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Allergic disease may protect against pancreatic cancer
People with hay fever or other allergies are less likely to die from pancreatic cancer, according to a study in the International Journal of Cancer. Scientists at Mt. Sinai Hospital, Toronto, Ontario, Canada, looked at the Ontario Cancer Registry, a population-based, case-control study in Ontario, examining the association between asthma or allergy history and pancreas cancer risk. The researchers identified 276 pancreatic cancer cases and recruited 378 control subjects. A history of allergies or hay fever was associated with a 57-percent lower risk of pancreatic cancer. Risk reduction was higher among men than women. The researchers found no association between asthma history and pancreatic cancer risk.  

CDC: Postpone Hib booster, due to recall shortage
Due to a Dec. 13 recall of 1.2 million vaccine doses against Haemophilus influenzae (Hib) by Merck and a resulting shortage of the vaccine, the U.S. Centers for Disease Control and Prevention recently recommended delaying the standard type B (Hib) vaccine booster, usually given at 12 to 15 months old, with some exceptions. The recall of PedvaxHIB and Comvax (Hib/hepatitis B) was the result of potential contamination during manufacturing. The CDC is asking physicians to keep track of patients who did not get the booster so parents can be notified when the shortage is over. 

Strategies reduce return hospital visits for asthma
Among strategies used in emergency departments to reduce return visit rates for children with asthma, preprinted order sheets coupled with access to a pediatrician were the most effective, according to a study in Pediatrics. Researchers at the Institute for Clinical Evaluative Sciences, Ontario, Canada, used a population-based cohort study that incorporated both comprehensive administrative health and survey data from all 152 emergency departments in Ontario, Canada. They looked at all 2- to 17-year-old children who visited an emergency department for asthma from April 2003 to March 2005. The authors noted that asthma management strategies were distributed across all hospital types, but small community hospitals in general had lower adoption rates than large community or academic hospitals. Employing both the availability of a pediatrician for consultation and the use of a standard, preprinted order sheet was associated with a 36-percent reduction in return-visit rates. 

A message from ACAAI President Dr. Jay M. Portnoy

The tyranny of CPT codes
This morning as I rolled out of bed, my wife reminded me to 94132 (placement of dirty clothes into laundry hamper, 1-3 items, moderately worn). I, of course, did that, but not before I 86612’d (replace toilet seat in lowered position after voiding in a standing position) and 71128’d (brush teeth, manual brush, top and bottom teeth) with a modifier (Crest with fluoride and special whiteners). I did not 71129 (floss between teeth, upper and lower teeth) because that is not covered by my oral hygiene plan. I would have performed a 98215 (comb hair, straight comb) but was not permitted to do that because I have 704.01 (male pattern baldness). I used to have a mustache, but now I don’t because 73245 (shave face, incl mustache) has now been authorized.

Sound absurd? Of course it does. But what if our daily lives were regulated by CPT codes the same way as is our ability to provide medical care?

It seems to me that we providers and our patients have become hostages to the tyranny of CPT codes. If you think about it, we are required to document items in the medical record that are often not relevant to patient care simply to justify a level 3 or level 4 visit. We are told how to document skin tests with a separate interpretation because the CPT description requires that we do so, whether patient care is improved or not. Since miscoding, whether intentional or not, can be construed as fraud by our government, many of us have turned to professional coders to protect us from liability. My suspicion is that the extra documentation fills our medical records with so much extraneous information that useful information gets lost, leading to reduced quality of care.

So how did we get into this situation? Current Procedural Terminology (CPT®) is a registered trademark of the American Medical Association. CPT codes are required to report medical services and procedures and are part of the process in determining how physicians get paid. They were first developed and published in 1966, and since then, they have become the preferred system for describing health care services and procedures. Medicare pays physicians according to a schedule that multiplies relative values for work and practice expenses—the Resource Based Relative Value Scale (RBRVS)—by a monetary conversion factor. Payments are then made on a per-visit or per-procedure basis as defined by the CPT codes. Most private payers take their cue from Medicare, but apply their own conversion factors.

Relative values are assigned to new CPT codes and to re-evaluated existing codes by the 27-member Relative Value Update Committee (RUC), which was formed in 1990 to make recommendations about the value of physician services to the Centers for Medicare and Medicaid Services (CMS). For the last 15 years, the RUC has been responsible for valuing all new procedures and determining what physicians get paid. Input by representatives from the Joint Council of Allergy, Asthma and Immunology (JCAAI) has been critical for our ability to get adequate reimbursement for many key allergy/immunology procedures.

Of course, it is helpful to have a consistent system for describing what we physicians do for payment purposes. If I simply stated “office visit” and charged whatever I wanted, the healthcare system would become extremely difficult to administer. In the old days, when patients paid their doctors directly (yes, that used to happen), fees were posted on the wall behind the registration counter and patients could decide whether they wanted to see that doctor or not. In other words, the marketplace regulated prices for medical care. Now that health plans are involved, it is impossible to determine what the actual fees are since they usually are discounted and are determined by the specific patient policy. Much like airline fees, each person who sees a particular doctor might pay a different fee for the same service.

Since a CPT code is required for payment, providers cannot bill for procedures that do not have such a code, though they may be required to perform that service anyway if it is the standard of care. Patient-initiated telephone calls are a prime example of this, though recent changes in CPT codes have addressed this issue. Sublingual immunotherapy (SLIT) is another example. The JCAAI is working with our ENT colleagues to develop appropriate codes for this procedure. A CPT code for environmental assessment hasn’t even been discussed, though it is questionable whether that could even be considered to be a medical procedure.

The bottom line is that our professional lives are regulated by CPT codes. We can either accept the status quo and comply with whatever changes are imposed on us by our non-allergy colleagues on the CPT committee or the RUC, or we can be proactive and influence the development of these codes and how they are valued. I personally have committed to stay involved so that my patients can continue to receive high-quality allergy care. We all can do this by staying involved with our professional allergy organizations at the local, state and national levels, including supporting the JCAAI. In addition, we each need to join the AMA and let our voices be heard. I believe that this would be a 99168 (membership in professional society, allergy or other unspecified).

CPT codes used in the column are fictitious. Resemblance to any real CPT codes is purely coincidental.

Apply for ACAAI CME joint sponsorship for your 2008 meeting
The College’s CME Web site launched last year has streamlined the Joint Sponsorship application process. Local, State and Regional (LSR) societies are able to go on line at any time during the application process and see the status of their applications.

No need to fax, e-mail call or mail materials. It eliminates postage, overnight package expenses and massive paper files. Easily check submissions from your speakers.

All program materials are uploaded or entered directly on the secure Web site. Speakers need to enter or update their disclosure form only once a year rather than completing a disclosure form each time they do a presentation for ACAAI.

The Web site has streamlined the CME Committee review process and helps with time constraints to resolve any conflict of interest (COI) issues. Improved communication between the CME Committee, ACAAI staff and the LSR also is another benefit of the online application process.

If you are planning a 2008 CME program – and require ACAAI Joint Sponsorship—please visit the CME Web site before you start to plan your meeting:

• Go to http://cme.acaai.org/CME
• Open the link to Joint Sponsorship Application
• Complete the Joint Sponsorship Application Request Form

Contact Mary Campbell at marycampbell@acaai.org if you have any questions.


Special thanks to our corporate sponsors
The College appreciates the many contributions from the following corporate sponsors:

Alcon Laboratories, Inc.
ALTANA Pharma US, Inc., a Nycomed Company
AstraZeneca LP
The Clorox Company
Dey, LP
Genentech, Inc. and Novartis Pharmaceuticals Corporation
GlaxoSmithKline
Greer Laboratories, Inc.
HollisterStier Laboratories LLC
Inspire Pharmaceuticals, Inc.
Lev Pharmaceuticals, Inc.
Lincoln Diagnostics
MedPointe/MEDA
Merck & Co., Inc.
Modulemd, Inc.
Novartis Pharmaceuticals Corporation
Olympus America, Inc.
Pfizer, Inc.
sanofi-aventis
Schering-Plough Corporation
Sepracor, Inc.
Teva Specialty Pharmaceuticals
UCB
Verus Pharmaceuticals

Board Review Corner
Jennifer W. Mbuthia, Senior and Junior Representatives of ACAAI’s fellows-in-training (FITs) to the Board of Regents. The Board Review Corner is an opportunity to help hone your Board preparedness.

To refer to a previous Board Review Corner, click the "FIT Archive" link in the left column.

Review Questions: Chapter 17 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al. Review questions were written by Drs. Bret R. Haymore and Jennifer W. Mbuthia, Walter Reed Army Medical Center.

Copyright © 2008 American College of Allergy, Asthma & Immunology. All rights reserved.
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Do you have news, responses or opinions to share with us? Please e-mail the association office at enews@acaai.org