December 4, 2019
IN THIS ISSUE / December 4, 2019
New opioid prescribing guidelines for dermatologic procedures
Prepare for next month’s intermediate and complex repair coding guidelines updates
2019 AMA House of Delegates Meeting: Regulation of PAs, board certification standards, and more
New opioid prescribing guidelines for dermatologic procedures
A workgroup of 40 board-certified dermatologists developed new guidelines outlining responsible opioid prescribing practices specific to common dermatologic procedures, which have recently been published in JAAD.
The workgroup developed recommendations for 87 of the most common dermatologic procedures. In all procedural scenarios, the panelists met consensus that non-opioid analgesics were appropriate for first-line postoperative pain management, unless contraindicated. They agreed that routine opioid prescriptions are unnecessary for 66 of the 87 procedures, as 10% or fewer of patients who undergo these procedures routinely require opioids at the time of discharge. A prescription of one to 10 opioids (equal to oxycodone 5 mg) for the duration of the patient’s recovery may be necessary for 16 of the procedures, including scalp and cheek reconstruction, and a prescription of one to 15 opioids may be necessary for only one of the procedures — Abbe flap — as 25% or fewer patients who undergo these procedures routinely require opioids at discharge. According to the guidelines, none of identified procedures routinely requires more than 15 opioids. The panel did not achieve consensus for five procedural scenarios: Karapandzic flaps, en bloc nail excisions, facial resurfacing with deep chemical peels, and small- or large-volume liposuction.
Related content:
Drugs you never thought you’d use in dermatology – Dermatology World (November 2019)
Is there a link between lupus and prescription opioids? – DW Weekly (October 2019)
Intermediate and complex repairs 2020: Part 1 – Dermatology World (October 2019)
Intermediate and complex repairs 2020: Part 2 – Dermatology World (November 2019)
DW Insights and Inquiries: Beware — discordance abounds among pathologists in the diagnosis of melanocytic neoplasms
The magnitude of the problem was highlighted in the latest and largest iteration of study of its kind by Elmore JG et al., involving 240 cases and 187 U.S. pathologists. Participating pathologists independently interpreted preselected cases of melanocytic lesions using their own diagnostic terms. Melanocytic lesions were categorized into five diagnostic classes based on Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx), a recently developed classification scheme that takes the multitude of diagnostic terms that are utilized by pathologists into account. The accuracy of the diagnosis was compared to a consensus reference diagnosis predetermined by a panel of three experienced dermatopathologists. Keep reading!
Prepare for next month’s intermediate and complex repair coding guidelines updates
Revisions to intermediate and complex repair coding guidelines go into effect Jan. 1, 2020. The updates provide detailed and distinct clarification of the work involved during an intermediate or complex repair procedure. To help with accurate reporting of intermediate and complex repairs, the AAD’s reference resource illustrates the revised guidelines and documentation requirements. Check out the AADA’s resources and check out the Academy's Coding and Practice Updates Live Webinar.
2019 AMA House of Delegates Meeting: Regulation of PAs, board certification standards, and more
Resolution 215
The DSC introduced this resolution which called for current AMA policy to be amended to include the following language: Opposes efforts by organizations to board certify physician assistants in a manner that misleads the public to believe such board certification is equivalent to medical specialty board certification.
Resolution 905
The DSC testified in support of a resolution, Sunscreen Dispensers in Public Places as a Public Health Measure, which calls on the AMA, as part of a successful skin cancer prevention strategy, to support free public sunscreen programs.
Other highlights from the meeting include:
Cyndi Yag-Howard, MD, and Hilary Johnson, MD, PhD, were re-elected as DSC Chair and Vice Chair, respectively. Andrew Lazar, MD, MPH, completed his term as Immediate Past Chair.
Jessica Krant, MD, MPH, was elected to serve on the Surgical Caucus Executive Committee. She also now serves on the AMA’s election task force, which held an open forum at the meeting.
George J. Hruza, MD, MBA, was elected to serve on the nominating committee for the Specialty and Service Society.
