NEW YORK (Reuters Health)—Combining paracetamol (acetaminophen) with ibuprofen does not cut postoperative use of morphine in a clinically meaningful way relative to ibuprofen alone, in patients undergoing total hip arthroplasty (THA), results of a Danish randomized trial suggest. “Although the combined use of paracetamol and ibuprofen reduced immediate postoperative morphine consumption compared with paracetamol alone…
Search results for: acetaminophen
Coding Corner Question: Billing for Joint Injection within a Series
A 68-year-old female Medicare patient with a diagnosis of primary osteoarthritis of the left knee returns to a practice for her third injection in a series of knee injections. She reports being able to resume her after-dinner walks, which last for 30–40 minutes at least twice weekly. She denies fevers or any rashes. She has…
Rituximab Maintenance Study: Is Fixed-Schedule or Tailored Dosing Best?
Rheumatologists prescribe rituximab for induction and maintenance treatment for anti-neutrophil cytoplasm antibody (ANCA) associated vasculitides (AAV). Maintenance treatment typically employs fixed-schedule dosing, but in the recent maintenance of remission using rituximab in systemic ANCA-associated vasculitis II (MAINRITSAN2) trial, researchers from the French Vasculitis Study Group examined whether individually tailored maintenance dosing might work better. “The…
2019 Changes to E/M Documentation
As of Jan. 1, 2019, the Centers for Medicare & Medicaid Services (CMS) will implement several coding and documentation policies to provide immediate burden reduction to providers. The 2019 Medicare Physician Fee Schedule Final Rule (MPFS) released Nov. 1, 2018, by the CMS contained significant changes to the Medicare Part B coding and documentation policies…
Nonsurgical Therapies for Knee OA Pain: From Medications to Bracing to Exercise, What Works & What Doesn’t
CHICAGO—Many nonsurgical therapies are available for knee osteoarthritis pain, but they vary greatly in effectiveness. “How should I proceed and figure out what to do with our patients?” asked David T. Felson, MD, MPH, professor of medicine at Boston University School of Medicine, during OA Management Without Surgery in 2018, a session at the 2018…
Case Report: A Patient Presents with Rare, Fulminant SAPHO Syndrome
Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is a heterogeneous, inflammatory, musculoskeletal disease. The disease is an insidious, sterile osteitis with associated skin and synovial inflammation.1 Diagnosis can prove challenging, but a thorough clinical history, high clinical suspicion and imaging techniques can help clinch it. The below case reveals a rare, fulminant presentation of…
Antidepressant of No Clear Value in Chronic Low-Back Pain
NEW YORK (Reuters Health)—Low-dose amitriptyline does not have clear benefits for patients with chronic low-back pain that has no specific cause, according to results from a randomized clinical trial. Despite the lack of evidence that antidepressants are more effective than placebo for low-back pain, seven of 14 national and international guidelines recommend their use in…
Coding Corner Question: Coding Scenario for 1997 Musculoskeletal Exam
A 55-year-old female patient with pain in multiple joints is referred to the office by her primary care physician. She complains of pain in both knees and both shoulders. She rates the pain at 7 on the pain scale. Her pain is worse at night after she gets off work. Soaking in her hot tub…
ACR Advocates for Access to Viscosupplementation for OA
In several U.S. states, Blue Cross/Blue Shield and other insurers have dropped or are considering dropping coverage of hyaluronic acid injection—or viscosupplementation—for patients with knee osteoarthritis. The decision appears to be based on guidelines published by the American Academy of Orthopaedic Surgeons in 2013, which at that time specified that research had not found hyaluronic…
A Comprehensive Review of NSAID Cardiovascular Toxicity
Non-steroidal anti-inflammatory drugs (NSAIDs) are the most used drugs for acute and chronic pain. More than 30 billion doses of NSAIDs are consumed annually from more than 70 million prescriptions.1 Despite their common use, NSAIDs are not free of serious toxicities. In the pre-Vioxx (rofecoxib) era, gastrointestinal toxicity was the primary concern for many NSAIDs….
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