Telogen effluvium diagnosis during the COVID-19 pandemic
In a recently published JAAD article in press, researchers found that the number of cases of telogen effluvium (TE) rose sharply during the COVID-19 pandemic, although Hispanic and other non-white patients accounted for the majority of this increase.
The authors compared the incidence of TE at eight New York City hospitals prior to and during the pandemic. During the first six months of the pandemic, there was a threefold increase in TE diagnoses compared to the preceding six months. Of the cases from the pandemic, 10 patients tested positive for COVID-19 and 98 were negative or untested. Additionally, nine of the 10 patients from the COVID cohort had underlying medical conditions that portent a more serious presentation of COVID-19, suggesting that the presence of comorbidities in conjunction with COVID-19 positivity may increase one’s risk of developing TE.
How has COVID-19 impacted dermatologists and their patients? Find out in this month’s DermWorld.
DermWorld Insights and Inquiries: For patients with erythropoietic protoporphyria the tide has come in
Oct. 8, 2019, was an eventful day for patients with erythopoietic protoporphyria (EPP) in the United States, when the FDA announced its approval of afamelanotide (Scenesse). The drug was first approved in Italy in 2010.
Patients with EPP and X-linked protoporphyria (XLP) present with acute, severe, non-blistering phototoxicity within minutes of sun exposure. Anemia is seen in about half of patients and approximately a quarter will develop abnormal serum transaminases. Gallstones are common; liver failure is rare. EPP results from the partial deficiency of ferrochelatase, and XLP results from gain-of-function mutations in erythroid specific ALAS2. The diagnosis of EPP and XLP is made by detection of markedly increased erythrocyte protoporphyrin levels with a predominance of metal-free protoporphyrin. Genetic testing by sequencing the FECH or ALAS2 gene confirms the diagnosis. EPP has a profound effect on a patient’s quality of life, causing physical and psychologic distress, social isolation, and a sense of feeling misunderstood.
Other than sun avoidance, sunscreen, and the questionable use of beta-carotene, the only established beneficial treatment for EPP is afamelanotide. Keep reading!
Derm Coding Consult: How does your use of benign and malignant excision codes compare to the derm average?
Benign and malignant lesion excisions are among many services performed in a dermatology setting, and the Medicare Part B National Utilization Data provides a good source of information on dermatology code utilization.
The AADA coding team has reviewed and compared the 2018 and 2019 national utilization for benign and malignant lesion excision codes to assist you in benchmarking your practice data. The data allows dermatology practices to determine their billing tendencies compared to the national Medicare averages for specific codes. View the numbers and learn more.
Clear vs. standard masks during outpatient surgical encounters
In a randomized trial published in JAMA Surgery, researchers found that surgeons who wore clear masks elicited higher ratings from patients than those wearing standard covered masks in terms of clear explanations, empathy, and trust. More than half of surgeons — eight of 15 (53%) — were not likely to choose a clear mask instead of the covered mask.
This study was conducted at a single academic medical center with 200 new patients recruited from 15 participating surgeons’ clinics across seven subspecialties. When surgeons wore a clear mask, patients rated surgeons higher for providing understandable explanations (clear, 95 of 100 [95%] vs. covered, 78 of 100 [78%]), demonstrating empathy (clear, 99% vs. covered, 85%), and building trust (clear, 94% vs. covered, 72%). Patients preferred clear masks (clear, 100% vs. covered, 72%), citing improved surgeon communication and appreciation for visualization of the face.
Less than two weeks after the Office of the Inspector General (OIG) updated its Work Plan to include developing a report on “dermatologist claims for evaluation and management services on the same day as minor surgical procedures,” dermatology practices have been receiving letters from the OIG seeking medical records for postoperative services provided during the global periods.
[Read about the OIG report for dermatologist use of modifier 25 from the April 28 DermWorld Weekly.]
The OIG has confirmed that this is not an audit of individual practices. The purpose of this audit is to verify CMS’ postoperative data collection efforts by compiling a report to the agency. Although this is not an audit of individual practices, after the report is complete, CMS may seek repayment for claims they deem erroneous.
AADA staff and a newly formed Modifier 25 Workgroup have reached out to the OIG to ascertain more details about the global period audit as well as the modifier 25 audit.
What you can do:
If you receive an audit letter from the OIG, with a deadline that you cannot meet, contact the auditor immediately to seek an extension.
Review Academy audit resources to assist with audit requests.
Stay tuned to DermWorld Weekly for updates as the AADA and physician leadership gathers more information.
Comparative effectiveness trials for topical medications
According to an article inJAMA Dermatology, among 157 trials from 2002 to 2020 of topical medications for acne, psoriasis, and atopic dermatitis, the proportion with an active comparator decreased by 5.2% per year.
[Apples to apples: Comparative effectiveness research gains traction in the real world. Read more in DermWorld.]
With nearly 30% of patients not taking prescriptions as directed because of cost, it’s important to address whether new and costlier drugs offer meaningful benefits when compared to existing less costly alternatives, the authors explain.
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