February 20
IN THIS ISSUE / February 20, 2019
- Biologics may help fight heart disease in psoriasis patients
- AAD mourns the passing of Richard L. Dobson, MD
- Feedback requested: AAD joint guideline for reconstruction after skin cancer resection
- Severe atopic dermatitis guidelines developed
- Private payer issues with new biopsy codes
- Tool may help predict melanoma recurrence after negative SNB
- View candidates and ballot book online
Biologics may help fight heart disease in psoriasis patients
According to a new study published in Cardiovascular Research, certain biologic drugs used to treat psoriasis appeared to help keep arteries clear by reducing the early plaque buildup that clogs arteries, restricts blood flow, and leads to heart attacks and stroke.
Researchers followed 290 psoriasis patients for one year — all of whom had low cardiovascular risk —and compared them to those who elected not to receive biologic therapy. Study results show that biologic therapy was associated with an 8% reduction in coronary artery plaque — effects similar to receiving a low-dose statin. Read more about how the development of treatment targets have allowed dermatologists and patients to aim for better clearance rates in Dermatology World.
Prior research had linked psoriasis with premature development of high-risk coronary plaque, and now this study has shown beneficial changes in the plaque when psoriasis is treated with biologic therapy — even without changes in other cardiovascular risk factors such as cholesterol, glucose, and blood pressure. Researchers say more work needs to be done to confirm whether the biologics have an anti-inflammatory effect, or whether the positive effect is the result of treating the underlying inflammatory disease.
Related Links:
- Which topicals work for scalp psoriasis – Dermatology World (June 2016)
- For your patients: Psoriasis Resource Center
- What lies beneath – Dermatology World (August 2012)
- AAD product: Psoriasis and Psoriatic Arthritis patient pamphlet
AAD mourns the passing of Richard L. Dobson, MD
The American Academy of Dermatology (AAD) has learned with sorrow of the passing of Richard L. Dobson, MD, on Feb. 16, at age 90. Dr. Dobson was considered an icon of dermatology in the late 20th century. He served as president and vice president of the AAD and was one of the founders of the Journal of the American Academy of Dermatology — serving as its second editor from 1988 to 1998. Dr. Dobson also served as president of the Society for Investigative Dermatology as well as the American Board of Dermatology.
Dr. Dobson received his medical degree from the University of Chicago School of Medicine, obtained his dermatology training from Dartmouth-Hitchcock Medical Center, and served a research fellowship in the United States Public Health Service. Following teaching appointments at the University of North Carolina and University of Oregon medical schools, he was professor and chairman of dermatology at SUNY-Buffalo School. After more than seven years at SUNY-Buffalo, he was then appointed to the professorship and chairmanship at the Medical College of South Carolina in Charleston, and served as emeritus professor — for whom a named lectureship was established.
In 1992, Dr. Dobson received the Academy’s Master Dermatologist award, which recognizes an Academy member who — throughout the span of their career — has made significant contributions to the specialty of dermatology, as well as to the leadership and/or educational programs of the American Academy of Dermatology. Dr. Dobson was selected as an Honorary Academy member in 2000, which recognizes a member of the Academy who has advanced the profession through leadership and service that affirms an uncommon and sustained dedication to dermatology.
Feedback requested: AAD joint guideline for reconstruction after skin cancer resection
The American Academy of Dermatology is requesting feedback from members about its draft joint guideline for reconstruction after skin cancer resection. AAD members are encouraged to provide comments on the draft guidelines before the comment period closes Feb. 25. View the draft guideline.
Guidelines serve as decision-making and educational aids for clinical practice to support and improve quality dermatologic care, and are used as the framework for quality measurement, reimbursement decisions, advocacy efforts, public messaging, and the identification of research gaps. When finalized, these evidence-based guidelines will be submitted for publication in the Journal of the American Academy of Dermatology and will be considered current for five years from the date of publication.
View the Academy’s current and upcoming clinical guidelines in the Practice Management Center.
Severe atopic dermatitis guidelines developed
Guidelines have been developed for the management of severe atopic dermatitis (AD) and have been published in The Journal of Allergy and Clinical Immunology: In Practice. Researchers note that AD should be categorized as severe if: A minimum of 10% body surface area is involved; there are individual lesions with severe features; there is involvement of highly visible areas or those important for function, and quality of life is significantly impaired.
Guidelines for treatment emphasize the use of moisturizers in combination with warm baths or showers; avoiding irritants or infections and known triggers; and maintenance with topical corticosteroids (TCSs) and other therapeutic agents in a stepwise manner. During flares, TCSs and topical calcineurin inhibitors can be prescribed. Wet wrap therapy is recommended in conjunction with TCSs, oral antibiotics, and other oral agents. If these basic therapies fail, dupilumab is an additional treatment option.
Read more about how dupilumab and crisaborole have changed atopic dermatitis treatment in Dermatology World.
Related Links:
- Can IL-31 inhibition reduce atopic dermatitis itch? – Dermatology World (June 2017)
- Academy clinical guidelines: Atopic dermatitis
- AAD product: Simulated Patient Encounter – Medication Management
Private payer issues with new biopsy codes
Effective Jan. 1, 2019, skin biopsy codes 11100 and 11101 were retired by the AMA CPT®. The CPT Panel in cooperation with the Centers for Medicare and Medicaid Services developed new skin biopsy codes 11102, 11103, 11104, 11105, 11106, and 11107 in order to better reflect the differences in the three distinct techniques used when biopsies are performed.
The Academy has received several member reports stating that practices are having two problems when submitting claims to private payers for adjudication utilizing the new biopsy codes.
- Insurance companies have not loaded the fee schedule, so the insurer is reimbursing below the appropriate rate.
- The physician’s office is being told it is out of network.
The AADA has performed an environmental scan and has identified the following payer issues:
| Insurer | State | Problem |
| Aetna | Georgia | Low reimbursement |
| Anthem | Nevada | Not in contract |
| Anthem | Ohio | Not in contract |
| Blue Cross Blue Shield SC | South Carolina | Low reimbursement |
| Cigna | Florida | Low reimbursement |
| Cigna | Georgia | Low reimbursement |
| Humana | Florida | Not in contract |
| Humana | Georgia | Not in contract |
| Independence Blue Cross | Pennsylvania | Not in contract |
The Academy will continue to monitor these issues and continue to update members with any new developments to ensure that practices are aware of the potential revenue cycle impact on day-to-day operations.
The AADA is in the process of contacting insurers to assist in resolving the errors. If your practice experiences reimbursement errors or denials related to the new biopsy codes, please contact the Academy at coding@aad.org.
After a negative sentinel node biopsy (SNB), measure of ulceration, Breslow thickness, and microsatellitosis are predictive of recurrence risk at one, two, five, and 10 years, according to a study published in JAAD. Current treatment guidelines do not adequately cover what kind of monitoring and treatment should apply to patients with melanoma after a negative SNB, so researchers sought to create an easy-to-use nomogram designed to evaluate recurrence risk for patients with a negative SNB based on pathologic and clinical characteristics of the primary melanoma.
Among the patients analyzed for the study, nearly 80% had a negative SNB. These patients had a mean follow-up of about 60 months, with 13.8% melanoma recurrences. Study investigators used the patient data to create a nomogram that assigned points to the three most predictive melanoma characteristics, to help physicians and patients provide an individualized follow-up program, as well as to identify high-risk patients who should be considered for adjuvant treatments.
Here’s how the nomogram works: A hypothetical patient with a primary melanoma tumor that has ulceration (61 points), a 2 mm Breslow thickness (10 points), and does not have microsatellitosis (0 points) would have a total score of 71 points. This can predict that the hypothetical patient has a 90% probability of being recurrence-free after the first year, 77% after year two, 64% after year five, and 50% after year 10.
What do the Academy’s updated melanoma guidelines say? Find out in Dermatology World.
Related Links:
- Should a patient’s age determine whether they receive SLN biopsy? – Dermatology World (December 2017)
- On target: New approaches to skin cancer treatment and prevention – Dermatology World (August 2016)
- Dermoscopy’s expanding universe – Dermatology World (January 2016)
- AAD product: Simulated Patient Encounter – Breaking Bad News
2019 AAD Election ballot packet moved online
Beginning in 2019, eligible voting members will receive emails with a link to the AAD Election Connection to view the ballot book and vote online. Voting members with email on file with the Academy will no longer receive an election ballot packet by mail.
- Members who wish to receive a PDF ballot book by email may request it at candidates@aad.org.
- Members who wish to vote by mail may print their online secure voting ballot beginning March 2. NOTE: All ballots must be received by March 16 at 11:59 PM (ET).
