New Patient

March 25, 2001

Hey! (I used to live down south, too, and know this is the preferred version

of " hi " !)

I don't know any surgeons in the Austin area with qualifications in

performing myotomy, but I wanted to chime in on the part of your message

concerning length of time you could " safely " postpone surgery. While I

wouldn't delay because, really, what's the point if you're only going to

have the surgery anyhow, waiting six months probably won't make much

difference. You've only been recently diagnosed, a point which is in your

favor since, presumably, there hasn't been as much stress and damage done to

your esophagus and LES muscle as is the case with folks who have suffered

for years. The more trauma we put those body parts through, the weaker they

are and the more distorted they can become.

Good luck and take care -

Carol

New Patient

> Hi,

>

> My name is Murali and have been diagnosed with Achalasia very recently

> (Just last week). A year back, I started having heartburn, I started

> taking Zantac and then, slowly, it got worse. Meaning I had excessive

> belching, started having diffficulty swallowing. My

> Gastroenterologist did an endoscopy ( in mid-february) and suspected

> Achalasia right away, because of the fact that he had to force the

> tube through my LES. It was very tight. He dilated it to 20mm. He

> also put me on ISODRIL, a vasodilator(given to heart patients, to

> dilate blood vessels), so that I can eat properly and regularly. It

> works wonders. Then, he asked me to go for a barium swallow and a

> manometry test. Manometry Test proved that I am a Classic example for

> Achalasia. My Gastroenterologist has asked me to see a surgeon and

> discuss/schedule myotomy(laproscopic one). My question to y'all:

> Please recommend me some good surgeons in Austin, Texas who can do

> this surgery. The surgeon I have been referred to is Dr. Fass.

> Also, how long can I postpone (say 6 months) my surgery. Any help I

> can get from y'all is greatly appreciated.

>

> Thank You very much.

>

April 4, 2001

Howdy,

Thanks for the information and support. Did you also have a

myotomy, if yes when and how are you feeling now. Do let me know.

Bye,

Murali

> Hey! (I used to live down south, too, and know this is the

preferred version

> of " hi " !)

> I don't know any surgeons in the Austin area with qualifications in

> performing myotomy, but I wanted to chime in on the part of your

message

> concerning length of time you could " safely " postpone surgery.

While I

> wouldn't delay because, really, what's the point if you're only

going to

> have the surgery anyhow, waiting six months probably won't make

much

> difference. You've only been recently diagnosed, a point which is

in your

> favor since, presumably, there hasn't been as much stress and

damage done to

> your esophagus and LES muscle as is the case with folks who have

suffered

> for years. The more trauma we put those body parts through, the

weaker they

> are and the more distorted they can become.

>

> Good luck and take care -

> Carol

>

> New Patient

>

> > Hi,

> >

> > My name is Murali and have been diagnosed with Achalasia very

recently

> > (Just last week). A year back, I started having heartburn, I

started

> > taking Zantac and then, slowly, it got worse. Meaning I had

excessive

> > belching, started having diffficulty swallowing. My

> > Gastroenterologist did an endoscopy ( in mid-february) and

suspected

> > Achalasia right away, because of the fact that he had to force the

> > tube through my LES. It was very tight. He dilated it to

20mm. He

> > also put me on ISODRIL, a vasodilator(given to heart patients, to

> > dilate blood vessels), so that I can eat properly and regularly.

It

> > works wonders. Then, he asked me to go for a barium swallow and a

> > manometry test. Manometry Test proved that I am a Classic

example for

> > Achalasia. My Gastroenterologist has asked me to see a surgeon

and

> > discuss/schedule myotomy(laproscopic one). My question to y'all:

> > Please recommend me some good surgeons in Austin, Texas who can do

> > this surgery. The surgeon I have been referred to is Dr.

Fass.

> > Also, how long can I postpone (say 6 months) my surgery. Any

help I

> > can get from y'all is greatly appreciated.

> >

> > Thank You very much.

> >

March 4, 2006

CPT defines a new patient as someone you have not seen before, or someone you have not seen within the last three years. The premise is that you should have recent history and past medical history available.

Also understand that your threshold for a higher level of service with an establish patient procedure code is easier to reach since you are only required to meet two of the three main parameters. Thus a detailed established patient evaluation could be submitted with 99214. The same exam, history, clinical decision making would be consistent with 99203 as a new patient. The Relative Value Units between the two are close (2.56 vs 2.18).

Tom Freedland

March 4, 2006

leary353@... wrote:

> docs;

> I know this has been dealt with before, but, when an existing patient is

involved in a new MVA, the mechanism of injury is different, new body parts

involved and new exam necessary, shouldn't we be billing for a new patient exam?

got one kicked back denied because they were an existing patient.

>

> any thoughts,

> Don Leary, Dc

> West Salem

>

IMHO, most certainly YES.....New injury requires new exam....It is

necessary to determine whether the old treatment plan or diagnosis were

adequate for the new post-injury status. I think the denial is bogus.

Document your findings, list what is new and different, and what

treatment arises from the new injury. Keep notes that reflect which

care/diagnosis is related to which condition. With the proper

documentation and the proper attorney, you will help your patient's

legal case too, as he is entitled to certain standard of care, including

diagnostic exams.

Good luck. Keep us posted.

J. Pedersen DC

>

March 4, 2006

Hi Don,

It would be my opinion that since this is an established patient you are

performing a " new exam " new area, due to a new injury, nonetheless they are

an established patient in your clinic. Consequently you would need to use

one of the established patient exam codes.

Vern Saboe, DC

Albany

new patient

> docs;

> I know this has been dealt with before, but, when an existing patient is

involved in a new MVA, the mechanism of injury is different, new body parts

involved and new exam necessary, shouldn't we be billing for a new patient

exam? got one kicked back denied because they were an existing patient.

>

> any thoughts,

> Don Leary, Dc

> West Salem

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve

members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

However, it is against the rules of the listserve to copy, print, forward,

or otherwise distribute correspondence written by another member without his

or her consent, unless all personal identifiers have been removed.

>

March 4, 2006

Don,

I agree with Tom and Vern. You've seen the pt. before but it requires a new exam so it''s an established pt. exam. To be accurate and to work in the best interest of truth and your patients, you need to keep your treatments separate and keep your records carefully separated. (Within reason.)

In the future when you reexamine the pt. you need to do two separate exams for the different injuries. It would be reasonable to downcode to a lower level exam for each but unreasonable to pretend they were not more complicated than examining the whole patient. You must anticipate being asked to demarcate all sorts of weird conclusions such as the affect of one injury on the recovery of the other. For that hassle, you get to separate your work and get paid for it.

To further the argument, if there were 2 separate insurers, it would be dishonest to make one of them pay for care for the other's covered injuries.

On the other hand, some things overlap. (A hospital stay for 2 conditions would necessarily be 1/2 the cost of 2 consecutive stays.)

I have had reasonable adjusters agree to share the cost of certain services. It is reasonable and defensible. If either case went to trial, the judge would probably instruct the attorneys to avoid discussing why some things were charged differently.

Important to add that if your name is Leary, then it once was O'leary and if so you already know that something that is Irish and sits out in the rain is termed...

Patio Furniture!

(Top of the evenin’ to ya!)

( E. Abrahamson, D.C.)

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

> From: " leary353@... " <leary353@...>

> Date: Sat, 4 Mar 2006 21:42:12 GMT

> < >

> Subject: new patient

>

> docs;

> I know this has been dealt with before, but, when an existing patient is

> involved in a new MVA, the mechanism of injury is different, new body parts

> involved and new exam necessary, shouldn't we be billing for a new patient

> exam? got one kicked back denied because they were an existing patient.

>

> any thoughts,

> Don Leary, Dc

> West Salem

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is to foster

> communication and collegiality. No personal attacks on listserve members will

> be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere. However, it

> is against the rules of the listserve to copy, print, forward, or otherwise

> distribute correspondence written by another member without his or her

> consent, unless all personal identifiers have been removed.

>

March 4, 2006

Hi Don,

We had a billing on a new patient kicked back without payment for the

initial exam. They just paid for the treatment. The front desk asked

me to call them. I asked how I was suppose to know what to do for the

patient without an exam. The first responder told me that it was

included in the treatment code. I asked to speak to her supervisor and

repeated my question. The super said, " It's an obvious mistake; I'll

take care of it. " And, it was....

Sears

Portland

On Mar 4, 2006, at 1:42 PM, leary353@... wrote:

> docs;

> I know this has been dealt with before, but, when an existing patient

> is involved in a new MVA, the mechanism of injury is different, new

> body parts involved and new exam necessary, shouldn't we be billing

> for a new patient exam? got one kicked back denied because they were

> an existing patient.

>

> any thoughts,

> Don Leary, Dc

> West Salem

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is

> to foster communication and collegiality. No personal attacks on

> listserve members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

> However, it is against the rules of the listserve to copy, print,

> forward, or otherwise distribute correspondence written by another

> member without his or her consent, unless all personal identifiers

> have been removed.

>

October 20, 2008

Mike and his mom

Welcome to our home and now your home also

Yes stress can do some strange things to us. For some it can make us worse and

others it can bring on flairs. I have had this fun life of stills now for over 8

years and I was 41 when I was dx with it. I was married at the time and had two

kids and a great Job. Well life threw me a few loops and some major changes but

in the end stills gave me some gifts and a happier life and a great wife that

replaced a none understanding one who divorced me because of stills.

One thing I can suggest that will help I believe you both and all of your

family that live with Mike and care and love him as you his Mother I believe

dose is go to concealing both for Mike as some things in life will change and it

can help him change and adjust to life with a chronic illness and to the rest of

the family as in dealing with some one in Mikes boat and how to best help them

but not destroy there self worth. It is a learning process and it is always

learning. Be it about stills or about your self. Life dose go one for some

better then others but it go's on and how you deal with it will I feel depends

on family, friends, and your doctors.

You have started in a good place as we try to pass info on and we have some fun

also. So with that welcome and ask any thing you wish be it here or privately

but I will worn you I am honest so do not ask if you do not want to really know.

By the way I am a man who is now 50 had stills for almost 9 years now and had

both bad and good changes from and because of it Best to ya

the rednecks

Marty & G.

the redneck's my space http://www.myspace.com/martyg58

Stills ; An illness I know to well!

To learn about Stills http://www.stillsdisease.org/stills_info

If you find yourself in a hole, the first thing to do is stop diggin'.

In the old days a man who saved money was a miser; nowadays he's a wonder.

~Author Unknown

" Taking my gun away because I might shoot someone is like cutting my tongue out

because I might yell `Fire!' in a crowded theater. "

-- Venetoklis

a government and its agents are under no general duty to provide public

services, such as police protection, to any particular individual citizen...

-- Warren v. District of Columbia, 444 A.2d 1 (D.C. App.181)

__________________________________________________

October 20, 2008