Practice Management
A 35-year-old male with a history of end-stage-renal-disease (ESRD) presents to urgent care complaining of back pain. The patient missed his dialysis session today because of the pain. An ECG is obtained. View the ECG captured below and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 15-year-old girl presents to urgent care with complaints of fever, arthralgia, abdominal pain, and a widespread rash that developed over the last 2 days. The patient says that the pain in her knees is severe and debilitating. On examination, the patient has a temperature of 100.3°F (37.9°C) as well as maroon and violaceous, purpuric papules and plaques on the legs, buttocks, and face. Laboratory examination shows elevated erythrocyte sedimentation rate and C-reactive protein, proteinuria, …
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Urgent Message: Abdominal pseudohernia is a rare diagnosis with variable presentation. Urgent care clinicians who are familiar with the condition and its variable presentations can reduce the risk of diagnostic errors and unnecessary or inappropriate diagnostic testing. Berkeley E Prewett, BSA; Stephen V Green, MD; Andrew L Juergens II, MD; Taylor K Ratcliff, MD Citation: Prewett BE, Green SV, Juergens AL, Ratcliff TK. Abdominal Pseudohernia and Urinary Retention Due to Spinal Nerve Root Compression From …
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Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Three elements determine the level for evaluation and management coding (E/M). “Amount and/or Complexity of Data to be Reviewed and Analyzed” is 1 of them and also the most confusing. Data Reviewed remained a point system after guidelines changed in 2021. As an auditor, I see both undercoding and overcoding in E/M caused by not applying the rules correctly. Let’s start with what tests count toward Data Reviewed. …
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President-elect Trump has announced his intended appointment of Janette Nesheiwat, MD, to be the next surgeon general, according to NPR. She is currently a medical director for CityMD and has contributed to Fox News. With a specialization in emergency and family medicine, she is known for supporting vaccine efforts with an emphasis on the balance of risk and benefit. CityMD merged with Summit Health and was ultimately acquired by VillageMD in early 2023 for $8.9 …
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The American Academy of Pediatrics (AAP) has issued its first clinical practice guideline on prescribing opioids for outpatient acute pain management in children, published in Pediatrics. The guideline recommends using immediate-release opioids at the lowest dose for age- and weight-appropriateness, with an initial supply of no more than 5 days unless the pain is due to trauma or surgery requiring longer treatment. Codeine and tramadol should not be prescribed to children under 12, adolescents with …
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In a study of 320,141 children published in JAMA Network, researchers found those treated with amoxicillin-clavulanate had a slightly higher risk of treatment failure (defined as lack of effectiveness or intolerability) compared with amoxicillin. And for those treated with amoxicillin-clavulanate, there was also a higher risk of gastrointestinal symptoms and yeast infections. Accessing treatment in urgent care was more common among patients who received amoxicillin-clavulanate (9.6%) than those who received amoxicillin (5.9%), and urgent care …
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Researchers quantified the real-world risk for hospitalization among adults diagnosed with respiratory syncytial virus (RSV) in outpatient settings in a study presented in JAMA Network Open. They examined all-cause 28-day hospitalization following outpatient RSV infections among all adults as well as a high-risk subgroup of adults across 6 RSV seasons comprising 67,239 outpatient infections. Data revealed approximately 5% of adults experienced all-cause hospitalization within 28 days following outpatient RSV infections. The analysis showed an absolute …
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Rates of postpartum depression (PPD) have doubled over the last decade, according to a Kaiser Permanente cross-sectional study of 442,308 births from 2010 to 2021, presented in JAMA Network Open. The rate of diagnosis jumped from about 9% to 19% in 2021 (P for trend <.001). In the study, 83.7% of subjects had initiated prenatal care during the first trimester, and authors note that in spite of better screening tools and clinician awareness, PPD continues to be …
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In the week ending November 9, 2024, 30%-40% of adults had received 2 of the most recommended vaccines, according to the latest update from the Centers for Disease Control and Prevention (CDC). An estimated 34.7% of adults reported having received a seasonal influenza vaccine, and 39.7% of adults age 75 and older have received a respiratory syncytial virus (RSV) vaccine. Likewise, 31.6% of adults aged 60–74 years at increased risk have received an RSV vaccine. …
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