January 23
IN THIS ISSUE / January 23, 2019
- How does skin age? Researchers may have found the answer.
- AAD refutes misleading sunscreen article
- Taking the pain out of prior authorization denials
- Academy responds to Vision for the Future Commission draft report
- NCCI and CMS address modifier 59 issues
- Virginia Board of Medicine audits compounding practices
- 2019 AAD Election ballot packet moved online
How does skin age? Researchers may have found the answer.
In a study published in Immunity, researchers say they’ve discovered a major reason why skin ages, and how the aging process impairs resistance to infection. Aging happens as dermal fibroblasts lose their ability to make fat cells that reside under the surface of the skin, and these fat cells give skin a smooth, youthful appearance. The fat cells also produce a peptide that plays a role in fighting infections. (Learn more about the top cosmetic procedures performed by dermatologists in 2017.)
"We have discovered how the skin loses the ability to form fat during aging," said senior author Richard Gallo, MD, PhD, distinguished professor and chair of the department of dermatology at UC San Diego School of Medicine. A protein that controls many cellular functions, called transforming growth factor beta (TGF-β), prevents dermal fibroblasts from converting into fat cells and prevents the cells from producing the antimicrobial peptide cathelicidin, which helps protect against bacterial infections, reported researchers.
In mouse models, researchers used chemical blockers to inhibit the TGF-β pathway, which caused the skin to return to a younger function and allowed dermal fibroblasts to convert into fat cells again. Understanding the biological process that leads to loss of these fat cells could be used to help the skin fight infections like Staphylococcus aureus (S. aurerus) — a pathogenic bacteria that is the leading cause of infections of the skin and heart, and a major factor in worsening diseases, like eczema.
Related Links:
- The aging hand – Dermatology World (July 2014)
- The elixir of youth – Dermatology World (March 2016)
- Body contouring carves out its niche – Dermatology World (June 2016)
- AAD product: Patient Safety in Dermatology
- For your patients: Anti-aging skin care
AAD refutes misleading sunscreen article
Academy President Suzanne Olbricht, MD, strongly refuted a recent Outside article, which suggests that sunscreen use may do more harm than good and espoused unprotected sun exposure. Noting the limitations of studies cited in the article, as well as the fact that several claims were not supported by any citations, Dr. Olbricht wrote in a letter to the editor, “As the article notes, the AAD’s member dermatologists see the impact of skin cancer in our offices every day, and UV exposure is the most preventable skin cancer risk factor — so we have good reason to promote sun protection.” The AAD encourages the public to protect themselves from UV damage by seeking shade, wearing protective clothing, and wearing a water resistant, broad spectrum sunscreen with an SPF of 30 or higher.
Related Links:
- Profiling sunscreen ingredients not approved for use in the U.S. – Dermatology World (May 2016)
- Infographic: Say Yes to Sun Protection
- What are the environmental effects of oxybenzone and other sunscreen ingredients? – Dermatology World (October 2018)
- Infographic: How to Select a Sunscreen
- Stats and facts: Vitamin D
Taking the pain out of prior authorization denials
Related Links:
- AADA prior authorization learning center
- Prior authorization resources for patients
- Step therapy legislation by state
- Managing prior authorizations – Dermatology World (April 2017)
Academy responds to Vision for the Future Commission draft report
On Dec. 11, 2018, the Continuing Board Certification: Vision for the Future Commission released its draft report, providing recommendations to ABMS aimed at addressing many concerns U.S. physicians have with the current Maintenance of Certification (MOC) model as well as ABMS Boards’ support of diplomates. While many areas of concern were included in the draft report, it does not suggest solutions.
On Jan. 15, after careful review, Academy leadership submitted a response to the draft report. Below are a few of the areas the Academy emphasized:
- Since ABMS has acknowledged the lack of evidence-based data to support continuing certification, the Academy believes that ABMS needs to be able to demonstrate validity for whatever methods are selected to be part of continuing certification.
- The Academy strongly supports the CMSS recommended time out on the use of the secure exam until the ABMS can implement recommended changes to any continuing certification process.
The AAD also signed on to a letter generated by the Council of Medical Specialty Societies (CMSS). Read the CMSS letter.
The Academy will remain involved and will continue to advocate on these issues. Further action will be taken when the ABMS and ABD have developed their responses to the report. The commission expects to present the final report to the ABMS in February 2019.
Leaders from the Academy are working proactively with the National Correct Coding Initiative (NCCI) — an entity developed by the Centers for Medicare and Medicaid Services (CMS) to promote national correct coding methodologies and control improper coding — to address coding hardship concerns members face due to the NCCI new procedure-to-procedure (PTP) edits. The updates present challenges for members processing claims when applying modifier 59, which ensures appropriate payment for distinct, independent multiple procedures performed by a single provider, in one day.
The Medicare Administrative Contractors (MACs) — multi-state, regional contractors responsible for administering Medicare claims and handling provider reimbursement services — implemented the policy to require modifier 59 be appended only to the column 2 code, overriding CMS’s and NCCI’s previous policy, which allowed modifier 59 to be appended to either column 1 or column 2 code. Modifier 59 is now required on the column 2 code of a PTP edit with a modifier indicator of “1.”
At this time, CMS and NCCI are collaborating with the MACs to accept the placement of modifier 59 on either column 1 or column 2 code of a PTP edit with modifier indicator of “1” when reporting claims, which will reinstate previous CMS and NCCI directives and address this administrative burden for members with a target date of July 1, 2019.
Prior to July 1, 2019, practitioners can submit a claim for two codes corresponding to one of the PTP code pair edits, and it will be denied because modifier 59 has been applied to the wrong code. If this occurs, practitioners may pursue an appeal, stating that modifier 59 has been incorrectly applied to the wrong code. However, once the MACs accept the placement of modifier 59 to either code in column 1 or 2, this should no longer be a problem. To avoid having to go through an appeals process, physicians and practices may consider continuing to append modifier 59 to column 2 until the target date of July 1, 2019, or when changes officially go into effect.
The Academy will continue to keep a close watch on any developments around this issue and will inform membership of any changes should there be any. Learn more about modifier 59, including helpful tables that outline the impacted code combinations when specific procedures are performed with a skin biopsy during the same encounter, in the Practice Management Center. For more coding help, visit the Academy’s Coding Resource Center.
Related Links:
- AADA Practice Management Center: Modifiers
- AAD product: 2019 Coding Webinar All-Access Pass
- AAD product: 2019 Coding & Billing for Dermatology Manual
- Ask an expert: AAD Coding Questions Community
- AAD product: Principles of Documentation for Dermatology, Second Edition
- AAD product: Digital Derm Coding Consult Pro
Virginia Board of Medicine audits compounding practices
The Virginia Board of Medicine has been auditing the compounding practices of a random selection of physicians based on geography and specialty. Specialists who tend to compound, like ophthalmologists and dermatologists, will likely be the focus. The audits are to ensure practices that compound are in compliance with the current USP Chapter 797 (revisions to this chapter are underway, but are not yet finalized).
An important requirement to note is that the administration of compounded medications must begin within 10 hours of the completion time of the preparation of the drug. If you practice in the state of Virginia and want more information about the requirements needed to pass the inspection, view the checklist now.
The AADA is looking into the other requirements and their impact on dermatologists and will provide updates in future issues of Dermatology World Weekly. Questions about compounding? Check out the Academy’s compounding toolkit, which includes a quiz to help you determine whether you’re in compliance with FDA regulations and how to access drugs that cannot be compounded in your office.
Related Links:
- The compounding conundrum – Dermatology World (March 2018)
- Essentials of in-office compounding – Dermatology World (June 2018)
- Dos and don'ts of in-office compounding – Dermatology World (August 2017)
- AADA web: Compounding toolkit
- AAD/A Position Statement on Pharmaceutical Compounding
2019 AAD Election ballot packet moved online
Beginning in 2019, eligible voting members will receive an email with an embedded link 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 p.m. (ET)
