According to a JAAD article in press, up to 20% of COVID-19 patients develop cutaneous manifestations such as erythematous rash, rash with petechiae, vesicular rash, acral ischemia, livedo reticularis, and widespread urticaria. The authors suggest a simple algorithm to help health care workers, who are working on the front lines during COVID-19, classify the rashes through physical examination.
When examining patients with generalized exanthem from COVID-19, the first step is to look for the presence of vesicles or secondary erosions with crusts. If absent, a blanching component can be easily assessed by firmly pressing the affected area for several seconds. Non-blanching generalized rashes composed of small red macules are indicative of a rash with petechiae. An acral distribution of non-blanching violaceus lesions is indicative of acral ischemia. Learn more about this rash algorithm and view the chart in JAAD.
DW Insights and Inquiries: On the cusp of extraordinary advances in extramammary Paget disease
I always include extramammary Paget disease (EMPD) and Bowen disease in my differential diagnosis of anogenital rashes for fear of missing them. It is good form to biopsy such lesions should they not respond to standard therapies for the more likely diagnoses in this region (tinea, Candida, seborrheic dermatitis, or psoriasis). Even with this prudent approach, I have diagnosed EMPD only a few times in four decades of practice.
EMPD commonly occurs on apocrine rich regions, usually affecting anogenital skin or the axilla, although the eyelid, ear canal, and umbilicus may rarely be affected. EMPD usually presents as an erythematous plaque on the genitals of patients aged 60 to 80 years. Compared to Paget disease of the breast, where 90% of cases are associated with an underlying breast cancer, only 7-40% of EMPD cases have an associated underlying internal malignancy. EMPD is considered primary when arising as an intraepidermal neoplasm with the potential for invasion or metastasis. Secondary EMPD represents intraepithelial spread of malignant adenocarcinoma cells from an underlying internal malignancy. Keep reading!
Derm Coding Consult: Telephone code Medicare reimbursement will be updated automatically
Dermatologists who billed audio-only E/M Medicare claims using codes 99441, 99442, and 99443 after March 1, 2020, will have their payments for those claims adjusted automatically to pay at the same rates as 99212, 99213, and 99214, respectively. No claims resubmission is necessary, but dermatologists are encouraged to track claims previously submitted with telephone E/M codes for Medicare patients beginning March 1 to ensure that all of these claims are accurately re-adjudicated. Learn more.
Register for the Academy’s virtual meeting experience, AAD VMX
The Academy has developed a virtual meeting experience called AAD VMX that will be held June 12-14, 2020. Participants will join the Academy for a three-day live and online experience from the comfort and safety of their home and/or office. AAD VMX offers at least 24 CME credits, more than 14 robust sessions on multiple clinical topics, live Q&As with presenters, 900 posters, a virtual exhibit hall, and more! Register now.
Young Physician Focus – Teledermatology: Love it or list it?
The title of this month’s column is a homage to one of the many HGTV shows I have binge-watched over the past couple months. In case you’ve been too busy revamping your practice to tune in, the premise of the show is that sharp-witted reality TV stars help homeowners grapple with the decision of whether to stay in their current home and renovate, or cut their losses and list the home for sale.
This particular show has resonated with me because I feel like the COVID-19 pandemic has catapulted the medical field into an existential crisis. We are at a crossroads, where we will soon need to decide whether to salvage the traditional practice model with some tweaks (we’ll call it “the reno”), or ditch it altogether (“the sale”) and fling ourselves wholeheartedly into the world of virtualized medicine. Read more from DW Young Physician Advisor Jenna O’Neill, MD.
Stay tuned: New E/M codes
In the 2019 Medicare Physician Fee Schedule proposed rule, CMS proposed significant changes to the way office evaluation and management (E/M) services would be reimbursed, taking effect in January 2021.
CMS proposed that payment for an E/M service or procedure would be reduced by 50% when the E/M is reported with a modifier 25. Cutting payments when modifier 25 is appropriately included with an E/M service would have resulted in an approximately 25% reduction of in-office E/M payments for dermatologists.
As a result of AADA advocacy targeting CMS, HHS, and Congress, CMS dropped the modifier 25 payment cut, abandoned its E/M payment compression, and accepted E/M codes from the house of medicine with new values.
Learn more about the upcoming Medicare changes that could affect you and your practice in Dermatology World.
From distilleries to the State House: Garnering support during COVID-19
DW Weekly talked to Art P. Saavedra, MD, PhD, MBA, at the University of Virginia School of Medicine, about his efforts to collect and donate supplies, and raise awareness for the front line health care workers during the COVID-19 pandemic.
DW Weekly: Tell us about your efforts to support front line workers during the COVID-19 pandemic. Why did you get involved and who did you band together with?
Dr. Saavedra: I think the first thing was the realization that we wanted to keep as many people in the workforce safe to take care of patients. If they got sick, then we would be depleted. We wanted to make sure that we behaved not as an institution in our own silos, but as a community. A few of us got together — myself from an academic institution, a pediatrician from the community, and others from various sectors — to think about and discuss how we could act as one. How do we share? How do we move forward?
DW Weekly: You noticed that there were three buckets of problems during the pandemic — the first being the dearth of PPE supplies. What did you do to tackle this problem?
Dr. Saavedra: When we looked at supply, we very quickly realized that some supplies were coming in internationally and so they were just getting quarantined. We also realized that sometimes institutions with more bargaining power and more of a presence could secure these supplies more easily and then share with other institutions with less bargaining power.
We also learned that we needed to mobilize the community because people were very interested to make donations but didn’t know where to donate or what to donate. We looked everywhere for supplies. We looked at big companies that could send us items, but we also looked at other smaller businesses in town that could give us stuff like tractor masks, eyewear, gloves, gowns, and masks of all types. We even reached out to a local distillery to help us make alcohol. Keep reading Dr. Saavedra’s story.
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