When is it appropriate to bill physician services using modifier -59?

Accurate coding of medical services is a constant challenge for physicians and could jeopardize a practice if not taken seriously. Insurance carriers use sophisticated claims-processing software that easily identifies coding trends by physicians and flags outliers within specialties. The Office of Inspector General (OIG) and the Center for Medicare and Medicaid Services (CMS) hire auditors to identify areas for review which are commonly miscoded. One area that has been flagged for review is billing with modifier -59 because misuse of this modifier has increased inappropriate reimbursement. Be cautious when using this modifier, due to the legal and compliance ramifications when documentation does not adequately support the "distinct procedural service" to justify the use of modifier -59.     

Treatment of shoulder dislocation: is a sling appropriate?

Acute anterior shoulder dislocations, when managed non-operatively, have traditionally been treated by placing the arm in a sling. There is no formal evidence that this treatment is of benefit. Three recently reported studies, one in cadavers and two in patients, suggest that the detachment of the structures in the front of the shoulder is made worse when the shoulder is placed in internal rotation, as when the arm is in a sling. By contrast, the structures are realigned when the arm is placed in external rotation. Shoulder dislocations, if managed non-operatively, should not be treated by placing arms in a sling. Rather, placing them in a splint or using a pillow so that the the arm is externally rotated should be considered.     

Globalisation: what is it and how does it affect health?

The term "globalisation" tends to be misused and overused. We need greater clarity in our understanding of the globalisation process, including the distinct changes involved and their relation to human health. The health impacts of globalisation are simultaneously positive and negative, varying according to factors such as geographical location, sex, age, ethnic origin, education level, and socioeconomic status. Globalisation is not an unstoppable force. Our key challenge is to create socially and environmentally sustainable forms of globalisation that provide the greatest benefits and least costs, shared more equitably than is currently the case. The health community must engage more directly in current research and policy debates on globalisation and encourage values that promote human health. At the same time, those at the helm of globalisation processes must recognise that attending to health impacts will strengthen the long-term sustainability of globalisation.     

Serum PSA levels in the Indian population: Is it different?

BackgroundSerum prostate-specific antigen (PSA) is an important tumour, marker which is widely used to trigger trans-rectal ultrasound (TRUS)-guided prostate biopsy. However, the PSA levels vary with race and ethnicity. Therefore, there is a need to have an Indian reference range.MethodsAll adult male patients meeting the inclusion and exclusion criteria were enrolled in this study. They were subjected to assessment of serum total PSA, digital rectal examination and trans-abdominal ultrasound. If any one or more of these were found abnormal, then a TRUS-guided 12-core prostate biopsy was done. Patients who were detected to have prostatic cancer were excluded from the final analysis. The data so obtained was grouped among the following three age groups: 40–49, 50–59 and 60–70 years, and the age-specific PSA values, prostatic volume and PSA density were found.ResultsA total of 1772 patients were analysed. The mean serum total PSA was 1.76 ng/ml with a standard deviation of 2.566 ng/ml. Group-wise age distribution of the mean serum total PSA was 1.22, 1.97 and 2.08 ng/ml in 40–49, 50–59 and 60–70 years age groups.ConclusionThe mean total PSA and the age-specific PSA range tend to be lower in the Indians than the Western population.     

Medical professionalism: is it really under threat?

Recent publications on medical professionalism have created an impression of a medical profession under siege in several countries. These publications recommend a new approach to medical professionalism to assist the profession to respond to new challenges. I suggest that the issue is not one of failed professionalism, but a shift in the balance of the ethical responsibilities brought about by major changes in health care systems. This shift has not yet been accepted or responded to by the medical profession. Medical professionalism is not under threat in Australia. Stronger leadership is required to address this altered ethical balance in the responsibilities of doctors.     

School-based screening for scoliosis: is it cost-effective?

INTRODUCTION: School-based scoliosis screening was implemented in Singapore in 1981. The rationale for the programme was so that conservative treatment (bracing) can be initiated early to prevent progression of curves, avoid the complications of severe scoliosis and reduce the need for surgery. The evidence for, or against, scoliosis screening and regular follow-up remains controversial. To date, there has been no formal cost analysis of Singapore's screening programme. The aim of this paper was to examine if there are economic justifications to continue with school-based scoliosis screening. METHODS: This cost-effectiveness analysis was done by comparing Singapore's existing school-based scoliosis screening and follow-up programme with the alternative of not having a programme. As the aim of the existing programme was to detect curves early, allowing bracing to be initiated and reducing the need for surgery, this analysis assumed that without the programme, students who otherwise would have received bracing and not needed surgery, would have required surgery instead. This retrospective analysis was based on School Health Service data obtained from screening 45,485 students in 1999 and 44,051 of this same cohort in 2001. Nett programme costs and health effects were computed, and a decision rule applied. RESULTS: The nett cost of the current mass screening programme was negative, while the nett health effects, albeit mostly intangible, positive; which made the programme an economically valuable one. CONCLUSION: Singapore's school-based scoliosis screening programme, which is implemented as part of a larger school screening and immunisation programme, is cost-effective. Cost-effectiveness may be further improved by targeting screening at high-risk groups, such as prepubertal females. More research is needed to quantify the positive health effects of scoliosis screening.     

Human papillomavirus vaccination for the prevention of cervical neoplasia: is it appropriate to vaccinate women older than 26?

Human papillomaviruses (HPVs) are the major cause of cervical cancer. Cervical cancer mortality has been reduced in Australia because of effective screening programs, but there are still about 800 new cases and 300 deaths per year. Worldwide, mortality and morbidity are high. Australia was the first country to introduce fully funded immunisation with a quadrivalent HPV vaccine for girls aged 12 and 13 in schools. A 2-year catch-up program covers all women to the age of 26 years. Age stratification of HPV prevalence showed the highest rates in women under 25 years of age, a decrease in women from 30 years of age and a second smaller peak in those over 45 years. Recently, a bivalent HPV vaccine has been licensed for use in women aged up to 45 years. Older women have robust immune responses to the bivalent HPV vaccine, and so should derive benefit from the vaccine if exposed to HPV type 16 or 18 in the future. It is likely that this vaccine will need to be purchased by women in the older age group (27-45 years).     

Research--what is it all about?

Research is an evolutionary process and being complicated, time-consuming and costly one whose end result is never known at the outset. Discovering a new drug has been likened to searching for the proverbial needle in a haystack. In test tube experiments called assays, compounds are added one at a time to enzymes, cell cultures or cellular substances grown in a laboratory. In the search for a new cholesterol drug, scientists found a fungus that inhibited the HMG-CoA reductase enzyme in a test tube. Chemists then had to identify which of the fungus' dozens of chemical by-products was actually inhibiting the enzyme. Once that was done, the chemical's structure was analysed and improved on to enhance its effects. Research has aimed at discovering what a drug does to the body. If a drug's active ingredients don't get into the blood, it won't work. In research one has to know when to cut losses if one goes down a wrong way. The role of FDA in the early stages of drug research is little. FDA first becomes involved when a drug company has completed its testing in animals and is ready to test a drug on humans. Drug research is a long, difficult and costly road certainly.