We’ve got new AK guidelines with CME credit

The AAD recently released a course to help members implement new guidelines of care for the management of actinic keratosis (AK). The on-demand, online learning will help you: ... Identify the appropriate background assessments needed before starting topical, cryosurgery, photodynamic, or combination therapy for adult actinic keratosis. ... Recognize the

A surgical pearl (in waiting) for the medical dermatologist

By Warren R. Heymann, MD ... Oct. 21, 2016 ... I admit it — the surgical aspect of my practice is rudimentary. Honestly, any non-cosmetic procedure that takes me more than 5 minutes gets referred. It’s amazing how I can make a living with shave biopsies, tangential excisions, electrodesiccation

Yeast rising: Predicting the efficacy of candida antigen immunotherapy for warts

By Warren R. Heymann, MD Oct. 2, 2017 ... Numerous flat warts (verrucae plana) seen on upper extremities of patient with epidermodysplasia verruciformis. ... Credit: ... JAAD Perhaps I’m paranoid, but I always think that warts are laughing at me, or at least at whatever I throw at them —

Boards Fodder: Procedural dermatology

Select a title below to access the Boards Fodder PDF. ... NEW! Surgical complications part 1: Acute and sub-acute complications of cutaneous surgery ... Access the PDF NEW! Surgical complications part 2: Long-term complications of cutaneous surgery ... Access the PDF Alopecia areata treatment Antiseptics and sterilization methods Atopic dermatitis

Understanding the difference between biopsy, excision, shave, and destruction codes

Biopsies, excisions, shaves, and destructions: In a nutshell ... Biopsies, excisions, shaves, and destructions may be very similar, but there are important differences. ... Biopsy removes a tissue sample for histopathologic examination. ... A destruction procedure ablates the lesion(s) with curettage, electrosurgery, cryosurgery, laser treatment, or chemical treatment. ... Excision

Destruction codes and differences between code categories

Destructons: In a nutshell ... Destruction involves the ablation of the lesion(s) with curettage, electrosurgery, cryosurgery, laser treatment, or chemical treatment. ... There are separate code categories for destruction of benign, premalignant lesions, malignant lesions, skin tag(s), and cutaneous vascular proliferative lesions. ... Coding rules vary within these categories. ...

CXCR4 antagonist therapy based on a WHIM syndrome

By Warren R. Heymann, MD, FAAD June 12, 2024 Vol. 6, No. 24 Emelio* had a delightfully whimsical personality that matched his syndrome’s acronym — WHIM ( ... W arts, ... H ypogammaglobulinemia, ... I nfections, and ... M yelokathexis). His smile was as infectious as his verrucae, and he

PDF for Clinical Pathway for Management of AK

PDT Not e: ALA-daylight PDT is less painful than but equally as effective as ALA- red light PDT CRYOSURGERY

Eyeing the use of cryotherapy for eyebrow alopecia areata

By Warren R. Heymann, MD April 5, 2017 I am always looking for alternatives to injecting eyebrow alopecia areata with triamcinolone acetonide (TAC). My protocol, based on the recommendation by Alkhalifah et al, is TAC 2.5 mg/mL, 0.5 mL to each eyebrow, every 4 to 6 weeks, as necessary (1).

What’s new in treating actinic keratosis?

Dermatologists discuss how to balance the latest evidence, patient preferences, and clinical experience when treating AKs ... Feature ... By Allison Evans, Assistant Managing Editor, November 1, 2022 Actinic keratoses (AKs) are commonly diagnosed and treated by dermatologists. In fact, the National Ambulatory Medical Care Survey on outpatient medical care

Actinic keratosis guideline

Actinic keratosis (AK), rough scaly patches that arise on chronically ultraviolet-exposed skin, is one of the most common conditions diagnosed and treated by dermatologists in the United States. This guideline addresses the management of actinic keratosis, providing evidence-based recommendations for treatment. ... Actinic keratosis guideline ... Access the full actinic

Dermatology benign, premalignant, and malignant destruction code utilization

The AADA coding team continues to educate dermatologists on the code utilization indicators for services provided in a dermatology setting. As a follow-up to the first in the series, ... How does your benign and malignant excision code utilization compare to the average in dermatology , the coding team has

Questions and answers: Evaluation and management (E/M) guidelines

Working with the AMA, the AAD’s coding experts are here to provide you with insightful solutions to your most common inquiries. In this informative question-and-answer article previously published in AMA CPT ... ® ... Assistant FAQ of August 2023, our coding team delves into the intricacies of coding for the

Determining the appropriate lesion destruction code — benign or premalignant

Derm Coding Consult ... By Tiffany McFarland, RHIT, Analyst, Coding & Reimbursement, April 1, 2024 Academy coding staff address important coding topics each month in DermWorld ... Coding Consult. Read more Derm Coding Consult articles . The correct designation of lesions as benign, premalignant, or malignant is important for coding

Location codes

Location: In a nutshell ... For some procedures, there are different codes for specific anatomical regions. ... There are site-specific biopsy and destruction codes available, and these codes should be reported as long as the coding criteria and guidelines are met. ... You need to pay close attention to where

October 20, 2021

Derm World Weekly - A Publication of the American Academy of Dermatology | Association ... IN THIS ISSUE / Oct. 20, 2021 ... AADA advocacy results in FDA approving iPLEDGE modifications DermWorld Insights and Inquiries : Probing pediatric pigmented purpuras DermWorld Young Physician Focus : Staying connected Scabies treatment may

Cutaneous Squamous Cell Carcinoma

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of human skin cancer with at least 200,000 to 400,000 new cases of cSCC expected each year in the US. These evidence-based guidelines on the management of cSCC provide the most current information on biopsy techniques, histopathologic assessment, tumor

PDF of DIR spring 2023

Emily Ptasnik, DO, and Chiara Rosenbaum, DO, MS General principles Optimal freezing techniques • Cryosurgery

Time for a Churchillian approach to idiopathic guttate hypomelanosis?

By Warren R. Heymann, MD Jan. 22, 2018 Limbs of patient with idiopathic guttate hypomelanosis lesions. ... Credit: ... JAAD I was only 10 years old when Winston Churchill died, but even as a child I was aware of his inspirational abilities. I was reminded his gift watching Gary

Thoughts on hyaluronidase and The House of God

By Warren R. Heymann, MD January 15, 2020 Vol. 2, No. 2 I was reminiscing about my internship at Bellevue-NYU forty years ago after reading Stephen Bergman’s (pseudonym Samuel Shem) reflections on the fortieth anniversary of his irreverent, but hilariously accurate, ... The House of God — a portrayal of

Routine Foot Care and Wart Paring

A common coding question in dermatology concerns Medicare coverage of routine foot care. Medicare Part B does not cover routine foot care, unless it is part of a medically necessary treatment for a disease or condition, such as metabolic, neurologic, or peripheral vascular disease. In addition, the need must be

Hot coding topics to keep you cool this summer

Derm Coding Consult ... By Faith C. M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, manager, coding & reimbursement, June 1, 2021 Academy coding staff address important coding topics each month in Derm Coding Consult. ... Read more Derm Coding Consult articles . Think back to the world a year ago:

PDF of Modifier 25 Educational Tool

............................................................. 7 Actinic Keratoses treated with cryosurgery

Of every possible solution for elastosis perforans serpiginosa, fractional carbon dioxide laser may be the best

By Warren R. Heymann, MD Nov. 13, 2017 ... Elastosis perforans serpiginosa. Clinical presentation. ... Credit: ... JAAD My initial attraction to dermatology, which still offers great appeal, is the challenge and joy of differential diagnosis and clinical-pathologic correlation. I learned quickly, however, that patients don’t want to be interesting

Direct-to-consumer telemedicine websites: Caveat emptor, a prediction, and proposal

By Warren R. Heymann, MD ... July 17, 2016 ... Two weeks ago, I experienced pain extending from my right groin to my buttock to the degree that I almost could not bear weight. I felt as though I was 90, and if anyone saw my gait, they would have

September 8, 2021

Derm World Weekly - A Publication of the American Academy of Dermatology | Association ... IN THIS ISSUE / Sept. 8, 2021 ... A review of spironolactone for androgenetic alopecia DermWorld Insights and Inquiries : Alarming but benign – The enigma of acute hemorrhagic edema of infancy What are the

A presidential viewpoint: “Nobody knew that benign vascular lesions of the lip could be so complicated”

By Warren R. Heymann, MD April 14, 2017 Well, maybe not as befuddling as replacing Obamacare, but there may be occasional difficulties in diagnosing benign vascular lesions of the lip, with implications for appropriate therapy. ... Tobouti et al, in a study from an oral pathology service, found that of

APACHE no more

By Warren R. Heymann, MD Dec. 4, 2017 ... A, Dark red, linear plaque on posterior area of right lower leg. B, Slightly raised, scaly, undulating lesion measuring 50 × 12 mm. ... Credit: ... JAAD This commentary is about being DC (Dermatologically Correct), not PC (Politically Correct as in

Happy 95th birthday, Mom! A Birthday vish in the Era of “Value-based” healthcare

By Warren R. Heymann, MD ... June 5, 2016 ... I am blessed that my mother is in reasonable health with a keen intellect. She’s a prolific reader, politically engaged, and still independent in mind, body, and spirit. ... She has fought medical ageism on several occasions. At age 88,

June 12, 2024

Derm World Weekly - A Publication of the American Academy of Dermatology | Association ... IN THIS ISSUE / June 12, 2024 ... Acne in pregnancy: The safest options DermWorld Insights and Inquiries : CXCR4 antagonist therapy based on a WHIM syndrome Nonsteroidal approaches for treating patients with atopic dermatitis

PDF of CPT billing codes of common procedures

15 lesions 17111 Non-axillae areas 64653 First lesion 17000 OnabotulinumtoxinA Units + qty J0585 Cryosurgery

Thinking about seborrheic keratoses: A rare event

By Warren R. Heymann, MD June 9, 2017 Clinical images of squamous cell carcinoma arising in seborrheic keratosis (SCC-SK). A, Invasive SCC-SK on forehead of a man aged 69 years. B, In situ SCC-SK from a pigmented keratosis on the back of a man aged 73 years. C, In situ

Modifier 25 and E/M coding in 2021

Derm Coding Consult ... By Cynthia Stewart, CPC, COC, CPMA, CPC-I, manager, coding & reimbursement resources, March 1, 2021 Academy coding staff address important coding topics each month in Derm Coding Consult. ... Read more Derm Coding Consult articles . The recently released 2021 CPT ... ® ... office or

Calcipotriene and 5-fluorouracil: Dermatology’s new dynamic duo?

By Warren R. Heymann, MD Sept. 18, 2019 Vol. 1, No. 28 Chatting with my chief resident, Tia Pyle, I was lamenting the recent comparative report that ingenol mebutate (and other treatments) did not fare as well as 5-fluorouracil (5-FU) for treating actinic keratoses (AKs). (1) (See previous ... Dermatology

No longer flailing with Flegel disease

By Warren R. Heymann, MD, FAAD April 19, 2023 Vol. 5, No. 16 I was a toddler in 1958 when Heinz Flegel described ... hyperkeratosis lenticularis perstans (HLP) a 50-year-old man with persistent lesions on his dorsal feet and lower extremities. (1) In the ensuing decades, other than the clinical

Reflections on reflectance confocal microscopy for diagnosing benign lichenoid keratoses

By Warren R. Heymann, MD, FAAD July 5, 2023 Vol. 5, No. 27 At the inception of my dermatology residency in July 1980 I read a brief article entitled "Benign Lichenoid Keratosis" (BLK) by Detlef Goette (1) and thought to myself "Remember this — I’ll probably see this lesion now

PDF of Oral disease, part 1

Actinic Keratosis/ Loss of normal dermatoglyphics, atro- Thickening of epithelium and hyper- Cryosurgery

Common coding questions: Answered

Cracking the code ... Dr. Miller, who is in private practice in Yorba Linda, California, represents the American Academy of Dermatology on the AMA-CPT Advisory Committee. ... By Alexander Miller, MD, April 1, 2020 Test your knowledge: Common coding questions ... Take the quiz to see if you're up to

Twenty years of imiquimod taking its toll on lentigo maligna — Where are we?

By Warren R. Heymann, MD February 12, 2020 Vol. 2, No. 6 Although Y2K never amounted to much, a solitary case report that year changed the dynamic in treating a vexing problem — melanoma in situ of the lentigo maligna (LM) subtype. Ahmed and Berth Jones reported treating an 88-year

Which treatment modality of pyogenic granuloma is worth its weight in salt?

By Warren R. Heymann, MD, FAAD July 31, 2024 Vol. 6, No. 31 I get palpitations with every pyogenic granuloma (PG) I encounter. Even though the clinical diagnosis is instant, my personal Jiminy Cricket dermatologist reminds me not to miss an amelanotic melanoma, squamous cell carcinoma, or cutaneous metastasis. If

The Venetian antithesis: Treating median canaliform nail dystrophy

By Warren R. Heymann, MD, FAAD Oct. 4, 2023 Vol. 5, No. 40 Tony Bennett may have left his heart in San Francisco, but mine remains in Venice. ... (The editorial staff of DWI&I offer our sincerest condolences to the families of those who perished, and our prayers for recovery

Dermatologic ergonomics: Straighten up and fly right

By Warren R. Heymann, MD, FAAD June 28, 2023 Vol. 5, No. 26 My posture has never been proper, having a proclivity to slouch. "Stand up straight, son!" my father would admonish. When I was young and supple, I would half-listen to the advice, usually reverting to my standard (incorrect)

Tag, you’re it!

By Warren R. Heymann, MD, FAAD Sept. 28, 2022 Vol. 4, No. 39 Chances are you will see a patient with skin tags today. ... Patients will likely ask you two questions: Why do I get them? What do you mean my insurance won’t cover their removal (for asymptomatic lesions)?

Nonepidemic Kaposi sarcoma: The fifth dimension

By Warren R. Heymann, MD Oct. 16, 2019 Vol. 1, No. 32 ... For more than a century, since first described in 1872 by Moritz Kaposi* as "idiopathic multiple pigmented sarcoma," dermatologists focused on classical Kaposi sarcoma (KS) — violaceous patches, plaques, and tumors on the lower extremities of

The vexing verruciform xanthoma

By Warren R. Heymann, MD, FAAD February 23, 2022 Vol. 4, No. 8 Verruciform xanthomas (VX) were first described 50 years ago, and they are still a source of debate. Only the most astute dermatologists will make the diagnosis clinically, with the possible exception of recognizing such lesions in patients

Directions in Residency archive

Download PDF versions of each issue ... 2024 Summer Feature: What residents need to know about pregnancy dermatoses by Raina Bembry, MD, and Tejesh Patel, MD, FAAD ... Race for the Case: Summer 2024 by Jessica Forbes-Kaprive, DO ... Boards Fodder: Dermoscopic structures and their histopathological and clinical correlations (PDF)

Watch your back!

Focusing on ergonomics can help dermatologists avoid a career-ending injury. ... Feature ... By Ruth Carol, contributing writer, February 1, 2021 After a long day of seeing patients, performing dermatologic procedures, or reviewing slides, do you have stiffness in your neck, pain in your back, or maybe an aching in

Coding lessons learned in 2022 — update on all of the common coding FAQs

Derm Coding Consult ... By Faith C. M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, Manager, Lead Coding and Reimbursement Strategist, January 1, 2023 Academy coding staff address important coding topics each month in DermWorld ... Coding Consult. Read more Derm Coding Consult articles . 2022 has come to a close

Warts and all

Remedies for warts abound, but high-quality studies are lacking. ... Feature ... By Jan Bowers, contributing writer, March 1, 2021 Warts, one of the most common skin disorders worldwide, can be easy to treat or maddeningly difficult. Although warts can resolve spontaneously, others readily respond to over-the-counter treatments such as

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