Comparing efficacy of JAK inhibitors used in alopecia areata
A systematic review published in Acta Dermato-Venereologica included 37 studies investigating the efficacy of JAK inhibitors for the treatment of patients with alopecia areata. In the meta-analysis of five randomized studies, baricitinib 4 mg once daily and deuruxolitinib 12 mg twice daily had superior results compared with brepocitinib and ritlecitinib in terms of SALT50, although the difference was not statistically significant. The randomized clinical trials investigating oral ruxolitinib and oral tofacitinib were not included due to different inclusion criteria of alopecia areata severity. The authors note that more randomized trials, with identical inclusion criteria and dose and duration of treatment, are necessary to confirm these findings.
What has research revealed about the pathogenesis of androgenetic alopecia, alopecia areata, and central centrifugal cicatricial alopecia as well as new potential therapeutics? Read more in DermWorld.
DermWorld Insights and Inquiries: Resorcinol’s resourcefulness in hidradenitis suppurativa
Management of hidradenitis suppurativa (HS) is challenging, including medical and surgical approaches, which are often combined for best outcomes. Therapeutic approaches include the use of topical therapies (clindamycin, dapsone, benzoyl peroxide, chlorhexidine), systemic antibiotics (doxycycline, minocycline, rifampicin, clindamycin, metronidazole), intralesional steroids, hormonal therapies (spironolactone, metformin, finasteride), and a wide range of immunomodulators/immunosuppressants (retinoids, methotrexate, cyclosporine) and biologic medications (tumor necrosis factor inhibitors, anakinra, anti-IL12/23, anti-IL-17). For mild or moderate HS disease (Hurley stages I and II), any safe, topical regimen that improves the quality of life is desirable. This commentary focuses on the expanding literature about the use of topical resorcinol 15% in HS. Keep reading!
Derm Coding Consult: CMS Targeted Probe and Educate (TPE) reviews are now in full swing
A Targeted Probe and Educate (TPE) program is a claim review process used by Medicare Administrative Contractor (MACs) designed to help dermatologists reduce claim and billing denials as well as appeals through “one-on-one” corrective action assistance. It is overseen by CMS’s Center for Program Integrity (CPI). The main goal of a TPE is to help dermatologists quickly improve their billing error rate by working in person with MACs to identify coding and billing errors and render corrective actions. When performing TPE reviews, MACs focus on specific dermatologists who report a particular item or service rather than all dermatologists billing the same item or service. This targeted dermatologist education is what makes this type of audit different. Read more about how dermatologists are selected.
Lebrikizumab for atopic dermatitis: Two phase 3 trials
Authors of a study published in the New England Journal of Medicine conducted two identically designed, 52-week, randomized double-blind, placebo-controlled, phase 3 trials. Both trials included a 16-week induction period and a 36-week maintenance period. Patients with moderate-to-severe atopic dermatitis were randomly assigned in a 2:1 ratio to receive either 250 mg of lebrikizumab (loading dose of 500 mg at baseline and week 2) or placebo, administered subcutaneously every two weeks.
In the first trial, the primary outcome was met in 43.1% of 283 patients in the lebrikizumab group and in 12.7% of the 141 patients in the placebo group. An EASI-75 response occurred in 58.8% and 16.2%, respectively. In the second trials, the primary outcome was met in 33.2% of 281 patients in the lebrikizumab group and in 10.8% of the 146 patients in the placebo group. An EASI-75 response occurred in 52% and 18.1%, respectively. The incidence of conjunctivitis was higher among patients who received lebrikizumab, and most adverse events were mild or moderate and did not lead to trial discontinuation.
Last May, Cigna announced a new policy that will require the submission of medical records for established patient encounters reported with E/M codes 99212, 99213, 99214, or 99215 when a minor procedure is performed on the same date of service and modifier 25 is appended. A minor procedure is identified as having a 0- or 10-day global period.
In response to AADA advocacy, Cigna delayed the original Aug. 13, 2022, implementation date, but has decided to move forward with this documentation policy. Beginning on May 25, if documentation is not sent supporting that a significant and separately identifiable service was performed, the E/M line will be denied. Required office notes must be submitted via the dedicated fax number, 833-462-1360 or to Modifier25MedicalRecords@cigna.com.
Protecting the appropriate use of modifier 25 is one of the Academy’s advocacy priorities. The AADA continues to advocate on this high-priority issue and is taking the following
actions:
Coordinating a joint response with the AMA and state and specialty societies.
Continuing to educate Cigna on the undue burdens created by the policy.
Learn more about the policy change in Derm Coding Consult, and stay tuned to DermWorld Weekly for updates on this policy.
What the end of the COVID-19 PHE means for dermatologists
The Biden Administration announced the end of the COVID-19 public health emergency (PHE) will be on May 11, 2023. Many flexibilities and exemptions that were put in place during the pandemic may be coming to an end, including telehealth flexibilities and other flexibilities, including vaccine and testing mandates, iPLEDGE, MIPS, and more. Here’s what dermatologists need to know about the end of the PHE.
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