This week's gem over at the Family Medicine Digital Resource Library is Michael Crouch's CHD risk estimator with adjustment for family history of CHD. It's an excel spreadsheet. I'd love to see this migrate to the web. It would be a great public service .. any takers?
Here's the best advice I found with a quick google search
we have found that there is some confusion as to how to correctly bill these claims. CPT code 17000, Destruction (eg. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (eg. actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; first lesion, should be billed once for the first such lesion treated, when fourteen or fewer total lesions are removed or destroyed. CPT +17003 is an add-on code specifically for use with the primary CPT code 17000, only. CPT +17003, Destruction (eg. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (eg. actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; second through the fourteenth lesions, each (list separately in addition to the code for first lesion), should be billed once for each additional lesion treated, up to a total of thirteen times. These two CPT codes, 17000 and 17003, can be thus combined to bill for a total of fourteen such lesions.When billing for the treatment of fifteen or more lesions, CPT code 17004, Destruction (eg. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (eg. actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions, should be used, and only billed one time for whatever number of lesions are treated beyond fifteen. Whether fifteen or sixty lesions are treated, CPT 17004 should only be billed once for the total service, and should not be combined with CPT 17000 or 17003.For example, for destruction of seven actinic keratoses, the billing would be as follows:17000 (for first lesion)17003 x number of services = 6, for total of seven lesionsIf sixteen lesions were treated, the billing would be:17004 (billed once for 15 or more lesions)Care must be used when selecting the proper CPT code to use, as the 17xxx series codes are not always consistent. For instance, CPT 17110, Destruction (eg. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of flat warts, molluscum contagiosum, or milia; up to 14 lesions, has no code analogous to 17000 for the first lesion. CPT 17110 is just used once for one to 14 lesions, while CPT 17111, Destruction (eg. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), flat warts, molluscum contagiosum, or milia; 15 or more lesions, is billed once for 15 or more lesions, not in conjunction with 17110.Some procedure codes for removal or destruction of lesions are billed by size of lesion treated, while others are based on number of lesions treated. The provider should know the descriptors of the procedure codes selected, and is responsible for choosing the appropriate code to reflect what was done. This allows Medicare to pay the correct amount the first time.It has also been noted that often when multiple lesions are removed, they will all have a Pathology evaluation. In cases where benign lesions are removed for the symptomatic criteria listed on the Local Coverage Determination, and are described in the medical record as benign, it does not meet medical necessity criteria for all these to have pathology evaluations. If these are suspicious lesions, the medical necessity criteria are clearly met, but when the description in the chart states that one or more symptomatic benign lesions were removed, pathology examination may not be required and should not be billed to Medicare.
The CDC released a report today on youth risk behavior. Excerpts:
Problem: Priority health-risk behaviors, which contribute to the leading causes of morbidity and
mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood,
are interrelated, and are preventable.
Reporting Period Covered: October 2004–January 2006.
Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories
of priority health-risk behaviors among youth and young adults, including behaviors that contribute
to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that
contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency
virus (HIV) infections; unhealthy dietary behaviors; and physical inactivity. In addition, the YRBSS
monitors general health status and the prevalence of overweight and asthma. YRBSS includes a national
school-based survey conducted by CDC and state and local school-based surveys conducted by state and local
education and health agencies. This report summarizes results from the national survey, 40 state surveys, and 21
local surveys conducted among students in grades 9–12 during October 2004–January 2006.
Results: In the United States, 71% of all deaths among persons aged 10–24 years result from four
causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2005
national Youth Risk Behavior Survey (YRBS) indicated that, during the 30 days preceding the survey, many
high school students engaged in behaviors that increased their likelihood of death from these four causes: 9.9%
had driven a car or other vehicle when they had been drinking alcohol; 18.5% had carried a weapon; 43.3%
had drunk alcohol; and 20.2% had used marijuana.
So today I was having fun during lunchtime. The rep from a local oxygen supply company was there to tell us about her new portable oxygen concentrator and she brought cool pens like these.
So of course I stuck one on my (growing) forehead and had lunch. Wouldn't you? Of course you would.
So now I have a forehead hickey.
I subscribe to the FMDRL RSS feed.
Today – this resource came across. It's a great overview of perineal repair. Alas – I'm doing a lot of that lately .. and last night I cut an episiotomy – only the 3rd I've done in my 8 years and 11 months as a physician. Of course – there was an indication (the same as the indication for the vacuum I used) but all is well and I was reminded by the experience how easy it is to repair an episiotomy. It is MUCH easier to see and understand the anatomy with an episiotomy than with a spontaneous tear .. so since we are never teaching residents to get oriented with episiotomies – curricula such as this is more important than ever.