Hi, I ’m an Attending and I am READY to Complain About Billing.
I barely knew anything about billing before becoming an attending – the only tidbits I knew were: 1) there are levels 2) gotta have a certain number of systems in your ROS with at least 2 specifics per system 3) the reason I document “fundoscopic exam: unsuccessful” in a 7 month old instead of deleting the line like a sensible person who understands 7 month olds has something to do with min-maxing billing, and 4) ED charts say “MDM” a lot. These are the charts our coders gave me during my 10 minute billing orientation: So that’s good – theoretically I should be able to just consult the horoscopes augheries billing charts and see what level I can bill for based on what I had time to document in my note, right? Except “Medical Decision Making” seems to supersede everything and is apparently totally derived from how many tests I order and how many prescriptions I give, rather than how much thought I put into NOT ordering extra tests and unnecessary drugs. It’s outrageous, really: you could meet every criteria for a Level 5 visit on those charts, but if the auditor thinks that your Medical Decision Making was ‘uncomplicated’ (meaning either your conclusion was that the pt was at minimal / low risk of imminent death, and / or you didn’t order more than 1-2 tests or prescriptions) then they will downgrade your whole beautiful 5 page note to a Level 2 visit and ding you for overbilling. OR you could...
Conclusions: Medical history, physical examination, and imaging studies are crucial in the diagnosis of retinoblastoma-associated orbital pseudocellulitis. Retinoblastoma should be excluded in all patients with signs of pre-septal orbital cellulitis through fundoscopy and/or imaging studiesOcul Oncol Pathol
Conclusions: A conservative approach with acetazolamide treatment or just observation was used in our case series in choroidal detachment without substantial visual loss if, over time, slow improvement was documented. However, further studies are needed to verify the effectiveness of the reported therapy.
Conclusion: We wonder if retinal degeneration may not have been previously recognized as a feature of Canavan disease. We highlight findings from animal models of Canavan disease to further support the association between Canavan disease and retinal degeneration. PMID: 32975148 [PubMed - as supplied by publisher]
CONCLUSIONS: This prospective population-based study represents the largest Brazilian cohort study of ZIKV in pregnancy. Congenital anomalies potentially associated with CZS are less frequent than previously thought. There is a strong relationship between the gestational age of infection (≤11 weeks) and worse early infant prognosis. A notable proportion of apparently asymptomatic newborns can present with subclinical findings within three months of age. PMID: 32920998 [PubMed - as supplied by publisher]
BACKGROUND/PURPOSE: Accurate identification of child physical abuse is crucial during the evaluation of injured children. Retinal hemorrhages (RH) are used for diagnosis, but clear criteria for screening with direct fundoscopic exam are lacking. We sought ...
Conclusions: This case illustrates the importance of careful evaluation and high clinical suspicion for this entity when dealing with patients with new-onset headache or stroke associated with visual impairment. Proper ophthalmologic evaluation is important so that adequate therapy is established.
Accurate identification of child physical abuse is crucial during the evaluation of injured children. Retinal hemorrhages (RH) are used for diagnosis, but clear criteria for screening with direct fundoscopic exam are lacking. We sought to identify key factors associated with RH to guide evaluations.
CONCLUSIONS: In female carriers of choroideremia and X-linked retinitis pigmentosa, differential diagnosis may be challenging. A speckled pattern of low- and high-density in autofluorescence is commonly found in female carriers of choroideremia. FAF is a powerful tool for making a correct clinical diagnosis because the pattern in FAF is much more apparent than the visible retinal changes obtained by fundoscopy. Although it is crucial to perform molecular analysis to confirm the diagnosis, FAF is useful when genetic testing may not be readily available. PMID: 32835561 [PubMed - as supplied by publisher]
This report suggests that, even in cases of intravitreal injection, patients with history of allergy, despite the anti-allergic treatment, should be hospitalized to detect late onset of such a life-threatening complication. PMID: 32820959 [PubMed - as supplied by publisher]
Conclusions: Both femtosecond lasers were safe and capable of creating highly reproducible, uniform, and regular flaps at the target preoperative thickness of 120 μm. The LenSx multifunctional femtosecond laser offers the advantage of allowing both cataract and corneal surgeries.