David C. Brodner, M.D.

New urgent update from Medicare Codes G0463 and G2211 G0463 Represents hospital outpatient clinic visits for the assessment and management of patients. • Modifiers: • PO: For excepted off-campus provider-based departments. • PN: For non-excepted off-campus provider-based departments. • Usage Examples: • GI Clinic: Follow-up on GERD management. • Orthopedics: Evaluation of knee pain and treatment planning. • Podiatry: Diabetic foot ulcer care with procedures like debridement. • Vascular Surgery: Comprehensive vascular assessment for leg ulcers. Important Notes: G0463 is specific to hospital outpatient settings and does not apply to regular office E/M codes like 99202-99205 or 99211-99215. G2211 Designed for outpatient office visits to reflect visit complexity. No changes in its usage for outpatient settings. Cannot be paired with G0463. G2211 is intended for office visits only, while G0463 is strictly for hospital outpatient visits with the required PO/PN modifiers. #CMSGuidelines #HealthcareUpdates #MedicareBilling #BillingAccuracy #HealthcareProfessionals #RevenueCycleManagement #HealthAdmin #MedicalEducation #OutpatientCare

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Learn about the efficacy of dental appliances and at-home sleep studies in addressing sleep apnea for averting potential cardiovascular complications. #Sleepapnea #Cardiovascular #Hearthealth #Cardiology #Heartdisease #DrDavis #Cardiologist #Fortlauderdale

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Learn about the efficacy of dental appliances and at-home sleep studies in addressing sleep apnea for averting potential cardiovascular complications. #SleepApnea #Cardiovascular #HeartHealth #Cardiology #HeartDisease #DrDavis #Cardiologist #FortLauderdale

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Decentralized Investigator Oversight, Or Over with the Investigator Decentralized clinical studies are the latest cause celebre. While I appreciate the rationale, I do not see how “Investigators” can possibly fulfill their obligations. Investigator oversight transforms from mantra to nightmare. Delegation to parties with whom the investigator has no contractual relationship raises a number of concerns. As an investigator, I do not have an agreement with whomever is shipping/dispensing medication to the patient. As an investigator, I do not have an agreement with the agency contracted to take histories, vitals, and perform physical examinations. I suggest everyone read 2.3.2 of ICH ED(R3). The investigator is responsible for the competence, training, and skills of those assigned trial activities “including the activities conducted by staff provided by other parties, for example, home nurses arranged by the sponsor.” Oversight? Good luck. Oversight is increasingly defined by the performance of silly and often irrelevant tasks. Ask why the PI has to separately sign and date every entry on the delegation log. “To demonstrate oversight,” is the common response. Of course it does not, but whatever. With decentralized studies, PIs will have to receive, acknowledge, and record text messages every 30 seconds to make sure they are engaged and know everything that is happening over the decentralized site. There are a dozen or more issues surrounding the role of PIs in decentralized studies. For some studies, vaccine studies specifically, decentralized studies make sense. For everything else, decentralized studies make no sense. #DCT #clinicaltrial #clinicalresearch #clinicalstudy #drugdevelopment

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• Coronary plaque presence increased with LDL-C and clinical risk, even in the absence of CAC. • There is considerable atherosclerosis in statin-naïve participants with low LDL-C and clinical risk. • About 2 in 5 statin-naïve participants with severe hypercholesterolemia did not have any plaque on CCTA imaging. Heterogeneity exists in subclinical atherosclerosis across LDL-C, CAC, and estimated cardiovascular risk levels. The value of CCTA in risk-stratifying asymptomatic adults should be further explored.

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Aortic Dissections occur when the inner layer of the aorta tears allowing blood to flow between the layers of the aortic wall. The aorta is made up of three layers, the intima, media, and adventitia. The tear is usually in the intima, but I'm not here to give an A&P lesson, and a cardiothoracic surgeon would be able to tell you more. The peak age of dissections is between 50 and 70 years old. They happen more commonly in males. Etiology includes: - Hypertension [about 75% of cases] - Genetics [Marfan's. Turner's syndrome, a Bicuspid aortic valve, Loey's-Dietz, and Ehlers Danlos] - Iatrogenic [caused by catheters, balloon pumps, etc.] - Trauma - Atherosclerosis - Pregnancy - Cocaine abuse - Heavy Weightlifting 65% of dissections occur in the ascending aorta, 10% happen in the aortic arch, and 20% happen in the descending aorta. There are two different ways to classify a dissection, Debakey and Stanford. I'm more familiar with the Stanford method. Debakey classifies them as: Type 1 - originating in the ascending aorta and extends to at least the aortic arch Type 2- involves only the ascending aorta Type 3 - begins in the descending aorta, and usually just distal to the left subclavian artery Stanford classifies them as: Type A - anything that involves the ascending aorta, can include the descending Type B- does not include the ascending aorta If the ascending aorta is involved, it's usually a surgical case, but again, that's up to a surgeon. Symptoms include: - jaw pain - neck pain - abdominal pain - fainting/dizziness - difficulty breathing Diagnosing includes: - EKG - Chest Xray - Echo/TEE - CT/MRI - Angiography Treatment includes: - Blood pressure control, ALWAYS - Beta blockers with HR goal of 60-70 and SBP of 100 mmHg[ish] - Surgical repair [especially with Type A] - Medical management [for Type B] - Possible stenting Here for any and all legal nurse consulting needs! [email protected]

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Paravalvular leak (PVL) is less common overall but occurs more frequently after TAVR than surgical valve replacement. Predictive tools like DASI simulation are helping us better anticipate and address this challenge, improving patient outcomes. #TAVR #Innovation DASI Simulations Lakshmi Dasi Teri Sirset

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After a long lull we are starting to see some new data on the demographics and prevalence of #DryEye disease in the U.S. Here is the latest: https://lnkd.in/e9k_TXDs

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THE MALIGNANT HYPERTHERMIA HOTLINE DEALS WITH UNUSUAL SITUATIONS One of the most remarkable and notable programs of MHAUS is the hotline. Any professional needing immediate assistance related to MH or suspected MH may call the hotline and be placed in contact within minutes with a volunteer , board certified anesthesiologist with expertise in dealing with the syndrome. Established in 1982, the hotline has handled over 20,000 calls since that time, over 700 calls per year. Occasionally, one of the consultants needs to reach out to others for assistance . In the past week or so , two such situations occurred. In one, the grandson of an MH susceptible (whom I diagnosed by contracture testing in about 1980) experienced signs of MH even though a trigger agent had not been used. Although the hotline was contacted the patient developed problems in the early post operative period and the parents were told that the physicians were not sure what was happening and what to do even though dantrolene was given. Because the family knew me, they asked for advice. I posted the information to the hotline consultants for comment. Several did and provided important advice on how to overcome the difficulties the patient was experiencing. After a short time, the situation improved and the patient is on the way to return to his preoperative condition. I cannot say for sure that the patient developed MH because all the data were not provided and that will have to looked into in the future. This situation was highly unusual since the hotline consultation is usually through the patient’s provider, not the patient or his family. I asked our hotline consultants for comment since I am no longer a consultant since I retired from practice. The energy and commitment of the consultants is extraordinary, but barely recognized by the anesthesiology societies.       The second case will be posted next, since I have exceeded space limits.    These cases demonstrate how the MH hotline of MHAUS is a resource for practitioners dealing with the complexities of MH. They also point out that although success in treating MH is usually high, there is still much to be learned. MHAUS and the dedication of the Board and the physician consultants make a difference in dealing with problems of MH on a daily basis There is a cost to management of the hotline and we have learned a lot about the disorder through the hotline. Support of the hotline and other programs derives from a variety of donations from patients, practitioners, advertisements on the MHAUS web site(mhaus.org) and written communications and membership fees, with minimal support from organizations (even anesthesia related organizations) representing physicians and nurses .     This is a small part of what MHAUS does. Working with and interacting with these many , dedicated individuals has been one of the most rewarding and satisfying aspects of my career.

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🚨 Do you have an Emergency Exit Strategy? A Letter of Instruction is one key element of that plan. Click below to download your free Letter of Instruction Template. 🚨 #practicetransitions #dentaltransitions #dentalpracticeforsale #dentalbroker #dentalpracticesforsalesandiego #sandiegodentist #henryschein #henryscheindentalpracticetransitions #letterofinstruction #emergencyexitplan

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Please check out this amazing podcast on Motivation Myths!

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Please join the American Cancer Society for the webinar "What do Patients Need and Want to Know Before Lung Cancer Surgery and/or Radiation Treatment?" Date/Time: May 30th 10am - 11am ET Details: Moderator Douglas Wood, MD; Thomas Varghese, MD, MS, MBA; Drew Moghanaki, MD, MPH; and Terri Ann DiJulio will present in an engaging session that brings together surgeons, radiation oncologists, and patients in a discussion around early-stage lung cancer treatment. First, they will highlight what patients should know in choosing between local therapies, and what they should know in preparing for surgery or radiation and the recovery and consequences of therapy. This will then be augmented by the patient voice of what patients want to know to help physicians be better attuned to the issues that are most important to patients as they consider and undergo therapy for early stage lung cancer. Register here: https://lnkd.in/eVwrAJFt Recordings of the first two webinars in the series can be found here: https://lnkd.in/eSUpKnN2 or on the website, nlcrt.org.

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We are pleased to announce the Supraglottic Airway for Resuscitation (SUGAR) trial was approved for $7 million in research funding by the Patient-Centered Outcomes Research Institute (PCORI). SUGAR is the first multicenter trial to be conducted through the American Academy of Pediatrics Delivery Room Intervention and Evaluation (DRIVE) Network. The trial will be coordinated at Children's Hospital of Philadelphia by Principal Investigator Dr. Elizabeth Foglia. SUGAR is a pragmatic hybrid effectiveness-implementation cluster randomized trial comparing two multicomponent implementation strategies to promote early supraglottic airway use for newborns ≥34 weeks’ gestation who require resuscitation after birth. The trial will also investigate whether increased supraglottic airway use improves patient-centered outcomes for newborns who receive resuscitation. Twenty-eight hospitals that have joined the DRIVE Network will participate in the study to address this evidence to practice gap to improve use of supraglottic airway in clinical settings and to evaluate how and why each implementation strategy worked.  To learn more about the trial, click here: https://lnkd.in/gmpWvr2J The DRIVE Network continues to grow. We currently have over 32 hospitals involved, representing 15 states, that are collecting core data about neonatal resuscitation practices. We are learning a lot about how the recommendations from the American Heart Association/American Academy of Pediatrics guidelines and the Neonatal Resuscitation Program® curriculum are being implemented, with the ultimate goal of improving the quality of care in the delivery room. If you are a U.S. based institution and want to find out more, write to [email protected] #PCORIFunding #HealthResearch #NeonatalResuscitation #SupraglotticAirway

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https://lnkd.in/dnERrF6a "For the first time, corporations own more physician practices than health systems or hospitals, according to an analysis from not-for-profit advocacy group the Physician Advocacy Institute (PAI)."

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Burnout is a condition that many neurosurgeons hesitate to acknowledge due to various factors, including their sense of duty to patients, fear of not meeting the high standards of their profession, and the associated stigma. In an era where employers prioritize productivity and the culture of the medical profession is evolving, recognizing burnout and addressing mental health concerns is critical for both healthcare practitioners and organizational frameworks. Ensuring work satisfaction is a key factor in employee retention. This newly published article, led by Professor Anthony Avellino and the American Society for Pediatric Neurosurgery, that I was honored to be part of, marks the beginning of an important conversation where every voice should be heard, supported, and valued. One way each of us can help is by fostering an environment of openness and empathy, encouraging colleagues to speak up about their struggles, and offering a listening ear without judgment. Sometimes, simply showing support and understanding can be the first step toward saving someone who may be silently suffering. #ASPN #wellness #Advocacy #Burnout #mentalhealth #neurosurgery #pediatricneurosurgery #healthcare #highreliableorganization #worksatisfaction #organizationalgoals

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Have questions about how to use PROMIS in clinical care or research? Can’t miss this opportunity to learn more about PROMIS from the experts and get your questions answered!

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#SGLT2i prescriptions for #HF are increasing, but still less than 1 in 4 receive this live saving therapy. We have to do better. Rapid #GDMT initiation and optimization includes SGLT2i across the LVEF spectrum.

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