The evaluation of a child with arthralgia who has a normal physical examination provides a challenge to rheumatologists. Here are some insights into assessing and treating children with musculoskeletal pain syndromes…
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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…
Coding Corner Answers: A Drug Administration Quiz
Take the challenge. C—This claim cannot be coded without querying the infusion nurse and physician. There must be documentation of the patient’s weight to document the correct dosage of the medication to be given to the patient. Also the start time and the completion time of the infusion must be documented to know which drug…
The Burden of Rheumatic Diseases Among Indigenous People in Latin America Is Disproportionate
Indigenous communities in Latin America lack good healthcare—and often lack any healthcare—for musculoskeletal and rheumatic diseases.1 Global health initiatives tend to focus on infectious disease, despite the increasing rate of chronic diseases. In a survey of 6,155 individuals from eight indigenous communities, conducted by a team of Latin American investigators, the prevalence of these conditions…
Case Report: Acne Drug Leads Patient to Retinoid Hyperostosis
Presentation A 26-year-old man with a history of acne vulgaris and hidradenitis suppurativa presented to our rheumatology clinic with persistent back pain and stiffness of three years’ duration. He described bilateral low back pain that was worse when he arose in the morning and at night when he was trying to sleep. In a similar…
Turmeric: The Evidence for Therapeutic Use for Arthritis
During a recent divisional grand rounds presentation, I asked a room full of my colleagues how many of them had been asked about turmeric by a patient within the past year, month, week or day. Most hands remained up by the end of the exercise. During a recent trip to New York City, I was…
Case Report: The Hairdresser Who Couldn’t Comb Her Hair
Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized by pain and morning stiffness at the neck, shoulders and hip girdle. It can be associated with giant cell arteritis (GCA); in fact, the two disorders may represent a continuum of the same disease process. This case describes a patient who initially refused treatment for PMR…
Dr. Bryce Binstadt Says Waterskiing Clears His Mind
Years ago, 16-year-old Bryce Binstadt, now a pediatric rheumatologist at the University of Minnesota Masonic Children’s Hospital, was waterskiing with friends on Potato Lake in Minnesota, where his family frequently vacationed. Dr. Binstadt had been an avid water-skier since he was 8 years old and had become very skilled at the sport—even skiing backward. This…
Anxiety Is an Independent Risk Factor for Bone Fractures
Higher anxiety levels in postmenopausal women may put them at increased risk of fracture and should be considered when assessing a woman’s risk of osteoporosis as well. This is the conclusion of a study recently published in the journal Menopause that looked at the role of anxiety in bone health.1 Specifically, the study examined the…
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