March 24, 2021
IN THIS ISSUE / March 24, 2021
Derm Coding Consult: Applying 2021 E/M coding concepts in everyday practice — Part 1
DermWorld Insights and Inquiries: Lipschütz ulcers — Not only for women
Imiquimod vs. photodynamic therapy for actinic keratosis of the scalp
Is mycophenolate mofetil effective for the treatment of cutaneous lichen planus?
Does maternal autoimmune disease have an impact on offspring?
Derm Coding Consult: Applying 2021 E/M coding concepts in everyday practice — Part 1
The introduction of the revised 2021 evaluation and management (E/M) coding guidelines has generated a plethora of questions from dermatologists in the application of the concepts used in the medical decision making table (MDM).
To help members navigate the E/M changes in a simplified and relatable manner in everyday practice, the Academy has developed a series of educational articles to illustrate how to apply the coding concepts and criteria introduced on Jan. 1, 2021, based on coding scenarios that are common in the dermatology practice.
This ongoing series of articles uses clinical vignettes to help dermatologists and non-physician clinicians walk through the process of breaking down the elements of MDM and elucidate how each level of service is achieved. Read the full article.
Get the latest information about accurate diagnostic and procedural coding as well as Medicare reimbursement issues in dermatology at Derm Coding Consult.
Related content:
DermWorld Insights and Inquiries: Lipschütz ulcers — Not only for women
LU (aka ulcus vulvae acutum, non-sexually related acute genital ulcers) are painful ulcerations of the external genitalia occurring primarily in adolescent females, with a mean age of onset of 14.5 years. They are often misdiagnosed as herpes simplex virus infection or Behçet disease, and may prompt an evaluation for sexual abuse, causing significant physical and emotional distress for the patient and parents. Nonspecific prodromal symptoms, including fatigue, anorexia, headache, and low-grade fever, often precede the appearance of ulcers. Keep reading!
Imiquimod vs. photodynamic therapy for actinic keratosis of the scalp
In a pilot study published in Photodermatology, Photoimmunity & Photomedicine, investigators assessed the efficacy, tolerability, recurrence, and aesthetic results of imiquimod 3.75% versus photodynamic therapy with 5-aminolaevulinic acid (MAL-PDT) for actinic keratosis (AKs) of the scalp. Each bald male participant was treated with one session of MAL-PDT to one-half of their scalp and with daily imiquimod 3.75% to the other half of the scalp for 14 days on, 14 days off, 14 days on.
The results showed comparable efficacy in reducing AK numbers: Imiquimod with a 68% reduction vs. MAL-PDT with a 56.5% reduction, although this difference was not statistically significant. Both treatments achieved long-term control with a similar recurrence rate of less than 10%. MAL-PDT caused slightly more discomfort, although only imiquimod was associated with more edema, erosions, scabbing, and flu-like symptoms during the active treatment period.
Tirbanibulin, a novel topical AK therapy, is expected to be available this year. Learn more about it in DermWorld Insights and Inquiries.
Related content:
No more waiting around on EHRs for MIPS!
If you have been planning to adopt an electronic health record (EHR) but haven’t gotten around to it, you have waited long enough. With the release of the 2021 Merit-based Incentive Payment System (MIPS) program requirements, it is clear that it will be impossible to avoid the 9% penalty or get an incentive without having an EHR. While eligible clinicians can still report through claims to meet the required point thresholds, you must either obtain an exemption for the Promoting Interoperability (PI) category or seek out other relevant exemptions — if available.
Each year, the requirements will only become more stringent and there are no guarantees when it comes to exemptions, so if you plan to switch to EHR, now is the time. The Academy offers resources to help you learn about EHRs and determine which may be right for your practice. If you are looking to report MIPS conveniently via DataDerm — the Academy’s clinical registry — be sure to check out DataDerm’s recognized EHRs.
If you're a paper-based practice and have questions about how to use DataDerm for 2021 MIPS reporting, sign up to attend a virtual DataDerm Office Hours session Monday, May 10, 12 - 1p.m. CDT.
Is mycophenolate mofetil effective for the treatment of cutaneous lichen planus?
Authors of a study published in JAAD sought to determine the safety and efficacy of mycophenolate mofetil (MMF) for the treatment of cutaneous lichen planus (CLP) with a retrospective case series. Ten patients with generalized or recalcitrant local CLP, who had previously failed first-line topical corticosteroids and topical calcineurin inhibitors, were identified between 2010 and 2019.
Half of patients achieved improvement (two mild, two significant, and one remission), mostly those with longer treatment durations (26.8 vs. 7.9 months) and higher doses (2,200 vs. 1200 mg). Three patients experienced flares when discontinuing MMF. Mild improvement was observed in two patients.
While immunosuppressants, like triamcinolone acetonide (TAC), are considered first-line treatment for nail lichen planus, it is unknown whether this may increase the risk of COVID-19-related mortality. Read more in DermWorld Weekly.
Related content:
Does maternal autoimmune disease have an impact on offspring?
In a study published in JAMA Pediatrics, researchers found a higher association of attention deficit/hyperactivity disorder (ADHD) in children whose mothers had an autoimmune disease during pregnancy. In a systematic review, they also found an association between ADHD (HR, 1.30) and maternal type 1 diabetes (HR, 2.23), psoriasis (1.66), and rheumatic fever or carditis (1.75).
A cohort study was conducted of children born at term gestation in Australia from July 2000 to December 2010 and followed up until the end of 2014. A child was considered to have ADHD if they had a prescription for a stimulant treatment for ADHD or received a hospital diagnosis. Five studies were included in the meta-analysis and were associated with ADHD: two studies with any autoimmune disease (HR, 1.20), four studies with type 1 diabetes (HR 1.53), three studies with hyperthyroidism (HR, 1.15), and two studies with psoriasis (HR 1.31).
What are the dermatologic implications of direct-to-consumer DNA tests? Find out in DermWorld.
Related content:
