Tuesday, September 24, 2013

September Is Healthy Aging Month



When you think of being old, I am sure certain visions come to mind:  less and/or grey hair, false teeth, eyeglasses, a cane or a walker, hearing aids.  Maybe you are an aging optimist “You are only as old as you feel.”  Well I guarantee, if you don’t pay attention to the things you do now, you will feel as old as you are someday, maybe even older.

The main focus of Healthy Aging® Month this September is to inspire and educate adults ages 50 and above to focus on the health of their physical, mental, social and financial lives.  That is a valuable goal; but why should we wait until 50?  A lot of damage could certainly be done by then. So, I say, start now, no matter what age, taking care of yourself today, is the best insurance for great tomorrows (and lots of them).
 
Ways to stay healthy fill store shelves and consume countless television commercial air time hours.  The keys to healthy aging can be very simple:





1.       Alcohol use:  Keep it at a minimum. Be aware that the recommended maximum consumption for:
Healthy men: 1 to 2 14 g servings per day, not to exceed 14 servings per week
Healthy (non-pregnant or breastfeeding) women: 1 14 g serving per day, not to exceed 7 servings per week.

2.       Diet:  Consume a healthy daily diet of fruits, vegetables and whole grains, with limits on foods with high calories, sugar, salt and fat. Follow recommended serving and calorie guidelines, find them here.

3.       Emotional bonding:  Love another living being and be loved.  This does not have to be a spouse/partner.  Friends, family, and pets are all important in nurturing our emotional side, and caring for others provides fulfillment as well.

4.       Exercise:  Find something you like to do and as Nike says “Just Do It”.  Participate in regular physical activity for a minimum of 2 and ½ hours per week (see recommended guidelines.) Walk your dog; he will love you even more.  Take a swim, ride your bike in the park.  Do it with someone else (see #3).  Whatever it is, get moving, both your body and your mind will thank you for it. 

5.       Intellect:  Read a book, start a new hobby, visit new places, see a foreign film.  Stimulate your brain; it makes you more interesting to friends and family (see #3).

6.       Joy:  Sounds easy right, but how many folks do you see every day walking around looking “mad at the world”.  Joy can be found in the sound, sights, smells, tastes and touch of each and everything around us.  You just have to stop and take the time to notice.  It also goes hand in hand with #’s 3, 4, and 5.

7.       Medical care:  Prevention, prevention, prevention.  See you doctor when you should, have the screening tests that are recommended, and follow prescribed treatments.  Those folks from #3 want to keep you around a long time. 

8.       Sleep:  The current recommendation for adequate sleep for adults is 7 to 9 hours a day.  Follow it so you can have energy for #4, a clear head for #’s 5 and 6, and studies show help with #11.  For more sleep related information, click here.

9.       Sun exposure:  Sun exposure does help a vital nutrient Vitamin D, so some is good.  It is important to be smart with sun exposure as current estimates are that one in five Americans will be diagnosed with skin cancer in their lifetime. This link offers information on lowering you skin cancer risk. 
 
10.   Tobacco use:  NONE, ZERO, NAUGHT, NIL, ZILCH is how much tobacco you should use.

11.   Weight:  Follow your physician recommendations on a healthy weight.  I bet if you follow #’s 1, 2, and 4, this one will be a breeze. 

Hopefully, you can take this list and start today with one or two of these healthy lifestyle tips.  Once you get going, no one can stop you from aging healthy!



As part of Healthy Aging Month, CMS is encouraging healthcare professionals to utilize Medicare-covered preventive services when addressing the health and quality of life of their patients.
Some of the preventive services covered under Medicare Part B include:

Alcohol Misuse Screening and Behavioral Counseling Interventions in Primary Care
Annual Wellness Visit (Providing Personalized Prevention Plan Services)
Cardiovascular Disease Screening
Depression Screening in Adults
Diabetes Screening
Initial Preventive Physical Examination (IPPE) (also commonly referred to as the “Welcome to Medicare” Preventive Visit)
Intensive Behavioral Therapy for Cardiovascular Disease
Intensive Behavioral Therapy for Obesity
Tobacco-Use Cessation Counseling

For More Information:
MLN Preventive Services Guide for Health Professionals

Thursday, September 19, 2013

“Sit still and pay attention!”



I am of an age where kids that didn’t pay attention and/or couldn’t sit still in class were just called “hyper” and corporal punishment was okay.  I can even remember one specific little boy from my First Grade class, a skinny little kid with a mop of unkempt blonde hair, super thick glasses and the need to get out of his chair during class.  The teacher was the seasoned, no nonsense type and how do you think she dealt with this unruly youngster? 


She tied him to his chair.  Yep, you heard me, right to the chair in the middle of class.  It probably didn’t help him learn any better, but at least he wasn’t running around disrupting class.  She had teaching to do!  She improvised and did the best she could for the rest of us. Looking back as an adult this seems really sad and mean, but in a way I am thankful.  I was there to learn and that wasn’t going to happen with him running around the classroom.  

If you are wondering,” why bother with this story?”  Well, it is National Attention Deficit Hyperactivity Disorder Month and thinking about that, made me think of that hyper little boy and that challenged, frustrated teacher.  I am sure like most people, I equate hyperactivity to ADHD, but this is not always the case.  

So in respect to that boy and probably many others that were at one time tied to their school desk chairs or even sent to the principal’s office for a paddling, I would like to share some enlightening facts about ADHD.

1.       It is estimated that 11% of school aged children in the US have ADHD and it can continue on into adulthood.

2.       ADHD is more often diagnosed in boys.

3.      Those who have ADHD do not misbehave on purpose; they typically are trying to behave the best way that they can.

4.      There are three ADHD Types: 

A.      Combined ADHD (the most common subtype), which involves symptoms of  both inattentiveness and hyperactivity/impulsivity

B.      Inattentive ADHD (previously known as ADD), which is marked by impaired attention and concentration

C.      Hyperactive-impulsive ADHD, which is marked by hyperactivity without inattentiveness

5.       Details for the three ADHD symptom categories: Inattention, Hyperactivity and Impulsivity.  Children with ADHD can present with symptoms from just one or multiple categories.  each with some unique symptoms, difficulties and advantages: 

A.      Inattention symptoms can include: unable to focus on details, makes careless mistakes, does not listen when spoken to, inability to follow instructions and complete tasks, disorganization, frequently loses belongings, forgetfulness

B.      Hyperactivity symptoms can include: inability to sit still or stay seated when needed, difficulty working/playing quietly, excessive talking, running around at inappropriate

C.      Impulsivity symptoms can include:  difficulty waiting for turn to speak or to play in a game

Fortunately, working with or around the symptoms of ADHD no longer include being tied to a chair or paddling.  For many families, behavioral therapy examines disruptive behaviors and provides instruction to both the children and parents on how to encourage/develop healthy behaviors. Support groups can help the patient and family connect with others who have similar problems.

Healthcare professionals have developed viable tools to assist teachers and parents both when encountering a child diagnosed with ADHD.  

Some of these tools include:

1.       Maintaining a consistent daily schedule, including regular times for homework, meals, and outdoor activities. 

2.       Providing advance notice to schedule changes.

3.       Providing an environment with as little distraction as possible.

4.       Ensuring the child receives proper nutrition and required sleep.

5.       Showing appreciation for the child’s good behavior.

6.       Setting rules that are enforced consistently. 

7.       Frequent and open communication between the child's teacher and parent.

As each child is unique, so will the plan of treatment be.  In some cases more than just techniques to accommodate inattention, hyperactivity, or impulsivity are required.  In these instances, prescription medication treatment can be indicated.  The most common medications that are used for ADHD are in the category of Psychostimulants; even though they are stimulants, they actually have a calming effect in people with ADHD.

Any medical condition, requires all involved parties to be well informed, therefore it is imperative to consult with the proper medical authority.  The best way to guide a child through the challenges of ADHD, is to be on the right path.  It may be a slightly bumpy path, or even a mountainous one, but reaching the destination successfully can be accomplished.

Tuesday, September 17, 2013

Flu Season Approaches!

The kids are back in school, the days are becoming just a little bit shorter and maybe a slight cooler.  You may be seeing pumpkins and Halloween candy in your local market.

fall flu seasonIt’s obvious, fall is approaching, and with it…. cold and flu season, UGH! flu virus

                                                                                                                                                                                                                                                                                                         
cold and flu facts Things to know about flu (and colds):

Colds and flu share many symptoms, but fever, body aches, extreme tiredness, and dry cough are more common and intense in cases of the flu. Whereas, colds tend to produce a runny or stuffy nose.

Tests during the first days of illness can detect influenza and may be indicated for those considered high risk to flu complications. 

Seniors and people with chronic health conditions—like asthma, diabetes, and heart disease—are at a higher risk for serious complications from the flu.

Based on research predictions, the upcoming season's flu vaccine will protect against these three influenza viruses: an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus.

Even though the timing and duration of flu seasons can vary, for those living in the US, winter is the time typical time with some outbreaks as early as October. Most of the time flu activity peaks in January or later. 

You can be contagious 1 day before any flu symptoms occur and you may be able to pass on the flu to someone else up to 5 to 7 days after becoming sick.

It will take approximately two weeks after vaccination for your body to develop the antibodies to protect against influenza virus infection.

Everyone 6 months and older should get a flu vaccine each year.

                                                                                                                                                                                                                                                                                                         
flu statisticsFlu and Pneumonia Stats:

According to the Centers for Disease Control and Prevention:

In a 30-year study period, from 1982-2012, flu activity most often peaked in February (14 seasons, or 47% of the time).

In a 30-year period, from 1976-2006, annual flu-associated death estimates ranged from a low of about 3,000 to a high of about 49,000 in the US.

The 2012 season deaths related to flu and pneumonia were the highest in nearly a decade, and people 65 years and older accounted for half of all flu-related hospitalizations.

                                                                                                                                                                                                                                                    
                                                      
 claim reimbursementSo let’s refresh our memories on the coding and reimbursement guidelines for Influenza Virus and Pneumococcal vaccinations.

denial If you are not submitting the correct diagnosis and procedure codes you will not receive the proper claim reimbursement.

The vaccine procedure code should be chosen based on the description of the drug and the age of the patient.

Each vaccine code should be billed with the appropriate administration code as well.

                                                                                                                                                                                                                                                                                                          
The following procedure and diagnosis codes are used for influenza virus vaccinations:
CPT/HCPCS CodeDescription
90654Influenza virus vaccine, split virus, preservative free, for intradermal use
90655Influenza virus vaccine, split virus, preservative free, for children 6-25 months of age, for intramuscular use
90656Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use
90657Influenza virus vaccine, split virus, for children 6-25 months of age, for intramuscular use
90660Influenza vaccine, live, for intranasal use
90662Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use. (High Dose)
Q2034Influenza virus vaccine, split virus, for intramuscular use (Agriflu)
Q2035Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Afluria)
Q2036Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluluval)
Q2037Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluvirin)
Q2038Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluzone)
G0008Administration of influenza virus vaccine

Diagnosis CodeDescription
V04.81Influenza vaccination with dates of service 10/1/2003 and later
V06.6Influenza and pneumococcal vaccination (Report this code when the purpose of the visit was to receive both vaccinations during the same visit)

                                                                                                                                                                                                                                                                                                  
The following procedure and diagnosis codes are used for pneumococcal vaccinations:
CPT/HCPCS CodeDescription
90669Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use
90670Pneumococcal conjugate vaccine, 13-valent, for intramuscular use
90732Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use
G0009Administration of the pneumococcal vaccine when no physician fee schedule service on the same day

Diagnosis CodeDescription
V03.82Pneumococcal vaccination
V06.6Pneumococcal and influenza vaccination (Report this code when the purpose of the visit was to receive both vaccinations during the same visit)

                                                                                                                                                                                                                                                      


cci editsCoding Hint: Based on CCI edits, when performing an unrelated E/M service on the same date as the vaccination, append a “25” modifier to your E/M service procedure code to prevent denials of your immunizations.

                                                                                                                                                                                                                                                    

coding hint

CMS has available on its website numerous resources to assist providers and will be posting Season 2013-2014 updates to their website soon.

Facts on Influenza, Pneumococcal, and Hepatitis B Immunizations: http://www.cms.gov/Medicare/Prevention/Immunizations/index.html?redirect=/Immunizations/


                                 
                                                                                                                                                                                                                                                    

vaccine finderIf you are not administering flu shots, recommend this free tool, HealthMap Vaccine Finder to help your patients locate a local vaccine provider.

Friday, September 13, 2013

Ovarian Cancer Whispers - Just Listen

September is National Ovarian Cancer Awareness Month.  Ovarian cancer ranks fifth in cancer deaths among women. To better serve your patients and help save lives, now is the time to review current information available on statistics, causes and prevention.

Ovarian Cancer Awareness – Fight Like a Girl!

Ovarian Cancer Awareness groups utilize this acronym: BEAT to highlight the four of the signs and symptoms of this typically “silent” disease.  (Only 15% of ovarian cancer cases are diagnosed in an early stage.)
Bloating that is persistent
Eating less and feeling fuller
Abdominal pain
Trouble with your bladder

Additional indicators for concern are: excessive dark and coarse hair growth, painful sex, back pain, abnormal menstrual cycle, nausea or vomiting, fatigue, constipation, and increased gas.

ovarian cancer Ovarian Cancer Statistics:

 Each year, approximately 250,000 women worldwide are diagnosed with ovarian cancer resulting in 140,000 deaths.

us cancer deaths Each year, more than 22,000 women in the US get ovarian cancer; that translates to a one in 100.  The American Cancer Society estimates 15,000 deaths from ovarian cancer in the United States annually, a rate that has changed little in the last 50 years. 

  causes of ovarian cancerEven though there are no definitive causes, it is known that the chances of developing the disease are greatly influenced by family history:

There is a 5 in 100 chance for women with one relative that has the disease.  The chance increases to 7 in 100 if two or three relatives have been diagnosed. 

risks of ovarian cancerBesides genetic influences, other factors thought to increase ovarian cancer risk include:
Women with lower birthrates and giving birth later in life.
Women who take Estrogen replacement without Progesterone for more than 5 years.
Women who have had breast cancer or have a family member with breast cancer.
Women from middle to advanced ages.  (Most Ovarian cancer related deaths occur in women over 55 years of age.)
ovarian cancerOvarian Cancer Screening

Any woman with signs of ovarian cancer, especially if they are considered high risk, should be offered by their physician these tests:

Pelvic Exam:Women age 18 and above should have a mandatory annual vaginal exam. Women age 35 and above should receive an annual rectovaginal exam (physician inserts fingers in the rectum and vagina simultaneously to feel for abnormal swelling and to detect tenderness).

Transvaginal Sonography:This ultrasound, performed with a small instrument placed in the vagina, is appropriate especially for women at high risk for ovarian cancer or for those with an abnormal pelvic exam.

CA-125 Test:This blood test determines if the level of CA-125, a protein produced by ovarian cancer cells, has increased in the blood of a woman at high risk for ovarian cancer or with an abnormal pelvic examination.  (ACA-125 test can be useful, but can be inaccurate. This test should be utilized with other testing for diagnosing ovarian cancer.)

ovarian cancerOvarian Cancer Diagnosis, Staging and Treatment:

A woman with any positive results should consult with a gynecologic oncology specialist immediately.  Additional testing may be ordered such as a CT scan and X-Rays. The most accurate way to confirm ovarian cancer is with a biopsy.

     Surgery
The initial surgery is typically performed via laparotomy to obtain tissue for biopsy, but may also include debulking of the visible cancerous tumor, removal of one or both ovaries and fallopian tubes (salpingo-oopharectomy) and often the removal of the uterus (hysterectomy).  From this procedure the gynecologic oncologist can determine the staging of the cancer and the cell pathology can be analyzed.  All of this information is crucial in planning the appropriate treatment strategy.

Subsequent surgical interventions may be required in the following instances:

"Second-look" surgeries are on occasion performed via laparotomy or laparoscopy as a follow-up for women whose cancer responds to chemotherapy.  It allows the physician to investigate whether any cancer remains in the abdominal cavity and will require further treatment.

Additional debulking surgerycan in some cases be indicated to reduce cancer symptoms and improve the effects of chemotherapy.

In the case of recurrent ovarian cancer, surgery is used toremove the new measurable disease after a reasonable disease-free interval or to remove bowel or ureteral obstruction caused by the recurrence.

     Radiation therapy

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors (only rarely used in the treatment of ovarian cancer in the United States).

     Chemotherapy

In the majority of ovarian cancer cases, chemotherapy is administered post-surgery to either destroy cancer cells or stop them from growing both in and outside the ovaries. (For cases that require the shrinking of the tumor prior to debulking surgery, neoadjuvant chemotherapy is used.)

   american cancer society info Follow this link to the American Cancer Society dedicated web page for Ovarian Cancer Information: http://www.cancer.org/cancer/ovariancancer/index

ovarian cancer awarenessBesides helping your patients, share this information with colleagues, family and friends.  You never know whose life it may save!