Tips for Allergy Sufferers

See the following tips on allergy exposure and prevention.  For more detailed information on Allergy and Asthma see the website for the Asthma and Allergy Foundation on America (AAFA).

Some facts about allergy exposure:

          Allergens can be inhaled                 ingested 

                                  injected    

         absorbed through the skin

Jackson, MS ranked #1 in the AAFA report on the 100 most challenging places to live with allergies 

Prevention tips: 

       dust to control mites               vacuum often 

                            reduce pet dander          shut out pollen                avoid mold spores

Allergy Immunotherapy Billing

Whoever wrote “April showers bring May flowers” held the key to the peak Allergy and Asthma season.  May has been designated an awareness month for Allergy and Asthma by the Asthma and Allergy Foundation on America (AAFA).  Asthma and allergy are commonly “linked” together as allergies can be one of the major contributing factors for those patients diagnosed with asthma.

Asthma and allergy have been estimated to affect one in five Americans.  As a health care professional, there are significantly high odds you encounter these conditions in a high proportion of your patient population.  If you are a primary care type provider, you may be able to adequately treat those mild sufferers.  For those with more severe symptoms, a referral to an Allergy and Asthma Specialist will be warranted.

A common treatment for allergies is Allergen Immunotherapy or “allergy shots”.  This type of treatment is prescribed by the Allergy specialist who also may administer the treatment personally.  In today’s healthcare environment though, many managed care organizations prefer the patient receive the treatment via their assigned primary care provider.  The table below provides CPT codes that are used in the billing of allergen immunotherapy.

CPT CODE	DESCRIPTION
95115	One Injection only, no serum-PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; SINGLE INJECTION
95117	Two or more injections,  no serum-PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 OR MORE INJECTIONS
95144	Serum only, single dose vial, bill number of vials-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY, SINGLE DOSE VIAL(S) (SPECIFY NUMBER OF VIALS)
95145	Single insect venom only, multi-dose vial, bill number of does-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); SINGLE STINGING INSECT VENOM
95146	Two insect venoms only, multi-dose vial, bill number of does-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); 2 SINGLE STINGING INSECT VENOMS
95147	Three insect venoms only, multi-dose vial, bill number of does-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); 3 SINGLE STINGING INSECT VENOMS
95148	Four insect venoms only, multi-dose vial, bill number of does-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); 4 SINGLE STINGING INSECT VENOMS
95149	Five insect venoms only, multi-dose vial, bill number of does-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); 5 SINGLE STINGING INSECT VENOMS
95165	Serum only, multi-dose vial, bill number of doses-PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY; SINGLE OR MULTIPLE ANTIGENS (SPECIFY NUMBER OF DOSES)

May 6th. is Melanoma Monday

The American Academy of Dermatology (AAD) designates the first Monday in May as Melanoma Monday®.  The AAD spearheads the effort to raise awareness of melanoma and other types of skin cancer. 

 Skin Cancer Statistics

·         Skin cancer is the most common cancer in the United States.

·         Current estimates are that one in five Americans will be diagnosed with skin cancer in their lifetime.

·         Melanoma, the deadliest form of skin cancer, is the most common cancer for 25- to 29-year-olds.

Don’t be one of those statistics.  Use the tools below:

Check your skin   Early detection through self-exams can sometimes be the difference between life and death.

Follow this link to an online self-examination guide:

http://www.aad.org/spot-skin-cancer/understanding-skin-cancer/how-do-i-check-my-skin

Free Cancer Screening   Dermatologists across the country volunteer their time to provide free skin cancer screenings. 

                    Follow this link to locate one in your area: http://www.aad.org/scs/search/default.aspx

Prevent Skin Cancer   The most preventable risk factor for developing skin cancer is sun exposure.

   Follow this link to get recommendations for lowering your exposure: 

http://www.aad.org/spot-skin-cancer/understanding-skin-cancer/how-do-i-prevent-skin-cancer

When scheduling a patient for their first visit to your practice, you should advise them of what they need to bring to help ensure a smooth registration process and to assist your physician in making that first visit as thorough as possible.

Follow this check list as a guide:

• Picture identification and current insurance card(s)

Hint:  Once provided with this information, you need to verify insurance coverage and benefits.  This is the optimum time to collect copayments from the patient.

• Contact information for emergency contact and/or healthcare surrogate

Hint:  Make sure the patient indicates the name(s) of any authorized persons on your HIPAA notification form.

• Contact information for all current healthcare providers

Hint:  Please have the patient add to the HIPAA form, the names of any physicians they would like your physician to communicate with or share their medical records.

• Copies of any applicable medical records and recent diagnostic testing results

Hint:  If you are handed records that are the patient’s only copy, make your own copy and return the “originals” to the patient.  They may need them for another provider.  X-rays or radiology “films” stored on computer discs, should be logged in the patient’s record if they are left behind after the visit.

• Complete list of current medications, both prescription and over the counter.

Hint:  Adding the pharmacy name and phone/fax number into the patient chart facilitates issuing any required prescriptions.

Medicare Covers STDs Screening

Sexually Transmitted Diseases (STDs) are no longer conditions that are only discussed in back alley clinics.  Proof is based on the fact that statistics show that STDs are commonly affecting those as young as 15 and Medicare now covers STD preventive services.  A diverse range of clinicians from Pediatrics to Geriatric Medicine are being called upon to help reduce STD’s in our communities.  

Not all diseases are preventable, but in the case of STDs, awareness is the key to prevention as emphasized this month by Centers for Disease Control (CDC).  As always awareness goes hand in hand with education.  As the key sponsor of Sexually Transmitted Disease Awareness for the month of April, the CDC is offering a wide range of information for both the public and healthcare professionals alike.  

Many people would be shocked to read these STD statistics:

Approximately 20 million new STD’s are diagnosed each year

Half of all new STD’s are attributed to people age 15-24

Annual cost of treating STD’s is almost $16 billion

Even though there have been noted disparities in the occurrence of STDs in certain populations, there is no race, sex, economic status or age group that is exempt.  It is of the utmost importance that healthcare professionals take advantage of each opportunity to have an open and frank discussion with all of their patients regarding these highly preventable conditions.   

These discussions should include these basics:

Inquiries about high risk behavior 

Ways to prevent contracting a disease

The signs and symptoms associated with common STDs

As mentioned earlier in this article, as of November 8, 2011, CMS made Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) part of its panel of covered preventive services. 

 The tables below highlight coverage information that can be found at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/PreventiveServices.html

 

 

Covered Screening Service for Increased Risk Patients	HCPCS/CPT Codes	ICD-9 Codes	Patient Financial Responsibility
Chlamydia	86631, 86632, 87110, 87270, 87320, 87490, 87491, 87810	Non-pregnant female:V74.5 & V69.8 Pregnant female: V74.5 & V69.8 & V22.0,V22.1, or V23.9	Deductible and coinsurance waived
Gonorrhea	87590, 97591, 87850	Non-pregnant female:V74.5 & V69.8 Pregnant female: V74.5 & V69.8 & V22.0,V22.1, or V23.9	Deductible and coinsurance waived
Combined Chlamydia and Gonorrhea	87800	Non-pregnant female:V74.5 & V69.8 Pregnant female: V74.5 & V69.8 & V22.0,V22.1, or V23.9	Deductible and coinsurance waived
Syphilis	86592, 86593, 86780	Non-pregnant female:V74.5 & V69.8 Pregnant female:V74.5 & V22.0, V22.1 or V23.9 Male: V74.5 & V69.8	Deductible and coinsurance waived
Hepatitis B	87340, 87341	Pregnant female: V73.89 & V69.8 & V22.0, V22.1, or V23.9	Deductible and coinsurance waived

Covered Counseling Service for Increased Risk Patients	HCPCS/CPT Codes	Frequency	Patient Financial Responsibility
High Intensity Behavioral Counseling	G0445	Up to two HIBC counseling sessions annually	Deductible and coinsurance waived

Equal Healthcare for Minorities

This April, National Minority Health Month is supported by the Office of Minority Health and other agencies to raise awareness about health disparities that continue to affect racial and ethnic minorities. The Patient Protection and Affordable Care Act's groundbreaking policies are aimed to reduce these disparities and achieve health equity.

The National Institutes of Health (NIH) defines health disparities as differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups.

The Patient Protection and Affordable Care Act also created the National Institute on Minority Health and Health Disparities (NIMHD) at NIH. The NIMHD will control all aspects of the NIH in regards to these minority health issues. The main goal is to bring attention to and find solutions for the unequal burden of illness affecting minority, rural and poor populations in this country.

The United States Department of Health and Human Services (HHS) drew on the same legislation when developing its Disparities Action Plan. The HHS Action Plan to Reduce Racial and Ethnic Health Disparities outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities that include current common healthcare improvement strategies of evidence-based programs, integrated approaches and best practices.

The HHS Disparities Action Plan is designed around race and ethnicity, but those are not the only American populations effected by health disparity. Geographical location and poverty have long been associated with reduced healthcare equity. Religion, gender, age mental health, disability, sexual orientation or gender identity can all provide obstacles to appropriate healthcare.

Even though causes of health disparities can vary as widely as the diversity of the population, one issue consistently shows to be a key indicator in the quality of health care received by minority populations: insurance coverage. Statistics have shown that racial and ethnic minorities are significantly less likely than the rest of the population to have health insurance. (See table below)

This article highlights how the ACA will facilitate access to insurance:
 http://www.iridiumsuite.com/mbs-blog/new-healthcare-law-2014-will-benefit-consumers-and-providers

As we have seen numerous public agencies have all joined together to affect change in the area of health disparities. Each of them plays a significant role in achieving the goals of the Healthy People 2020 initiative. Additional information can be found on the main CDC Minority Health website.

2010 United States Census has published the following insurance coverage statistics:

Race/Ethnic Group	% of Population with No Insurance
African-Americans	20.8
American Indians/Alaska Natives	29.2
Asian-Americans	18
Hispanics	30.7
Native Hawaiians/Pacific Islanders	17.4
Non-Hispanic Whites	11.7

The Benefits of a Care Team Approach for Head and Neck Cancer Treatment

As part of Oral, Head and Neck Cancer Awareness Week, I have reached out to South Florida Radiation Oncologist, Dr. James T. Parsons for some professional insight.  Dr. Parsons is an internationally recognized expert in the field of Head and Neck Cancer treatment.  

We would like to emphasize the importance of a coordinated team approach for successful treatment of one of the most complex of all cancer diagnoses.

Unless they have a previous experience or personal knowledge, when most people think of cancer treatment, rarely do they truly understand that it will require a finely choreographed coordination amongst several healthcare professionals and other caregivers.

I posed the following questions to Dr. Parsons about the “Care Team” approach in the treatment of Head and Neck Cancers.

Q:  Who would you say are the necessary healthcare professionals that a patient should consult when he or she is diagnosed with Head and Neck Cancer?

A:

1. Head and Neck Surgeon
2. Medical Oncologist
3. Radiation Oncologist
4. Dentist
5. Oral Surgeon

 Q:  How do patients navigate through the many treatment options, such as chemotherapy, radiation therapy and surgery or combinations of multiple modalities, to make the right decision about their treatment course?

A:  This is one of the benefits of having a “Care Team” approach.  If all the healthcare providers work together in evaluating the patient’s treatment needs, usually this provides a consensus of opinion, simplifying the decision-making process for the patient.  Occasionally, providers may agree on multiple treatments options, this is when assistance from family and/or close friends can be extremely helpful in the decision making process.

Q:  You mention the patient’s family and friends; I assume these persons can also have a tremendous impact on the well-being of the patient during and after treatment.  Do you consider family and friends to be part of the patient “Care Team” as well?

A:  Definitely.  Treatment for Head and Neck type cancers, like most cancers, can produce multiple side effects.  A strong at home support system is just as crucial to the success of the treatment as any medical service.  Once treatment begins, additional healthcare resources may join the “Care Team” such as: social workers, registered dieticians, and home health nurses or aides.  

Q:  Any final thoughts on the “Care Team” approach?

A:  Early intervention by the surgeon, medical oncologist, radiation oncologist, dentist and oral surgeon ensure that a rational plan of care can be developed, reducing the occurrence of any surprises along the way.

You can follow this link to the National Institutes of Health’s website for more information on Oral Cancer:

http://search.nih.gov/search?utf8=%E2%9C%93&sc=1&query=oral+cancer&m=&embedded=&affiliate=nih&filter=moderate