Disposable sheath endoscopes: a new office technology.
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Disposable Equipment↗
Biomedical subjects
T J Zuber
Publications and source records attributed to T J Zuber.
The fusiform excision.
The fusiform excision of a skin lesion is a common procedure in outpatient care. The appearance of the final scar is improved by orienting the excision parallel to resting skin tension lines with at least a 3:1 length-to-width ratio, undermining the lateral wound edges and using absorbable subcuticular sutures. A properly designed fusiform excision can be closed primarily and infrequently results in the formation of excessive mounds of tissue at the wound ends, known as "dog-ears."
Dermatologic Surgical Procedures↗
Nodular fasciitis.
Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts in the subcutaneous tissues. The lesions are generally small and solitary, arising commonly in the upper extremities of adults and in the head and neck region of infants and children. A history of trauma may precede these reactive lesions, but their cause is unknown. The rapid growth, abundant cellularity, and mitotic activity frequently cause these lesions to be misdiagnosed as sarcomas. Local excision is the treatment of choice for these generally nonrecurring lesions. A case report, differential diagnosis, and review of the literature are presented. Physicians need to be aware of this clinical entity and to work closely with pathology consultants in confirming this difficult diagnosis.
Adult↗
Coding and reimbursement for gastrointestinal endoscopic procedures in primary care.
Endoscopic diagnostic procedures have become part of the comprehensive care provided by many primary care physicians, and when these physicians interact with third-party payers, they must correctly report the endoscopic services they have provided. Included in this review are commonly used upper and lower gastrointestinal endoscopic procedure codes; corresponding reimbursement values from one state's Medicare and Medicaid program; lists of diagnosis codes used in reporting upper and lower endoscopy services; and instructions for reporting visits and intravenous anesthesia associated with endoscopy procedures.
Anesthesia, Intravenous↗
Earlobe keloids.
Earlobe keloids are a challenging management problem. These benign, fibrous proliferations develop in predisposed persons at sites of cutaneous injury or as the result of ear piercing, burns or surgical procedures. Earlobe keloids usually appear as shiny, smooth, globular growths on one or both sides of the earlobe. Patients frequently complain of cosmetic embarrassment, but also may report pruritus, pain or paresthesias. No single therapeutic modality is best. The location, size, depth and duration of the earlobe keloid influence the choice of therapy. Surgical treatment for earlobe keloids generally includes core excision with low-tension wound closure, and shave excision. Surgical repair with corticosteroid injections and postoperative pressure on the incision site usually provide good cosmetic results. Patients must be counseled about recurrence, palpable postoperative nodules and the need for close monitoring.
Adrenal Cortex Hormones↗
Medicare CPT codes.
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Abstracting and Indexing↗
Interspecialty wars over endoscopy.
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Endoscopy↗
Occupational Safety and Health Administration regulations for the physician's office.
Mandatory reporting and recordkeeping on job safety were established for all employers by the Occupational Safety and Health Administration (OSHA) Act of 1970. Physician interest in OSHA regulations recently increased with the publication of the Bloodborne Pathogens Standard. This review examines general employer communication to employees about new standards as well as reporting requirements for physician offices, including special OSHA forms needed to comply with illness and injury reporting.
Acquired Immunodeficiency Syndrome↗
Primary care physician consultations.
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Centers for Medicare and Medicaid Services, U.S.↗
Physician payment reforms and family physicians.
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Fee Schedules↗
Coding and reimbursement of primary care biopsy and destruction procedures.
Current medical practice requires physicians to accurately report services provided to patients. Billing for destruction of benign and malignant lesions and for surgical, needle, and endoscopic biopsy procedures involves the selection of specific 1992 Current Procedural Terminology (CPT) codes. Payment for these procedures by third-party payers often requires the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding for neoplastic lesions. This review explains the proper codes to use in identifying common biopsy and destruction procedures performed by primary care physicians. The Health Care Financing Administration's relative value units and one state's published Medicaid payment rates are included for each procedure code. Instructions for selecting site-specific biopsy and destruction codes are provided.
Abstracting and Indexing↗
Coding and reimbursement of primary care debridement and excision procedures.
Current medical practice requires physicians to accurately report services provided to patients. Patient billing for debridement and excision procedures involves the selection of specific 1992 Physicians' Current Procedural Terminology codes. Although a site-specific surgical procedure code often yields higher reimbursement than a general procedure code, physicians should select the code that most accurately reflects the procedure performed. This review identifies the codes used to report destruction and excision procedures performed by primary care physicians. Included in this review are skin debridement, burn debridement, excision of benign and malignant lesions of the skin and subcutaneous tissue, cyst and ganglion excision, nail excision, anorectal lesion excision, shave, paring, and skin tag excision procedures, and foreign body removal. The Health Care Financing Administration's relative value units and one state's published Medicaid payment rates are included for each procedure code. Instructions are provided for selecting between multiple coding options when more than one code describes the service provided.
Abstracting and Indexing↗
New CPT codes: hospital, consultation, emergency and nursing facility services.
New evaluation and management codes were created by the Current Procedural Terminology (CPT) Editorial Panel to ensure more accurate and consistent reporting of physician services. The new hospital inpatient codes describe three levels of service for both initial and subsequent care. Critical care services are reported according to the total time spent by a physician providing constant attention to a critically ill patient. Consultation codes are divided into four categories: office/outpatient, initial inpatient, follow-up inpatient and confirmatory. Emergency department services for both new and established patients are limited to five codes. In 1992, nursing facility services are described with either comprehensive-assessment codes or subsequent-care codes. Hospital discharge services may be reported in addition to the comprehensive nursing facility assessment. Since the 1992 CPT book will list only the new codes, and since all insurance carriers will not be using these codes in 1992, physicians are encouraged to keep their 1991 code books and contact their local insurance carriers to determine which codes will be used.
Ambulatory Care↗
Skin damage associated with the Norplant contraceptive.
Three cases of localized skin reaction in the first month after implantation of the Norplant contraceptive resulted in a partial implant expulsion and removal in one patient, and implant removal in another. Clinical evidence of infection was absent in all patients. While lidocaine with epinephrine was used in all three patients, the cause for these skin reactions remains unclear. Physicians should be alerted to the possibility of significant skin reactions associated with this procedure.
Adult↗
Monitoring physician use of new CPT codes by Medicare.
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Abstracting and Indexing↗
A guide to the new office evaluation and management codes for 1992.
The new office evaluation and management codes require an understanding of definitions that have been recently created by the Current Procedural Terminology (CPT) Editorial Panel. Code selection is based on seven components; the three key components are the history, the physical examination and medical decision making. Office visit codes are divided into five levels of visits, based on service. New-patient office visits require all three key components for any level visit; established-patient office visits require only two of the three components. The new office code descriptions were created to assist physicians in code selections. Only when counseling or coordination of care dominates the visit (e.g., more than 50 percent) is time to be considered a controlling factor. Physicians are urged not to code only from time descriptors. The 1992 CPT book will list only the new evaluation and management codes, deleting the old level-of-service codes. Physicians are encouraged to contact local insurance carriers to ensure that they will also be using the new codes in 1992.
Abstracting and Indexing↗