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RSL Matters
Emergency Epinephrine in Schools-A Continuum & Opportunity
As state after state passes laws for unassigned epinephrine in schools, there remains need and opportunity. In Texas, the legislative session, convening every other year, is about to begin. The Texas Allergy, Asthma & Immunology Society has been proactive and organized strong pre-session support with the Texas Medical Association's legislative staff and a State Senator has filed the bill. Legislative attention has increased after the death of a middle school student last year following fire ant-induced anaphylaxis during a football game.
Too often laws passed are slow to implement or not mandatory leaving an opportunity for RSLs to work locally to educate school personnel. In this regard, a plan is in development. Stay tuned!
Local Advocacy Leads to Delay in Compounding Legislation
About a year ago A/I physicians in Maryland became aware of a pending law that could impact their ability to compound allergy extracts in their offices. Over the past several months, Maryland A/I physicians working in collaboration with the Maryland State Medical Society, their lobbyist and other physicians who compound medications in their offices, have been able to delay the implementation of this compounding legislation while they work on a legislative fix. There is an expectation of further action on this issue yet this month. The compounding issue in Maryland highlights the importance of local A/I physicians, in all states, being vigilant in monitoring ongoing legislative and regulatory issues that can impact their ability to deliver care. Furthermore, this effort highlights the importance of developing collaborative relationships with one's
state medical society and other specialty societies for the benefit of patient care.
RSL Assembly Forum Adopts Roundtable Discussion Format
Allergy/immunology thought leaders will speak out on issues impacting their practices at the AAAAI RSL Assembly Forum and Business Meeting during the 2015 AAAAI Annual Meeting on Friday, February 20 from 4:45 pm to 6:30 pm. This year's forum will be unique. Gone is the typical lecture/didactic education. Instead, RSL leaders look forward to engaging participants in a roundtable discussion on issues affecting the practice of allergy.
ICD-10 Codes for Urticaria and a New Code for FPIES
Readying your practice for the transition to ICD-10? The ICD-10 codes for urticaria are classified similarly to ICD-9 codes for urticaria. So the transition to ICD-10 is simply to use the new ICD-10 codes - no need to learn new classifications of urticaria.
K52.21 is a new, approved ICD-10 code for Food Protein-Induced Enterocolitis Syndrome (FPIES). FPIES is a non-IgE gastrointestinal food hypersensitivity that manifests as delayed, profuse vomiting, often with diarrhea, acute dehydration, and lethargy. The most common triggers are milk and soy, but any food, even those thought to be hypoallergenic (e.g., rice and oat), can cause an FPIES reaction.
According to the International FPIES Association, hundreds of patients suffer from FPIES, a rare non-IgE form of food allergy. The new code K52.21 will take effect when ICD-10 implementation is completed in 2015.
The Office of Practice Management is your source for coding expertise. Send your day-to-day coding questions to us at coding@aaaai.org. Teresa Thompson, CPC, CMSCS, your AAAAI coding consultant, and your coding staff will answer your questions as quickly as possible. The AAAAI website also has a multitude of coding resources for your practice. Bookmark this page and visit it often.
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Practice Changers
We have partnered with the editors of JACI: In Practice to bring you monthly "Practice Changers" from recently published journal articles.
Highlighting cutting-edge information keeps you current and assists you in educating patients and physicians who rely on the expertise of our specialty!
Outcomes of Allergy/Immunology Follow-Up After an Emergency Department Evaluation for Anaphylaxis. By Ronna L. Campbell et al.
A study of outcomes of allergy/immunology follow-up among 201 patients seen in the emergency department (ED) for anaphylaxis demonstrated that 35% of patients had an alteration in the diagnosis of anaphylaxis or trigger after allergy/immunology evaluation. In addition, two percent of patients were diagnosed with a mast cell activation disorder, and 6% underwent immunotherapy or desensitization. These results underscore the importance of allergy/immunology follow-up after an ED visit for anaphylaxis. These data also provide ED physicians with an important rationale to present to patients for encouraging additional allergy/immunology evaluation. They also provide a strong rationale for the development of multidisciplinary collaborative efforts between allergists and emergency physicians to alleviate barriers to allergy/immunology follow-up after an ED visit.
Early Epinephrine Means Less Hospitalizations for Kids with Food Allergies. By Jude T. Fleming et al.
Fleming and colleagues investigated the impact of early treatment with epinephrine for food-induced anaphylaxis (FIA). Over a 6-year period, they reviewed 384 visits to a pediatric emergency department (ED) for FIA. Approximately two-thirds of patients received epinephrine before ED arrival, while one-third first received epinephrine in the ED. Patients given epinephrine before ED arrival required less treatments overall and were less likely to be hospitalized. This study supports the prompt use of epinephrine for FIA. Owning an epinephrine auto-injector increased the likelihood of early treatment, which suggests that improved access to epinephrine may help to lower FIA hospitalizations in children.
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Advocacy Matters
NIH Now Accepting Applications for Research on Eosinophilic Diseases
The National Institutes of Health (NIH) recently published a Program Announcement for Research on Eosinophil Associated Disorders. This is the culmination of a 3-year AAAAI effort that helped lead to the appointment and report of the NIH Taskforce on the Research Needs of Eosinophil-Associated Diseases (TREAD), an award that allowed the formation of the Consortium of Eosinophilic Gastrointestinal Disease Researchers, and this Program Announcement. The specialty has come a long way from little or no NIH-funded research in 2010 to this multi-Institute Program Announcement to encourage research applications on eosinophilic disorders.
AAAAI Supports Breath of Fresh Air Act
During the opening week of Congress, Rep. Sheila Jackson Lee (D-Texas) reintroduced the Breath of Fresh Air Act, H.R. 72. This legislation, which was previously introduced by Rep. Jackson Lee during the last Congress, would establish a grant program for the purchase of nebulizers in elementary and secondary schools. The AAAAI had previously identified this bill as a high priority and with the news that it has been reintroduced, the AAAAI has submitted an official letter of support.
Practice & Policy Matters
Reminder: Submit Comments on Environmental Assessment and Exposure Control of Fungi Practice Parameter by January 23
You are invited to consider and comment on an important document that is currently out for review. The Joint Task Force on Practice Parameters is accepting comments on the draft of a new practice parameter titled "Environmental Assessment and Exposure Control of Fungi: A Practice Parameter."
Do You Have a New Year's Resolution to Get an EHR or Upgrade Your Existing EHR?
When upgrading or purchasing your Certified EHR system, tell your vendor you expect to be able to upload data to the AAAAI Quality Clinical Data Registry (AAAAI QCDR). For more information on connecting your EHR to the AAAAI QCDR, contact the registry directly at cjackson@cecity.com or qcdr@aaaai.org.
Have You Used the Practice Management Resource Guide or Attended a Practice Management Workshop?
The AAAAI Practice Management Committee has been very active this past year. Accomplishments have included publishing the fifth edition of the Practice Management Resource Guide, hosting the ninth Annual Practice Management Workshop in Atlanta and presenting a webinar on ICD-10.
Act Now to Avoid the 2014 PQRS Payment Adjustment
The 2014 Physician Quality Reporting System (PQRS) reporting year is quickly coming to an end but there is still time to report quality measures data through the PQRSwizard by the February 26, 2015, at 5:00 pm ET submission deadline. Individual providers and group practices can use PQRSwizard, a CMS-approved registry, to avoid both the automatic 2% penalty on Medicare payments for non-participation and the additional 2% penalty through the Value-Based Payment Modifier (applied to groups of 10 or more providers in 2014). Use PQRSwizard to collect, validate and report PQRS measures to CMS. In 2015, CMS will require reporting on a minimum of 9 measures which can be done through registries such as PQRSwizard or the AAAAI QCDR. Stay ahead of your reporting in 2015 by planning today.
How to Bill As-Yet Uncoded Drug for IVIG Patients
When a new drug is introduced and does not have a code, and payers do not yet have coverage policies, physician practices struggle with how to get treatment with new formulations paid. A sample letter has been posted that documents a claim for HyQvia, a new product for use in some immunodeficiency patients that bills in different units than other options. Teresa Thompson, AAAAI's coding consultant, adds that it might be useful in such a letter to provide price information for the drug.
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