Osteonecrosis, also called avascular necrosis or aseptic necrosis, is a condition in which the death of bone cells (due to decreased blood flow) can lead to pain and collapse of areas of bone. This collapse of bone, in turn, can lead to degenerative arthritis of nearby joints, most commonly the hips and knees. Less frequently affected are the shoulders, hands, and feet. In rare instances, osteonecrosis can occur in the jaw— resulting in pain and mouth ulceration. Osteonecrosis is not fatal, but can lead to pain, arthritis, problems with physical activity, and even the need for joint replacement. Most of the 10,000 to 20,000 Americans developing osteonecrosis annually are between age 20 and 50. These individuals usually have a history of serious trauma, corticosteroid use, excess alcohol intake, or other conditions including systemic lupus erythematosus, dysbarism (“the bends” that occur with scuba diving), blood disorders, HIV infection, and radiation therapy.
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Coding Corner Question: February 2008
February’s Coding Challenge
Coding Corner Answer: February 2008
February’s Coding Answer
Marc C. Hochberg, MD, MPH, Named PI for Upcoming OA Guidelines
The ACR has named Marc C. Hochberg, MD, MPH, as the principal investigator (PI) for the upcoming, “Guidelines for the Management of Osteoarthritis [OA] of the Hip, Knee, and Hand.” Dr. Hochberg is professor of medicine and epidemiology and preventive medicine and head of the division of rheumatology and clinical immunology at the University of Maryland School of Medicine in Baltimore.
Take the Measure of Osteoarthritis
The WOMAC index standardized OA status measurement, as described by its creator
How Medically Unlikely Edits Affect a Practice
Medically unlikely edits (MUEs), formally known as medically unbelievable edits, took effect with the Centers for Medicare & Medicaid Services (CMS) on January 2, 2007. The function of MUEs is to detect and deny unlikely CMS claims on a pre-payment basis with the intention of improving Medicare’s payment process.
Coding Corner Question: January 2008
January’s Coding Challenge
Rehabilitation and Myositis
Physical therapy to manage inflammatory muscle disease
Science from our Sisters
Recommended reading from A&R and AC&R
Joint Surgery
Modern joint replacement surgery involves removal of worn cartilage from both sides of the joint, followed by resurfacing of the joint with a metal and plastic replacement implant that looks and functions much like a normal joint. Although nearly every joint in the body can be replaced, most replacement surgeries involve the hip or knee. Joint replacement surgery is typically recommended for patients who have tried non-surgical treatment but still have joint pain. While this is an extremely effective surgical treatment, total joint replacement should be considered as the last (rather than the first) treatment option for patients with advanced arthritis of the hip, knee, or shoulder.