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From: The Rheumatologist, May 2011
Features
The Granulomatosis of Wegener's
Delving deeper into the nonvasculitis aspects of the disease
Wegener’s granulomatosis (WG) is per definitionem a granulomatous disorder involving the respiratory tract and is usually associated with vasculitis, affecting small to medium-sized vessels and the production of antibodies to neutrophil cytoplasmic antigens (ANCA) directed to the antigen proteinase 3 (PR3). Although vasculitis may be its classical feature, WG also may occur as a persistent granulomatous inflammatory process without apparent vasculitis. While there is no clear definition of...
Plan Now for ICD-10 Changeover
Coding changes will have an impact on staff, physicians, and even the finances of rheumatology practices
October 1, 2013 will mark a momentous, system-wide change for physicians in practices throughout the United States. That is the day the International Classification of Diseases, 10th Revision (ICD-10) code sets go into effect. Everyone covered by the Health Insurance Portability and Accountability Act (HIPAA)—not just those who see Medicare and Medicaid patients—will begin using the new code set.
CARRA
Working for Children with Rheumatic Diseases
What a difference a decade makes. In the late 1980s and early 1990s, the viability of pediatric rheumatology seemed in doubt. Few fellows were being trained, and medical centers were fortunate if they had even one pediatric rheumatologist on staff. The paucity of trained pediatric rheumatologists created severe access problems for children with disorders like juvenile idiopathic arthritis (JIA) and pediatric lupus. Depending on where they lived, children needing care for a rheumatic disease might be...
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News
Medical Societies Ask, What's in a Name?
ICD-11, history, and confusion a catalyst for replacing eponyms with descriptions in disease nomenclature
The eleventh revision of the International Classification of Diseases (ICD-11) has accelerated a trend away from using people’s names and toward a more descriptive or etiologically based nomenclature for diseases. The most recent example is substituting the granulomatosis with polyangiitis (Wegener’s) for the vasculitis currently known as Wegener’s granulomatosis.
Hydroxychloroquine Retinopathy Still Alive and Well
How rheumatologists are affected by new guidelines from ophthalmology
Hydroxychloroquine (Plaquenil; HCQ) has been an important and effective drug for the treatment of lupus erythematosus and related autoimmune and inflammatory diseases for half a century, although its potential to cause retinal damage continues to raise concern among rheumatologists and ophthalmologists. Further, despite the overall safety profile of HCQ, some patients with preexisting vision problems (e.g., glaucoma, cataracts) may be reluctant to take a medication with any potential for ocular toxicity,...
Rheumatology's Virtual "Water Cooler"
The ACR list serves allow rheumatologists and health professionals across the country to connect and share ideas
When availability of the pennies-per-pill drug colchicine was threatened by the branded drug Colcrys—at $5 a pill—Fairfield, Ohio–based rheumatologist Edward B. Herzig, MD, posted the news on the ACR advocacy list serve. The result? Outrage among his fellow rheumatologists and immediate action by ACR leadership, which approached the U.S. Food and Drug Administration about the issue and the impact it would have on patients with gout and familial Mediterranean fever who depended on the...
Never Give Up on a Patient
ACR President David Borenstein, MD, receives AF honor for his dedication to rheumatology
The Arthritis Foundation (AF) Mid Atlantic Region recently honored ACR President David G. Borenstein, MD, with the Marriott Lifetime Achievement Award for his work with the foundation and his dedication to the fight against arthritis.
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From the College
ICD-10 from a Coder's Perspective
For the past 30 years, coders have used the International Classification of Diseases, Ninth Revision (ICD-9) to identify and report diseases, signs, and symptoms as well as to measure morbidity and mortality in the United States. In general, coders identify ICD-9 as the heartbeat of reimbursement for medical procedures because this is what drives medical necessity.
Congress Spending More Time at Home: Good News for Advocates
Members of Congress will spend more time in their respective districts this year. This is great news for both experienced and new advocates, because members of Congress are often more accessible when they are home. If you are apprehensive about meeting with your members of Congress in Washington, D.C., these district work periods provide the perfect opportunity to begin building a valuable relationship with your legislators. Here are a few ways for you to reach out to your legislators while they are at...
RA Treatment May Be Beneficial Even After Patients Meet Remission Criteria
An analysis of wrist MRIs from participants in the Treatment of Early Aggressive Rheumatoid Arthritis (TEAR) clinical trial indicates that patients continue to show joint inflammation even after two years of early aggressive therapy.
ACR Member to Chair Rheumatology Department at Cleveland Clinic
Abby Abelson, MD, has been named chair of the Department of Rheumatic and Immunologic Diseases at the Cleveland Clinic. She had served as interim chair of the department since May 2008. She also chairs the Medical and Scientific Committee of the Arthritis Foundation.
GO! A Scientific Program that Surpasses Excellence
Join us in Chicago, November 4–9, 2011, for the 2011 ACR/ARHP Annual Scientific Meeting, the premier rheumatology meeting.
Coding Corner Question
May’s Coding Challenge
Incident-to Billing
Coding Corner Answer
May’s Coding Answer
Practice Page
Incident-To: What Are The Guidelines?
In today’s busy medical practice, many rheumatologists are utilizing the services of nonphysician healthcare professionals such as nurse practitioners (NPs), physician assistants (PAs), clinical nurse specialists, certified nurse midwives, occupational therapists, and medical technologists. Rheumatology practices typically employ the services of NPs and PAs to assist with the overall patient flow. Having an NP or PA can be a great time saver and a revenue booster to rheumatology practices because...
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Departments
Drug Updates
Information on New Approvals and Medication Safety
Belimumab (Benlysta) finally received Food and Drug Administration (FDA) approval on March 9, 2011, to treat patients with active, autoantibody-positive systemic lupus erythematosus (SLE) who are receiving standard therapy.1 Belimumab is administered by intravenous infusion and is the first B-lymphocyte stimulator protein inhibitor to be approved by the FDA. The last SLE drugs to be FDA approved were hydroxychloroquine and corticosteroids.
Rheum with a View
Panush’s perspectives on selections from the literature
It’s been nearly 20 years since Bernadine Healy, then the Director of the National Institutes of Health, gave the Yentl syndrome its name. Healy wrote eloquently about gender inequality in medicine. She titled this predicament after Yentl, a woman in a story by Nobel Prize–winning writer Isaac Bashevis Singer. Yentl had to disguise herself as a man to study Talmud. (Maybe you’ve seen the movie about this of the same name, directed, co-written, and co-produced by and starring Barbara...
Ethics Forum
What’s your ongoing obligation to care for patients who can’t pay?
This month we will explore the difficult yet increasingly important question of how to provide care to patients with chronic conditions who do not have health insurance or other means to pay for their care—and we want your help.
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Columns
2013–A Whole New World
ICD-10 will change the coding and billing landscape, and practices should start preparing now
I have been practicing medicine for 33 years. Wow, 33 years. I am sure many of you are like me in that when you have been practicing this long, some information is ingrained in the depths of your mind. For instance, whenever anyone says rheumatoid arthritis, I know instantly the International Classification of Disease (ICD) code is 714.0. It has been 714.0 for as long as I remember. But moving forward, it could possibly be M05.70, M06.9, or M05.9 because the Centers for Medicare and Medicaid Services (CMS)...
The Saddest Disease to Prevent
When preventing a disease is harder than its treatment
When I was an intern, our chief of medicine would make a regular trip to the wards for a case presentation. The event was a high-stress affair where we all donned our clean white jackets and had our charts looking spiffy and organized, lab values charted accurately and up to the minute. The cases for discussion were usually very challenging and complicated, allowing the ward team to show its stuff with elaborate workups that included everything from A to Z.
Russians Mourn Iconic Rheumatologist
Valentina A. Nasonova, MD, was Renaissance figure in Russian rheumatology
We are saddened to announce to the ACR membership the February 2, 2011, passing of ACR Honorary Member Valentina Alexandrovna Nasonova, MD, of the State Institute of Rheumatology in Moscow and a full member of the Russian Academy of Medical Sciences (RAMS). Dr. Nasonova’s sizable career contributions domestically and internationally are matched only by descriptions of her by colleagues as a consummate physician scientist and transformational leader, an educator whose regard was sustained by her great...
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Viewpoints
Letter to the Editor
I enjoyed reading your musings on European travel in the February TR [“Medical Renaissance”], particularly when reflecting on my own experiences as a rheumatologist in Europe, wearing two very distinctive hats. It was a rare treat to be invited to lecture at the ACR during fellowship (twice when in Mannik’s lab as a research fellow, not at all during my clinical year at The University of California, San Francisco), yet the occasions were more numerous (limited by clinic duties, attending...
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Audio
ONLINE EXCLUSIVE: Experts discuss the process of becoming “meaningful users” of electronic medical records
Listen to Itara Barnes, ACR senior specialist of health informatics, discuss the meaningful use electronic health record certification process.
