Does topical tacrolimus for AD increase cancer incidence in children? Study says ‘no.’
A study recently published in JAAD showed no increased incidence of cancer in children using tacrolimus to treat atopic dermatitis. The incidence of all cancers closely matched the expected rate in age- and sex-matched populations from the countries represented in the study.
7,954 patients enrolled at 314 sites in nine countries participated in this study. Throughout 44,629 person-years, there were six confirmed incident cancers. No nonmelanoma skin cancers or incident lymphomas occurred.
DW Insights and Inquiries: Juvenile lichen sclerosus — A loss of innocence
Juvenile lichen sclerosus (LS) is a difficult disorder — symptomatically, emotionally, diagnostically, and therapeutically. During my residency it was “common knowledge” that juvenile LS would abate by adolescence. I am always curious how such perceptions become dogma, only to be retracted by future analysis.
Vulvar LS has a bimodal distribution occurring in childhood and in postmenopausal women; 5% to 15% of cases of LS occur in prepubertal girls with an estimated prevalence of one in 900. The average age of LS onset in girls is four to six years, however there is often a diagnostic delay of one or two years as other disorders are considered — contact dermatitis, vitiligo, lichen planus, morphea, infections, and child abuse. Although often asymptomatic, patients may experience anogenital pruritus, soreness, constipation, and dysuria.
Morell et al conducted a systematic review of 37 studies yielding information on long-term consequences of vulvar LS, of which 13 were cohort studies and 24 case reports or series. These publications revealed that signs and symptoms persist after puberty and beyond, scarring and permanent architectural changes occur, treatment is effective with regard to symptoms, and long-term quality of life is affected. A possible relationship with risk of malignancy was suggested. The authors concluded there is low-level evidence suggesting long-term repercussions of juvenile vulvar LS. Keep reading!
Derm Coding Consult: Watch out for MIPS 2019 overpayment and recoupment notification
Dermatology practices may soon receive notification of over- or underpayment from their Medicare Administrative Contractors (MACs) due to an error in claims payment. The error arose from provisions in the Bipartisan Budget Act of 2018 that made several changes to the Merit-based Incentive Payment System (MIPS), including no longer calculating the cost of Part B drugs in the low volume threshold.
If a practice was over- or underpaid, it will receive a notification letter from its MAC requesting recoupment or outlining a forthcoming positive adjustment. The letter will outline the reason for overpayment, recoupment request, and your rights to appeal. If you receive a notification, review your MIPS 2017 performance score (payment adjustment applied in 2019), read the letter carefully to understand what is being requested, and contact your MAC with any questions. For more information about overpayments, review this Medicare Overpayment Factsheet.
Derm Coding Consult: Streamlining the claim denial process in your practice
Claim denials are a reality for every dermatology practice. It is wise to be proactive and understand what you need to do when you receive a claim denial. Streamlining your claim denial process requires understanding the meaning behind each denial on the explanation of benefits (EOB) and the appropriate action you need to take.
Most private payers and the Medicare Administrative Contractors (MACs) use the American National Standard Institute (ANSI) codes to identify a post-initial adjudication adjustment.
Within the ANSI codes, there are two distinct code sets that help explain why a claim was denied. They are the Claim Adjustment Reason Codes (CARCs) and the Remittance Advice Remark Codes (RARCs). Learn more about how to interpret code sets on claim EOBs.
AAD and NPF release psoriasis guidelines on topical treatments
The American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) developed the Guidelines of Care for the Management and Treatment of Psoriasis with Topical Therapy and Alternative Medicine Modalities for Psoriasis Severity Measures. Read the guidelines.
Participate in MIPS cost measure field testing
CMS and its contractor, Acumen, LLC, will conduct field testing Aug. 17 – Sept. 18, for five episode-based cost measures before consideration of their potential use in the ‘cost’ performance category of the Merit-based Incentive Payment System (MIPS). Cost is one of the four MIPS performance categories. CMS will test episode-based cost measures, which are used to gauge the total cost of care for a condition and related services during the performance year. Among the measures being tested is a melanoma cost measure developed with input from the AADA. These measures were developed with input from various specialty societies and other clinician groups.
Why is it important to participate? Field testing is an opportunity for physicians and other stakeholders to provide feedback on the draft measure specifications of the cost measures. Feedback shared on these draft specifications will be used to consider potential measure refinements following field testing.
Who is qualified to participate? During field testing, physicians and practices who were attributed 10 or more episodes from at least one of the cost measures during the 2019 measurement period will receive a report with information about their cost performance. Qualified providers can also access the report on the QPP website. Dermatologists who meet the 10-episode threshold may volunteer to provide feedback on the resources associated with the measure. Responses will be used to help validate the costs associated with melanoma care.
The American Academy of Dermatology is a non-profit professional organization and does not endorse companies or products. Advertising helps support our mission.
