Gout affects nearly 4% of American adults, causing joint inflammation, pain and crystal deposits that may lead to bone erosion over time. At least five different classification criteria for gout are used worldwide, creating potential discrepancies in clinical trial enrollment and eventual results. An international panel of investigators collaborated to create new, standardized gout classification…
One month has passed since the U.S. healthcare system overcame a historical milestone with the conversion from billing ICD-9-CM to ICD-10-CM. Although the transition to ICD-10 had a major impact on coding operations, its far-reaching tentacles go beyond coding alone and are deeply rooted in the entire revenue cycle. There is room to criticize the…
CPT: 99213, 73500-RT, 73500-LT ICD-10: M16.52 This E/M service entailed: The history is detailed; The examination is expanded problem focused; and The medical decision making is of low complexity. The X-ray reviewed was for radiologic examination, hip, unilateral: one view for the left hip and for the right hip. M16.52—The diagnosis identifies unilateral post-traumatic osteoarthritis…
Post-Traumatic OA A 70-year-old female patient comes in for a follow-up visit for pain and stiffness in her left hip. She injured her hip in a skiing accident three years before and reports the X-rays at that time showed no fractures. Due to no obvious fracture at the time, she was given ibuprofen and advised…
“Do you seriously want me to stand on my tiptoes?” my gruff 68-year-old patient at the VA Rheumatology Clinic asked, incredulous. “I came with a walker. I think you very well know, doc, that if I get on my tippy-toes, then I’m going to fall flat on my face.” He had a point, one that…
I sometimes find myself mired in sticky clinical circumstances. I am facing a distraught patient who is seeking my opinion about a condition that, according to some, may not truly belong in the rheumatologist’s bailiwick. Case example: hearing loss. The Steroid Test Sudden sensorineural hearing loss (SSNHL) and its relative, autoimmune inner ear disease (AIED),…
In the late 1990s, Thomas Baranowski, PhD, professor of pediatrics specializing in nutrition at the Baylor College of Medicine, Houston, applied for a grant. For years, he had been interested in finding ways to get children to change their diet and physical activity. He decided to try a video game, and he got the money…
Background Autoimmune diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematous, occur when the body attacks its own tissue because it cannot differentiate between self and non-self. This is mainly through deregulation of the immune system. Vitamin D has been known to play a critical role in bone mineralization and bone health. Activated vitamin…
I am a few weeks post-retirement. Having written thank you notes and completed urgent home projects, I swing in a hammock at our currently fire-threatened cabin north of Winthrop, Wash., and reflect. I feel like a young boy while freely flipping pages of a hand-scribed picture book, The Principles of Uncertainty, by Maira Kalman. She…
Recent updates to criteria used for diagnosing neuromyelitis optica (NMO) are aimed at helping physicians make the differential diagnosis of this disorder differentiating it from other inflammatory disorders—a diagnosis that can be difficult given the presenting symptoms that can mimic a number of other conditions, such as multiple sclerosis. Published in July 2015, the new…