Derm Coding Consult: Are you ready for E/M coding changes?
Several major E/M guideline revisions will go into effect Jan. 1, 2021, including:
E/M guideline additions, revisions, and restructuring;
Deletion of CPT code 99201 and revision of CPT codes 99202 – 99215
Updates to components for code selection to include:
A medically appropriate history and/or physical examination (though required, it is not to be used as part of the code level selection);
Medical decision making (MDM); OR total time on the date of the encounter.
This article, the first in a series, explains how these changes came to be, how the AADA advocated to prevent changes that would have had a worse impact on dermatology, and how dermatologists can begin preparing for the changes. Learn more about the upcoming E/M changes.
DW Insights and Inquiries: Phacing the future — When patients with PHACE syndrome grow up
The acronym PHACE syndrome, emphasizing the characteristic findings of this neurocutaneous syndrome: posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities, was initially proposed by Frieden et al in 1996. They detailed two patients (and 41similar cases) with large facial hemangiomas, congenital cataracts, and structural arterial abnormalities, particularly of the central nervous system vasculature. One of these infants also had a Dandy-Walker malformation. Subsequently an “S” was added to denote sternal defects (PHACES).
In 2009, diagnostic criteria were elaborated for the syndrome, which were updated in 2016. The basis for diagnosing PHACE syndrome is the presence of facial hemangioma [segmental, infantile] > 5cm with one major criterion or two minor criteria. A possible diagnosis of PHACE syndrome requires a cervicofacial hemangioma with one minor criterion (major and minor criteria discussed in the article). PHACE syndrome is considered a sporadic disorder of uncertain etiology, without a genetic predisposition, despite its overwhelming female predominance. Keep reading!
You’re not alone: AAD survey reveals significant impact of COVID-19 on dermatology practices
The results of an AAD survey sent to members in mid-May show that at the height of state COVID-19 stay-at-home orders, almost all dermatology practices in the United States had reduced their hours significantly and were seeing only emergency patients. 603 dermatologists responded to the survey out of 6,000 who were sent it via email. While the sample was random, it saw more solo practitioners and fewer academic dermatologists respond than are reflected in the AAD’s membership overall.
Key findings included:
Almost 3 in 4 of respondents’ dermatology practices were operating with reduced hours, reduced days per week, or both, with 71% reporting being open 3 days per week or less; 10% had closed completely.
In mid-May, 90% of respondents reported using teledermatology, a tenfold increase from the 9% who were using it before the pandemic. The volume of teledermatology patients did not make up for the reduction in in-person care, though. Respondents’ practices went from seeing 107 patients in person per week, plus a trivial amount by teledermatology, to seeing a total of 34 per week — 18 in person and 16 by teledermatology.
Almost every respondent — 95% — reported that their practice was collecting much less revenue in mid-May than before the pandemic began.
As a result, 82% of respondents reported having taken a salary cut, while 57% worked in practices that had furloughed staff. Medical assistants were the most likely staff type to be furloughed. Nearly half (47%) of respondents reported that practice owners were spending out of their own pockets to keep practices afloat.
The survey was fielded to help the Academy prioritize its efforts to respond to COVID-19 and advocate on behalf of its members for relief. To learn more about these efforts, visit staging.aad.org/coronavirus.
Pride 2020: What is the meaning of Pride and how exactly should it impact our practice?
As we commemorate another LGBTQ (lesbian, gay, bisexual, transgender, queer) Pride Month, we recognize that each year’s celebration carries a distinct tone — an aura that is emblematic of both the accomplishments and setbacks of the prior year as well as the current cultural context in which we find ourselves.
Our commitment in the AAD Expert Resource Group on LGBTQ/SGM (sexual and gender minority) Health remains steadfast in unwavering support of LGBTQ/SGM people of color. We affirm the inherent value of every human being and recognize that the ongoing oppression of health disparities and barriers to care are unacceptable.
Additionally, the AAD position statement on sexual and gender minority health, which was approved just over a year ago, emphasizes the importance of intersectionality as we approach inequity in marginalized populations.
These principles will serve as our guidepost in our work to create more inclusive medical curricula, address work force diversity, and to help guide the AAD in its mission to become a visionary leader in LGBTQ/SGM health in dermatology. Read more.
Young Physician Focus: The power of collaboration
As we settle into these COVID times, theories about the virus and the infection it causes seem to be debunked as quickly as they surface. Our understanding of the pathogenesis, spread, and manifestations of the virus has evolved at a breakneck pace over the past three months. The fact that this is a novel virus that causes a potentially deadly illness has caused much stress and fear among the public and has required the health care community to adapt and learn quickly as new information comes to light. I’m sure many of you have been following along with the dermatologic iteration of this phenomenon with widespread reports of “COVID toes,” starting in March of this year. Read more from DW Young Physician Advisor Jenna O’Neill, MD.
ECHO on the front lines of COVID-19
Karen Edison, MD, senior medical director for the Missouri Telehealth Network & Show-Me ECHO, discusses the use of the Extension for Community Healthcare Outcomes (ECHO) Project during the COVID-19 pandemic.
DW Weekly: Just for some background, what is the ECHO project?
Dr. Edison: Traditionally, the ECHO project entails a weekly didactic conference video with 10 to 20 primary care physicians located in rural and underserved areas, about a medical topic, such as dermatologic conditions, to improve patient access to care. We have been doing ECHO in a major way here in Missouri for about five years. We have 25 different topics including dermatology — it’s one of our longest-standing ECHO programs. We do the dermatology ECHO a couple times a month on Fridays.
DW Weekly: You have adapted the ECHO Project and have held several COVID-19 ECHO standups recently. Tell us how you came up with this idea.
Dr. Edison: I was just watching the news and seeing what was happening and seeing the disease spread in our country. I called Randall Williams, MD, director of the Missouri Department of Health and Senior Services on a Tuesday night and had a meeting with him on Wednesday morning. I asked him to serve as the lead health official in the state for a standup ECHO on COVID-19. A week and a half later, we had our first one. We have had four COVID-19 ECHOs since then. We’ve done all of this in partnership with the Missouri Department of Health and Senior Services and the Missouri Hospital Association.
DW Weekly: Who is the audience for these video conferences and what has participation looked like?
Dr. Edison: We see everyone at the COVID-19 ECHOs: primary care doctors, emergency physicians, advanced practice nurses, clinic case managers, etc. We even see school nurses. For the last three COVID-19 ECHOs, we’ve had over 300 participants on each call. Keep reading!
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