications • ‐ 196°C (−320.8°F) – Benign, premalignant, in situ malignant lesions • Temperatures of −25°C to −50°C (−13°F to −58°F) within 30 seconds with spray or probe • Objective – Selective tissue necrosis • Benign lesions: −20°C to −30°C (−4°F to −22°F) • Reactions predictable • Malignant lesions: −40°C to −50°C. – Crust, bulla, exudate, edema, sloughing • Post procedure hypopigmentation • Rapid cooling intracellular ice crystals • Slow thawing tissue damage – Melanocytes are more sensitive to freezing than • Duration of THAW (not freeze) time is most keratinocytes important factor in determining success Am Fam Physician. 2004 May 15;69(10):2365‐2372 Liquid Nitrogen Cryosurgery • Fast freeze, slow thaw cycles – Times vary per condition (longer for deeper lesion) – One cycle for benign, premalignant – Two cycles for warts, malignant (not commonly done) • Lateral spread of freeze (indicates depth of freeze) – Benign lesions 1‐2mm beyond margins – Actinic keratoses‐ 2‐3mm beyond margins – Malignant‐ 3‐5+mm beyond margins (not commonly done) From: Bolognia, Jorizzo, and Schaffer.
    [Show full text]