The patient is a 17-year-old boy who presents with a ‘twisted” left knee sustained in a fall. He is able to bear weight, though it is obvious he is in pain. View the image taken and consider what your diagnosis and next steps would be.
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Clinical Challenge 2: March 2011
The patient is a 37-year-old woman in her second trimester of pregnancy. She presents a day after experiencing a fall, with impact to her left hip. She is walking, but with a noticeable limp. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read More62-year-old experiencing progressive shoulder pain
The patient is a 62-year-old who presents with a primary complaint of right shoulder pain that developed over time. The patient denies any trauma and appears well. The history and examination are unremarkable. View the image taken and consider what your diagnosis and next steps would be.
Read MoreTuberculosis: Post-Exposure Testing and Management
Urgent message: Patients who present after exposure to tuberculosis test the clinician’s ability to assimilate broad and generalized information, including a unique set of historical, clinical, and laboratory data required to customize appropriate, patient-specific assessment and treatment plans. By Jacqualine Dancy, PA-C, MPAS Not long after I contributed the article Tuberculosis Screening in Urgent Care Medicine (JUCM, July/August 2010), our urgent care clinic was faced with the exposure to tuberculosis of numerous employees at a …
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March 2011
Abstracts in Urgent Care: March, 2011
Not All Infectious Diseases Society of America Practice Guidelines Are Created Equal Key point: More than 1/2 of recommendations in guidelines from the Infectious Diseases Society of America rely on low-quality evidence. Citation: Lee DH, Vielemeyer O. Analysis of overall level of evidence behind Infectious Diseases Society of America practice guidelines. Arch Intern Med. 2011;171(1):18-22. Researchers examined 41 guidelines published by the Infectious Diseases Society of America (IDSA) since 1994. Of the 4,200 in- dividual …
Read MoreDeveloping Data: March, 2011
In each issue on this page, we report on research from or relevant to the emerging urgent care marketplace. This month, we offer one more snapshot of data presented in a Health Affairs article entitled Many Emergency Department Visits Could Be Managed at Urgent Care Centers and Retail Clinics,1 in which prescribing trends in the urgent care setting are compared with trends in other settings, such as the emergency room and retail clinics. Below, we …
Read MoreCoding Concerns: Versajet Debridement, Time Frame for New/Established Patients, Detailed Exams, Denial of S9088, –57 Modifier, and Billing for Injections
DAVID STERN, MD (Practice Velocity) Q.How do I code when using Versajet to debride an ulcer? A.For Versajet debridement, you should report CPT code 97597 (removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high-pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel, and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or …
Read MoreInnovation in Occupational Health Marketing
In a recent episode of the popular television show Mad Men, super ad man Don Draper opined to his up-and-coming colleagues that “marketing is all about innovation.” He’s right. But the best-laid plans often sink into the abyss of the “same old, same old.” After all, if marketing is about distinguishing one’s organization from its competitors, why not rely on the tried and true to punctuate the difference? This reasoning is flawed, however; marketing should …
Read MoreAccountable Care Organizations, Where do Urgent Care Centers Fit?
JOHN SHUFELDT, MD, JD, MBA, FACEP Under the Affordable Care Act, the Centers for Medicare and Medicaid Services will pioneer a number of new projects which affect the delivery of healthcare in the United States. Among these projects, the most ambitious is the proliferation of the Accountable Care Organizations (ACOs). Other initiatives include pay-for-performance (P4P) and quality improvement agendas proffered by organizations responsible for accreditation, all focusing on clinical delivery pathways or “care paths.” The …
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