A retrospective study published in JAAD examined whether a clinical association exists between the presence of type 2 diabetes mellitus and prediabetes and the severity of central centrifugal cicatricial alopecia (CCCA) in Black patients. The researchers found that of 35 patients with CCCA, 20 had type 2 diabetes or prediabetes — 15 patients did not. Of the patients who had diabetes or prediabetes, the average HbA1C was 6.93% compared to 5.26% in the control group. Patients with CCCA and diabetes/prediabetes had higher CCCA severity grades compared with controls. The average CCCA severity grade in the diabetes/prediabetes group was 3.16 versus 2.57 in the control groups. The authors suggest that a shared mechanism (peroxisome proliferator-activated receptor-γ) may be a marker of metabolic dysfunction.
Is there a genetic basis of CCCA and, if so, what is it? Read more in DermWorld.
DermWorld Insights and Inquiries: Fixing the concept of the neutrophilic fixed drug eruption
Can anyone other than your mother recognize you from your baby photograph? The concept that lesions have lives is nothing new — clinical and histopathological changes vary from lesional inception to involution. Despite this truism, confusion about nosology for many dermatoses, based on the timing of assessment, is replete in the medical literature. This commentary will focus on the neutrophilic fixed drug eruption. As trite as it is, clinical-pathologic correlation is of paramount importance in deciphering neutrophilic dermatoses. On a histologic basis alone, many of the features described could be observed in Sweet’s syndrome, adult-onset Still disease, autoinflammatory disorders, non-bullous bullous pemphigoid, or prurigo pigmentosa. A good clinical history and morphologic description will help guide your dermatopathologist. Keep reading!
What’s the risk of IBD in patients with chronic inflammatory skin diseases?
A retrospective, claims-based study published in the British Journal of Dermatology followed up with patients with chronic inflammatory skin diseases to determine the risk of developing inflammatory bowel disease (IBD) — ulcerative colitis (UC) and Crohn’s disease. Compared with participants in the control cohort, those with psoriasis and hidradenitis suppurativa (HS) had an increased risk of Crohn’s disease, and only those with HS had an increased risk of ulcerative colitis. No significant association was noted between IBD risk and vitiligo, atopic dermatitis, or alopecia areata.
Have you explored the redesigned AAD Learning Center? Check out the Skin of Color Curriculum, Biologics for Psoriasis course, Suture Techniques course, and more!
After research had shown that scalp cooling in patients treated with docetaxel could be reduced from 90 to 45 to 20 minutes, researchers sought to investigate whether the post-infusion cooling time (PICT) might be able to be reduced for patients treated with paclitaxel as well. The study, published in Supportive Care in Cancer, found that in patients treated weekly with paclitaxel, chemotherapy-induced alopecia (CIA) can be controlled as effectively with a 20-minute post-infusion cooling time (PICT) as with 45- or 90-minute PICT.
Of the 38 patients in the 20-minute PICT group, hair preservation was accomplished for 82%, and of the 36 patients in the 45-minute PICT, hair preservation was accomplished for 75% — the same success rate for those with the standard 90-minute PICT (85%).
Dermatologists step in to treat cutaneous side effects of cancer treatments so patients can complete their therapy. Read more in DermWorld.
As a direct result of AADA’s advocacy, UnitedHealthcare (UHC) has agreed to amend its polices on prior authorization for Mohs and adjacent tissue transfer, and multiple procedure payment reduction. These changes will improve payment for dermatological services for appropriately reported services, which were being inappropriately reduced under UHC policy.
UHC prior authorization requirement for Mohs and adjacent tissue transfer
UHC currently requires prior authorization for adjacent tissue transfer, which the AADA pointed out is burdensome and unproductive for both payer and provider. UHC agreed to change its policy and will waive the prior authorization requirement if adjacent tissue transfer is billed in association with a Mohs procedure code. Before it is finalized, the policy change must be reviewed and approved by the UHC Utilization Management Program Committee which meets later in October 2022. Once approved, UHC anticipates the change to be implemented in early 2023.
Multiple procedure payment reduction (MPPR)
UHC will adjust its multiple procedure payment reduction policy after AADA Patient Access and Payer Relations Committee leadership pointed out that the insurer’s policy does not fully align with CMS’. Under Medicare, the payment reduction does not apply if surgeons of different specialties are each performing a different procedure (with specific CPT codes). In such cases, neither co-surgery nor multiple surgery rules apply (even if the procedures are performed through the same incision). However, UHC had been applying the multiple procedure payment reduction when procedures were performed by two physicians of different specialties, but under the same Tax Identification Number (TIN), on the same patient on the same day.
The revised UHC policy will no longer apply a payment reduction when a Mohs surgery (CPT codes 17311-17315) and a claim for a surgery service from a different CPT code range are submitted by different specialties, regardless of the TIN. UHC will include this in its Nov. 1, 2022, provider notifications and will complete its claims edits by the end of the first quarter of 2023. In the interim, UHC will monitor impacted claims for an override; however, if a payment reduction is applied for surgeries by different specialties as described above, dermatologists should appeal through the UHC appeal process. If the appeals are not resolved, AAD members should report it to privatepayer@aad.org.
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