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In his office he scolded me in his nasal voice, "There's not a damn thing wrong with you. God Almighty, don't give your poor mother something more to worry about. Think about her instead of being selfish. What you need is a psychiatrist." I can see his face redden with anger.

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Didn't he remember? Earlier, after his MVP diagnosis, he had curtailed any sports with the use of my arms, which is not the way MVP is handled now. According to him, in two years I would be fine. Actually I had felt better before the sports restriction. Without sports for two years I had lost muscle strength and tone.

MITRAL VALVE PROLAPSE

MVP is the most commonly inherited heart problem in the United States. Yet it is listed with the National Organization of Rare Disorders (NORD) because the disorder is not completely understood or acknowledged by most physicians. While the statistics vary with sources, the estimated percentage who have this problem includes as many as thirty percent in this country. According to a survey in the late 80s, three times more women have MVP than men.

The heart has four valves inside it to pump the blood in and out: the aortic, the mitral, the pulmonary, and the tricuspid. The mitral valve acts like a door between the left atrium and the left ventricle in the heart. When the lower part of a normal heart contracts, the mitral valve closes and prevents any blood leakage into the upper chamber. With MVP, the valve balloons out of shape. A physician hears this through a stethoscope as a click. If the valve shifts enough, it can allow some blood to flow back into the upper chamber, and the physician hears a murmur.

Have you heard your own heart through a stethoscope? Have you heard the click or the murmur? Ask your physician to allow you to do this. It's important you know what sound your heart makes. Of course, some murmurs and clicks are difficult even for a cardiologist to detect. But give it a try. If you squat, the hardest position on the heart, you will hear it. One woman chose her physician based on whether the physician could hear her murmur.

However, this structural defect is not what usually causes the myriad of symptoms. Most MVP people have healthy hearts.

MITRAL VALVE PROLAPSE SYNDROME WITH DYSAUTONOMIA

A syndrome is a collection of symptoms which has more than one cause, whereas a disease has a single cause. MVPS/D has a recognizable pattern of symptoms and signs. As the physicians and researchers understand, the symptoms reflect a failure of control mechanisms, specifically in the nervous system. The more they learn about the disorder, the more likely they will be able to find a single cause and convert MVPS/D to a disease status.

The nervous system is divided into two parts: voluntary and involuntary. The involuntary nervous system, also known as the autonomic nervous system (ANS), is more complex and controls most bodily functions such as body temperature, sweating, blood pressure, heart rate, salivation, pupil dilation and contraction, sleep-wakefulness balance, intestinal functions, digestion, and many others. This system has two major divisions: sympathetic, which speeds up the system, and the parasympathetic, which slows the system.

The physicians connect some MVP symptoms to the ANS, an imbalance known as dysautonomia or an autonomic (which means automatic) nervous system dysfunction. Therefore, when the MVP patient experiences symptoms that involve the ANS, the physicians refer to the disorder as mitral valve prolapse syndrome with dysautonomia, the most common type of dysautonomia.

The central problem of MVPS/D is the body's excessive response to adrenaline and adrenaline-like hormones. (Hormones and nerves serve as control systems in the body.) Most MVPS/D patients have a bit too much noradrenaline, a related hormone. Most of the symptoms come from various organs' over-responsiveness to even normal amounts of adrenaline-like hormones.

Thus, you can see it would be best for MVPS/D patients to minimize the release of adrenaline into their blood streams. Of course stimulants of any kind-caffeine, sugar, alcohol, chocolate, aspartame, NutraSweet, Splenda, monosodium glutamate, and some over-the-counter medications, those containing caffeine, epinephrine, ephedrine, and pseudoephedrine-should be eliminated from your diet. Stimulants can include people and activities. Movies, at times, can over-stimulate my system, even talking.

Check with your physician before a therapist uses electricity, which can trigger symptoms. Patients should allow only moderate sun and heat exposure and gradually progress to condition their bodies to exercise. These cautions will sustain a high blood volume. A higher blood volume means an adrenaline increase is less likely. Patients also need to control their responses to stressful emotional situations. Yeah, right! That's a trick in itself.

Debbie Petersen, who has yet to get her symptoms under control, calls the dysautonomia part an everyday hell to live with. "Right now it's just trial and error every day."

'I was so happy to know there was a name for what is partly wrong with me: dysautonomia," wrote Rita McNeil. "Most people have never heard of it, let alone know what it means."

"The disorder takes a significant toll on lifestyle and work capacity," commented Linda Smith of the National Dysautonomia Research Foundation (NDRF).

Dr. David H. P. Streeten, a research pioneer for orthostatic intolerance (OI), sums the impact of dysautonomia on a person's life: "While we are not constantly aware of the activity of the autonomic nervous system as we are of unusual sensory and motor events, the normal functioning of the autonomic nervous system day and night, from heart-beat to heart-beat, plays a largely unconscious but vital role in our livelihood. It is not surprising, therefore, that autonomic abnormalities, though they are usually more difficult to recognize than a severe pain, a sensory loss, or paralysis of a limb, may be even more important in impairing the quality and even jeopardizing the continuation of life."

SPACE SHUTTLE COLUMBIA

The astronauts experience similar problems when they take off from Earth and land from outer space. Dr. Andrew Gaffney, cardiologist and astronaut, served as Payload Specialist on Spacelab Sciences 1 as part of a Space Shuttle Columbia mission in the early 90s to study the astronauts' problems.

Understanding how our MVPS/D problems work helped him understand why the astronauts experience their symptoms such as dizziness and faintness when they stand. During the early part of the space flight, Dr. Gaffney flew with a catheter inserted into his arm vein to record the blood pressure around his heart. Within a few hours after lift-off, his blood pressure and blood volume dropped remarkably, according to Popular Science Magazine, March, 1993.

"As we sort out that data," Dr. Gaffney said, "we are learning a lot more about where the blood goes, where it is stored-in terms of the venous system, and the relationship between the adrenalin levels and the blood volume."

Dr. Gaffney, chief of clinical cardiology at Vanderbilt University School of Medicine, Memphis, TN, describes what he knows MVPS/D to be: "There is a primary abnormality of autonomic tone so that these people tend to be vascularly constricted." That constriction leads to shrinkage of blood volume. The lower volume feeds back and causes more constriction and that becomes a vicious cycle.

That cycle contributes to the symptoms such as fatigue. "We all know patients who are anemic have fatigue, and everybody understands that," Dr. Gaffney said. "Well, it is perhaps a little more difficult to understand (with MVPS/D). You can have the right amount of blood volume but if you don't have enough red cells in it, then you get tired because you don't deliver the oxygen. That's anemia. You can have the right concentration of red blood cells, so you are not anemic, but if you don't have enough blood, then it is the same problem. Absolute number of red blood cells that carry the oxygen is what determines whether you can exercise more."

BLOOD VOLUME

"Blood volume is critical to prevent symptoms from starting," said Susan Elliott, who taught physics before MVPS/D symptoms changed her lifestyle. "When blood volume gets low, it tends to trigger a chain of reactive events that cause things like tachycardia, feeling too hot or too cold."

Even a slight imbalance in the ANS can cause low blood volume in MVP patients. Up to twenty-five percent lower. The thirst signal fails to turn on, keeping the blood volume low.

It is very important for people with MVPS/D to drink at least 70 ounces of fluids daily, more if the temperature is higher. A good way to remember the amount is if the temperature is higher than 70, drink the equal number of ounces to the degrees in temperature. Such as if it is 86 degrees, drink 86 ounces of fluids. An easy way to achieve this is to keep a water bottle with you and try to drink eight ounces every hour. And to make it really fun, sing the tune to "Pump Up the Volume," by M/A/R/R/S.

Susan also found the more water, the less her MVPS symptoms such as twisting leg muscles. Also included in her regimen were potassium, zinc, and magnesium, minerals helpful to heart and muscular function and energy metabolism.

Fluids "fake out your body," Susan says, making it seem to have higher blood volume. She drinks a gallon of water a day, always remembering to salt the water or eat something salty with it. The salt helps retain water and valuable nutrients such as potassium. Another thought is to intake fluids with salt present like sports drinks or soups. However, patients with hypertension (high blood pressure) need to consult their physician first.

VERTICAL VS HORIZONTAL

When a MVPS/D person lies down, she can immediately experience symptoms such as tachycardia or heart pounding. "If you lie flat, that can produce too much blood to your head and heart too fast," Susan said.

While we are vertical, the blood circulates the entire body with less volume than people without MVP. When our bodies become horizontal, the blood floods the head and the heart chambers, causing the symptoms, until the pumping adjusts.

To offset this, some people sleep on a slight incline such as in a recliner. To create her slant, Susan puts a board beneath her headboard. Pat Conrad sleeps on two pillows. Then her palpitations are "not so extreme." When the heart pain continues, she elevates her feet. My husband and I use two thick encyclopedia volumes that help me and his gastrointestinal reflux disorder (GERD).

ORTHOSTATIC INTOLERANCE (OI)

People take their ability to stand for granted. OI patients do not. Daily they struggle with the symptoms brought on by the vertical position. Upon standing, a person with orthostatic hypotension, another word for OI, might experience lightheadedness, dizziness, palpitations (throbbing or heavy beats), tremulousness, visual changes, a stuffed head feeling, ears ringing or buzzing, fainting, and poor concentration because her blood pressure has suddenly fallen. About a half million Americans have OI, according to the National Dysautonomia Research Foundation.

Being upright produces blood pooling in the lower abdomen and limbs, blood which is no longer available to the upper body. With an effective ANS, the body quickly compensates by increasing the heart rate and other cardiac output.

When the OI person stands, her blood volume lowers, her blood vessels lose an excessive amount of plasma, and her kidneys pour out salt.

Some patients experience fatigue, tachycardia (abnormally rapid heartbeats), and shortness of breath, which is termed sympathontonic or hyperadrenergic orthostatic hypotension because the sympathetic part of the ANS increases.

Not every patient has all these abnormalities. Most OI patients have a mild case which can improve over weeks or months. Most will eventually be free of their symptoms.

However, in patients with severe symptoms or with a sudden ANS alteration such as actor-director Christopher Reeves experienced with his fall, the recovery may never come.

A few other names used for OI are as follows:

orthostatic tachycardia syndrome

postural orthostatic tachycardia syndrome (POTS)

hyperadrenergic postural hypotension

partial dysautonomia

sympathotonic orthostatic hypotension

hyperadrenergic orthostatic hypotension

mitral valve prolapse syndrome

SUPPLEMENTAL HELP

CALCIUM

Calcium, the body's most abundant mineral, is located mostly in the bones and teeth because its function is to build and maintain bones and teeth. It also is essential for healthy blood, regular heart beats, and proper nerve transmission. Calcium is beneficial for cardiovascular disorders. Cases of calcium deficiency have provoked heart palpitations, slow pulse rates, and excessive irritability of nerves and muscles.

The best supplemental source lies in calcium lactate or gluconate because these are natural derivatives and easier to absorb. Foods rich in calcium are milk products, green leafy vegetables, shellfish, and molasses.

MAGNESIUM

This necessary mineral lives within the body cells to activate enzymes for the metabolism of carbohydrates and amino acids. It helps to regulate the acid-alkaline balance and to promote absorption and metabolism of other minerals and vitamins. With nearly 70 percent of it located in the bones, magnesium aids during bone growth, is vital for proper nerve, muscle, and heart functions, helps regulate body temperature and blood sugar convert to energy. Magnesium is alkaline, so it should not be taken after meals but can be used in place of antacids.

This mineral can help prevent heart attacks and depression. It is beneficial for neuromuscular disorders, nervousness, and sensitivity to noise. Contrary to the old sayings, magnesium helps form the hard tooth enamel that resists decay, not calcium.

Large amounts of magnesium can be toxic if the calcium is low and phosphorus is high. Magnesium loss increases with the use of diuretics and alcohol. Foods rich in this mineral are seafood, whole grains, dark-green vegetables, molasses, and nuts.

POTASSIUM

Elaine Hansen had spells of irregular heartbeats that would last up to twelve hours, often during the night. She felt very tired afterwards. Her family physician said the cause was low potassium.

This essential mineral works with sodium to help normalize the heartbeat. If you're prone to palpitations, you might feel them when you are in the low-to-normal range for serum potassium. When they come on, try drinking orange juice to help the palpitations go away.

Together, potassium and sodium regulate the body's water balance, i.e. they distribute the fluids on the cells' walls. They equalize the acid-alkali factor, help in muscle contraction and expansion and in nerve stimulation. With phosphorus, potassium sends oxygen to the brain and with calcium regulates neuromuscular activity. This is a handy little mineral for our bodies.

However, potassium and sodium must be in balance or excessive salt will deplete potassium. Alcohol and excessive sugar can deplete both potassium and magnesium. Potassium is excreted through urination and perspiration. Foods with potassium are lean meats, whole grains, vegetables, dried fruits, legumes, and sunflower seeds. A high potassium level can be life-threatening and can occur in renal failure.

SODIUM

Half of our body's sodium is found in the extra-cellular fluids such as the blood vessels, arteries, veins, and capillaries. As I wrote in the last section, sodium works in conjunction with potassium. It keeps other blood minerals soluble so they won't become deposits in the bloodstream. Foods naturally rich in sodium are seafood, celery, milk products, table salt, and baking powder.

WATER

In elementary school we learned water is two-thirds of our body weight, so we know it's our body's most important nutrient. It makes up about 70 percent of our weight. We can live longer without food than we can without water. Water is needed for everything from maintaining body temperature to carrying away our waste. For MVPS/D, water is essential to maintain a level high blood volume.

My young neighbor Ryan had a problem with constipation. His parents used all the usual remedies. Still, Ryan might wait as long as five days without a bowel movement.

Finally his doctor asked how much water he drank daily. When his mother answered, the doctor said that was sufficient for some; however, some people's colons absorb water at different rates. The faster the absorbency, the firmer the stools. Presumably then (assuming no other variants), the more water one drinks, the softer the stools.

I never considered water as an answer to my irritable bowel syndrome (IBS). I had assured myself I drank enough water. Besides, my stools usually change when I've overworked and my other symptoms, such as migraine and fatigue, come out of hiding.

When I began drinking my gallon (and that takes discipline!), my stools softened to normal consistency without my other MVPS/D appearing. Since I've been on the gallon regimen, my stools have been firm or softened, never irritably hard.

Of course, other elements can be involved such as the foods we eat and much more. Chocolate and red meats harden stools. I discovered . . . for me . . . that water helped my IBS.

Someone commented about drinking too much water. In the May, 2000, issue of Town and Country magazine, Diane Quagliani, a registered dietitian and spokesman for the American Dietetic Association, was quoted, "Everyone loses about ten cups of water daily, so it's important to drink about eight eight-ounce cups of fluid-the rest is made up by water in foods and the water the body makes in metabolism. The bigger, more active, and more overheated you are, the more fluids you should take in. Taking in too much (water) is not very likely, unless it is gallons a day, and the main danger would be flushing out too many electrolytes. Healthy kidneys can keep up with most consumption."

Others complained they would have to run to the potty more often. In hot humid weather, the average person should eliminate urine every two hours if the person drinks sufficient water to cover sweating, according to my family physician.

When I tried the gallon experiment, some days I hit the toilet plunger more than the norm. But another day I wouldn't. What is normal anyway? The question should be "What is best for your body?"

The Town and Country article writer, Ila Stranger, wrote that it "makes sense that drinking enough water is bound to help us avoid dehydration-which can happen as easily in the overheated rooms of midwinter as in the summer sun-and make us look and feel alive and well."

Each day I grab a gallon jug of spring water or fill a gallon pitcher and set it on the counter to remind me to strive to drink more water. Not only for my IBS but for my blood volume, blood pressure, and the many other tasks my body constantly performs. I've found in the winter lukewarm water is swallowed easier. Ice water is a shock to the throat, sometimes even in hot weather.

Some people prefer to drink mineral water rather than tap water. Others use well water. Neither should be relied upon for a person's source of minerals. Distilled means the water has been boiled water with all harmful or beneficial minerals eliminated. Fruits and vegetables are good dietary sources for chemically pure water, which is 100 percent pure hydrogen and oxygen. The use of these are an individual choice.

The Environmental Protection Agency's hot line is 1-800-426-4791; its website is http://www.epa.gov/safewater. The Natural Resources Defense Council website (www.nrdc.org) contains in its archives the results of a recent four-year study on bottled waters. The author of the summary results is Dr. Andrew Weil on the website http://www.pathfinder.com/drweil.

ANTIBIOTICS

Before any invasive procedures, MVPS/D patients with valve leakage should take antibiotics to prevent bacterial infection from forming on their valve. Such as dental work, body piercing, tattoo, and surgery. A few years ago the physicians recommended antibiotics for all MVP patients. Now only those with definite regurgitation (leakage) are urged to do this, and the dosage has been cutback to only before the procedure.

For other surgeries and procedures you can consult with your physician or the MVP clinics.

RESEARCH IN MVPS/D

Dr. Al Davies, associate professor of medicine at Baylor College of Medicine in Houston, has led the MVPS/D research of chemical reactions between adrenaline and several important proteins.

The proteins are located near the lining membrane of a cell of a body organ. Three proteins of greatest importance are: the receptor on the cell's surface, a G-protein located inward, and an enzyme called adenylyl cyclase on the inside cell membrane's surface.

Normally, adrenaline attaches to the receptor protein, which combines with the G-protein. (Full name is stimulatory guanine nucleotide regulatory protein.) Once these are activated, they turn on the enzyme which causes internal actions such as rising blood pressure or increased heart rate.

Dr. Davies and his colleagues have shown that the MVPS/D patient's abnormally increased sensitivity to adrenaline is due to an overly active, abnormal G-protein.

The possibilities to the question "Why?" are numerous. And there are many steps before a full answer and treatment are developed. The researchers thought this might be due to an abnormal gene since the illness is hereditary. However, their studies show the gene is normal.

To the MVPS/D patient, that finding carries hope because the cause is not something as simple as a bad gene passed down from our grandfather. Something happens to the protein after the gene makes it and before the adrenaline activates it.

Editor of the November, 1998, special American Journal of Medical Sciences supplement on OI, Dr. David Robertson entitled the issue "Epidemic of Orthostatic Tachycardia and Orthostatic Intolerance." Dr. Robinson writes that many centers actively pursue OI research and expect rapid improvements in diagnosis and therapy. The director of the Clinical Research Center at Vanderbilt University, Nashville, he adds, "A healthy appearing 20-year-old woman with dizziness, palpitations, and fatigue is certainly no longer passed over as having a psychosomatic illness!" Well, maybe not in Nashville. Generally the tilt table test is used to diagnose a dysautonomia.

MANY PHYSICIANS' ATTITUDES

My former country physician may sound old-fashioned and something of the past; however, we with MVPS/D know his attitude remains with most of the physicians we meet today. One of the tough barriers we have to get around is finding a knowledgeable, caring physician.

For most people who have diabetes, cancer, or even strange diseases, they can contact a physician, and within a few visits they have their illnesses diagnosed. They are believed from the time they enter the physician's office.

We with MVPS/D are not believed. We must research our own disorder, be abreast of the latest drug regimens, carry literature about our illness to give to the physician, and then know the physician probably will not consider our illness legitimate or treat us. It's just crazy when you think about it! How much proof does a physician need? Why can't they keep informed about MVPS/D when a fifth of the nation has MVP and might possibly become symptomatic?

Education and research are keys to solving the MVPS/D puzzle in our bodies. With these always lies hope. Miles and miles of hope!

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To get proper reimbursement for the procedures they perform, radiologists need to execute proper disease and diagnosis coding or ICD-9 coding (using three-digit codes that are modified by including a fourth or fifth digit as characters following a decimal point), and procedural coding using Current Procedural Terminology (CPT), comprising 5 digits with 2-digit modifiers. The procedure will be considered medically necessary only with a supporting ICD-9 diagnostic code. Sometimes multiple codes, such as radiological and surgical codes may become necessary to report a full procedure. Cardiology medical billers have to be thorough with radiology CPT codes that are bundled with other CPT codes. When billing for radiology services, 'upcoding' (coding a higher or more complex level of service than what was actually performed) has to be strictly avoided since this is regarded as fraud or abuse. Another important factor is to ensure whether the services require prior authorization to be properly reimbursed by the carrier.

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Radiology Codes

Radiology codes comprise the 70,000 series of codes organized by the method or type of radiology and the purpose of the service. They are subdivided on the basis of the type of service and anatomical site.

These include:

• Diagnostic Radiology 70000 - 76499
• Diagnostic Ultrasound 76500 - 76999
• Radiologic Guidance 77001 - 77032
• Breast, Mammography 77051 - 77059
• Bone/Joint Studies 77071 - 77084
• Radiation Oncology 77261 - 77999
• Nuclear Medicine 78000 - 79999

Interventional radiologists use certain surgical codes to signify the procedures they perform. Some major surgical codes include the following:

• Mechanical Thrombectomy: 34201, 34421, 34490
• Biliary Drainage: 47510, 47511, 47530
• Cholecystostomy Tube Placement: 47490
• IVC Filter Placment: 37620
• Biliary Stone Removal: 47630

HCPCS Codes

Medical services and supplies that are not included in the CPT coding terminology are listed in the HCPCS (Healthcare Common Procedure Coding System procedural codes). These are represented by 1 letter (from A to V) followed by four digits. Numeric or alphanumeric modifiers can be used along with these codes to clarify a procedure.

Billing for Radiology Services

Radiological service can be billed for the physician's work as well as the use of equipment or supplies. The technical component (TC) includes facility charges, equipment, supplies, pre-/post injection services, staff and so on. The professional component (PC) involves studying and making inferences about the radiological test and submitting a written report with the findings. Modifiers are used to signify the technical and professional components in a radiological service. They are 2-digit numbers that are used to explain a procedure in more detail. They can indicate repeat or multiple procedures, such as radiographs performed bilaterally. When billing for the technical component only, the modifier 52 has to be used; when billing only for the professional component, the modifier 26 is to be used. In the latter case, a written report by the physician providing the services is required to avoid claim denial.

Some other examples of modifiers:

• -22 - unusual (increased) procedural service
• -32 - mandated services
• -51 - multiple procedures
• -66 - surgical team
• -76 - repeat procedure by same physician
• -77 - repeat procedure by another physician
• -LT, -RT, -TA to -T9, -FA to -F9, -LC, -LD, -RC - Anatomical modifiers

The global fee comprises the total payment due for the technical and professional components and this also requires a formal written report.

Billing for Professional Component

Physicians can bill for the professional component of radiology services provided for an individual patient in all settings regardless of the specialty of the physician who performs the service. Reimbursement will be given under the fee schedule for physician services. However, for radiology services provided to hospital patients, insurance carriers reimburse the professional component only under the following conditions:

• Services should meet the fee schedule conditions
• Services provided should be identifiable, direct and discrete diagnostic or therapeutic services given to an individual patient

Payment for the Technical Component

As regards the technical component or TC of radiology services furnished to hospital patients and to Skilled Nursing Facility (SNF) inpatients during a Part A covered stay, insurance carriers might not provide reimbursement. The fiscal intermediary (FI)/AB MAC makes the payment for the administrative/supervisory services offered by the physician, as well as for the provider services. The TC of radiology services offered for inpatients in hospitals, excluding CAHs or Critical Access Hospitals are included in the FIs/AB MAC payment to hospitals. In the case of hospital outpatients, radiology and related diagnostic services are reimbursed according to the Outpatient Prospective Payment System (OPPS) to the hospital. In the case of a SNF, the radiology services offered to its inpatients will be included in the SNF Prospective Payment System (PPS). For services offered for outpatients in SNFs, billing can be made by the provider of the service or by the SNF according to arrangements made with the provider. When the billing is made by the SNF, Medicare reimburses in accordance with the Medicare Physician Fee Schedule.

Radiology Billing Standards

Radiology services can be billed in a number of ways. Some of the services are split billable and the codes for these are separately reimbursed by different providers for the professional and technical component. The physician and the facility can bill for their respective component with modifiers 26, TC or ZS. In full fee billing, the physician bills for both the professional and technical components and makes the payment due to the facility for the technical component provided. In standard billing, the facility bills for both the professional and technical components and reimburses the physician for his professional component. Services that cannot be separately billed are not individually reimbursed for the professional or technical components. These codes are reimbursed only for one provider and must not be submitted with the 26, TC or ZS modifiers.

Assigning the Codes

• Medical documentation is carefully studied to identify the radiological service performed.
• Identify the anatomical site
• Find the terms in the CPT index
• Select the codes on the basis of radiology terminology
• See whether modifiers are to be assigned

The following skills are essential for accurate coding and billing for radiology services:

• Ability to review clinical issues and CPT, ICD-9 and HCPCS coding guidelines for interventional and non-interventional radiology
• Knowledge about the differences between diagnostic radiology codes and therapeutic interventional radiology codes
• Skill to review coding guidance for modifier usage with interventional radiology procedures
• Ability to code challenging case scenarios

Professional Coding Services for Accurate Billing and Coding

When it comes to coding, the radiologist faces two main issues: first, understatement of completed treatment could mean insufficient reimbursement; second, if the codes overstate the treatment, it could result in risk of abuse, repayments and fines. Another problem is the complicated and ever-changing directives with regard to CPT procedures.

Radiologists can resolve all these issues by going in for the services of professional medical coding companies. They have skilled CPT coders to do the job. With great attention to detail, in-depth knowledge of the coding system, application of basic coding principles, and thorough documentation, these companies offer accurate, customized and affordable radiology medical billing and coding services in quick turnaround time. Most of the professional companies utilize state-of-the-art billing software to guarantee efficiency and accuracy in billing and coding, for checking local coverage determination and so on to ensure that all claims are reimbursed.

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Before considering alternative methods of nutrition and hydration there are certain questions that need to be asked:

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Has there been a swallow study (Modified Barium Swallow) done to rule out a physical problem which makes swallowing difficult? Muscle strength typically decreases as we age. This decrease in muscle strength can effect the muscles involved in swallowing. Strokes or TIAs ("mini"-strokes) can affect the muscle control needed to swallow effectively. Are ill-fitting dentures or poor dentition to blame for a decrease in eating? If dentures do not fit well, eating can become problematic and even painful. Chewing and eating can also be difficult if natural teeth are broken or missing. Is there a fear of drinking or eating because of problems with incontinence? The elderly often have problems with incontinence and may refrain from eating or drinking if they are afraid that they may have an "accident" or not have easy access to a bathroom when needed. Is depression a factor? Clinical depression can cause a lack of appetite which may result in weight loss. Depression can also cause a lack of interest in activities such as family dinners, eating out, etc. Are medications to blame? Many medications can cause a lack of appetite or make food "taste funny". Is dementia a factor? Elderly people with dementia may forget how to prepare food, how to feed themselves, or how to chew and swallow. Is a decrease in appetite the result of a terminal illness? One of the problems encountered with terminal illness is a natural decrease in hunger and thirst as the body prepares for death. Medical professionals should be involved in helping patients and their families to understand the disease process and its impact on nutrition and swallowing.

If alternative means of nutrition and/or hydration are being considered certain questions should be considered:

Will alternative nutrition/hydration improve nutritional status? Will alternative nutrition/hydration decrease the risk of disease or prevent disease? Will alternative nutrition/hydration help to increase life expectancy? Will alternative nutrition/hydration improve the quality of life? Is alternative nutrition/hydration a short-term or long-term intervention? What are the risks involved with alternative nutrition/hydration? Are there any considerations if alternative nutrition/hydration is provided, but there is a "change of heart"?

All of these questions need to be considered very carefully before taking steps to pursue alternative means of nutrition. Professionals need to educate families on the benefits and contra-indications of tube-feedings, nutritional supplements, appetite stimulants, etc. before a decision is made. This education needs to be specific to the patient involved and take into consideration the overall medical condition of the patient.

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The Mango is really a tropical fruit discovered purely in Africa's western coastal rainforests. It differs from other mango fruits in that it produces a peculiar seed, which natives of Africa refer to as 'Dikka nuts'. Despite the recent frenzy surrounding its weight reduction advantages, this fruit has actually been used as a dietaryaid for centuries. For hundreds of years, an extract from the seeds, known as irvingia gabonensis, has been used by Cameroon villagers for its wide-ranging medicinal positive aspects.

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The pill form has been well studied over the past 20 years. But it has only recently recognized by the industry as a whole. These pills claims to thermogenically burn more fat, detoxify the body, suppress appetite, fight belly fat, give you more energy, control leptin, and lower cholesterol with an entirely stimulant free approach.

These pills are not a silver bullet that will reduce your weight by its own. Although clinical trials have shown that men and women can lose fat by taking one Mango Pill a day for 30 days, it is highly recommended that it be part of a diet and exercise program in order to see the best results in the shortest amount of time. In order to lose the most weight you must first go on a diet and exercise program. Adding these mango pills to the diet and exercise program helps dramatically increase your weight loss.

African Mango Pills:

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Essentially, counselors and doctors know whether or not a person has been abusing a particular matter from the start. Still, in order to recommend someone for clinical treatment, professionals must be able to determine whether or not a person is truly addicted. So, how is a substance abuse evaluation done? Most professionals use the same method in order to find out. The type of test given to a person that is suspected of addictive behavior is called a "CAGE" test, and this type of test is a lot trickier than you may think.

Pro Clinical

Upon first glance, the CAGE test doesn't really appear all that insightful or intrusive. However, someone that is highly trained will look for certain responses to the follow questions. C: Has anyone ever felt you should Cut down on your drinking? A: Have people Annoyed you by criticizing your drinking? G: Have you ever felt Guilty about your drinking? E: Have you ever had a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? If a patient response positively to one or more of these questions, they are likely to have an abuse issue.

How is a substance abuse evaluation done when a professional uses the MAST method? Interestingly, studies have shown that white females simply do not respond all that well to the CAGE method, which has prompted researches to devise the MAST method. The first MAST question is: have you ever had a drinking problem? The second question is: when was your last drink? For some reason, white females seem to respond better to these questions than to any other method.

There are many other methods used in order to determine someone's abuse level, and many of them are targeted specifically for one group or another. As it turns out, those that are within certain cultural groups respond differently to varying questions. Even if a person that has an addiction knows about these methods before going in to see a professional, counselors and doctors know when a person is telling the truth.

Now that you know the answer to the original question (how is a substance abuse evaluation done?), you may be able to ask yourself these questions if you are have any concerns. However, it is not recommended that you try these questions on any one that you suspect of having an abuse problem. Instead, try and get them to see a professional for best results.

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