Drug may offer prolonged improvement in chronic spontaneous urticaria
According to a recent correspondence inThe New England Journal of Medicine, new data suggest benralizumab could be an important new option in the treatment of patients with chronic spontaneous urticaria (CSU). In a small investigation of 12 patients who were unresponsive to standard treatment of second-generation H1 antihistamines, the anti-interleukin-5-receptor alpha monoclonal antibody led to a sustained improvement in CSU symptoms.
The study had a run-in period of 14 days, after which patients were given a single dose of placebo and then three monthly subcutaneous injections of 30 mg of benralizumab. Two more monthly visits were conducted in the two months following treatment.
By the third visit, UAS7 scores had declined by an average of 10.9 points; the fourth check-in saw a similar benefit (10.8-point decline). By the fifth visit, the average decline was 15.7 points, with five patients reporting a complete response (UAS score of 0), and two patients reporting UAS7 scores of 6 or lower at 20 or 24 weeks.
The authors said the use of benralizumab may be effective because urticarial lesions are characterized by increased lymphocytes and perivascular eosinophilic infiltrates, which they said implies that interleukin-5 plays a role in the disease.
DermWorld Insights and Inquiries: Looking into the whites of the mouth
How often do you perform an oral examination? If you’re like me, probably only under two circumstances — when the patient has specific complaints (soreness, a raised lesion, or a discoloration noted by their dentist), or when we are seeking specific findings to confirm our clinical suspicions based on our cutaneous examinations (e.g., lichen planus, Darier disease, Cowden disease, etc.).
In the United States, [at least] 48,330 cases of oral and oropharyngeal cancer are diagnosed annually, comprising approximately 3% of all cancer cases. Risk factors include alcohol, tobacco, and human papillomavirus infection (notably HPV-16 and HPV-18). Although head and neck mucosal melanoma is rare, accounting for only up to 4% of all melanomas, it is highly aggressive, with 5-year overall survival rates ranging from 20 to 40%.
I will begin with a conclusion — we should probably routinely examine the oral cavity.Keep reading!
Why will dermatology experience a 2% payment reduction in 2021?
In August of this year, CMS released the 2021 Medicare Physician Fee Schedule (MPFS) proposed rule, and the AADA recently submitted comments to the agency. The proposed rule projected an overall cut in payments to dermatology of 2%. In addition to the pay cuts, this first article in a two-part series on the MPFS will detail what is contributing to the untimely reduction of the conversion factor.
Proceduralists are facing large cuts in 2021 according to the estimates included in the proposed rule. New Medicare payment polices for evaluation and management (E/M) services commencing Jan. 1, 2021, will provide payment increases to physicians and other providers who primarily deliver office-based services while slashing payments to those who mostly perform procedures such as pathologists and radiologists.
CMS asserts it is required to apply the budget neutrality adjustment to offset the estimated $10.2 billion increased spending included in the 2021 fee schedule, which results in reducing the conversion factor by 11%. This double-digit reduction is due in part to CMS’ insistence on covering the add-on code GPC1X, which has a $3.3 billion price tag, as well as other CMS proposals that increase payment for cognitive services.
CMS developed the GPC1X add-on code with the intention of it being used with complex E/M visits, but the AADA and many other physician specialty societies have urged CMS to drop the code since it is unnecessary and the definition is unclear. The cuts driven by budget neutrality efforts will cancel out many positive effects from the office visit valuation changes. It is the AADA’s position that any additional complexity in E/M visits should be defined by the CPT editorial panel and valued by the RUC.
What’s next?
As the house of medicine awaits the final rule before the end of the year, the AADA will continue to push for changes that would balance the impact on dermatology. Just last month, the AADA held its first virtual Legislative Conference, where one of the legislative asks was for Congress to ensure Medicare stability for physicians and patients by waiving budget neutrality requirements for the finalized E/M code changes slated for implementation Jan. 1, 2021.
The AADA is working both independently and in coalitions to ensure CMS and Congress understand that waiving the budget neutrality adjustment to the conversion factor would pave the way for the agency to implement the new E/M payment policies without cutting pay rates for procedures. To prevent the cuts, congressional action would need to occur before Congress adjourns for the calendar year. Stay tuned to Academy news and publications for updates about budget neutrality and the MPFS.
Ah, 2020…in terms of shock value, this year has certainly not disappointed. Aside from the obvious, there have been a number of important changes in the health care world that all of us are following closely. A hot topic around the water cooler at my office is the 21st Century Cures Act, which mandates that patients be provided access to their medical record in its entirety starting Nov. 2, 2020. The act prohibits delaying or blocking health information, which means that patients will be privy to their pathology reports at the same moment as their clinician — without having the context or expertise to interpret the report. The prospect of a patient learning of his melanoma diagnosis via the patient portal is upsetting to say the least. Read more from DermWorld Young Physician Advisor Jenna O’Neill, MD.
Derm Coding Consult: Updated NCCI edits now available
CMS has completed its quarterly update to the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits. Version 26.3 is now available for use effective Oct. 1, 2020.
The NCCI PTP code pair edits were designed to prevent improper payments when incorrect code combinations are reported together for Medicare Part B covered services and most private payers. The NCCI PTP table of edits includes a list of correct code edits for physicians and non-physician clinicians (NPCs).
When Healthcare Common Procedure Coding System (HCPCS) code and Current Procedural Terminology (CPT) code combinations that are mutually exclusive from one another are billed together on the same day by the same physician or NPC for the same patient, one of the services may be bundled into the primary procedure resulting in a claim denial. Learn more about the NCCI code edits.
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