PubMed · 16637788
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Donald E Letendre. 2006. Against the wind.. https://doi.org/10.1592/phco.26.5.597
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PURPOSE: A basic overview and definitions of commonly used billing and reimbursement terminology that pharmacists will need to know to obtain reimbursement for cognitive services are provided. SUMMARY: Currently, the profession of pharmacy has been gathering momentum in its efforts to seek and obtain reimbursement for cognitive services. However, there have been major barriers in seeking reimbursement, including the lack of understanding by third-party payers of the pharmacist's role in patient care and the pharmacist's in-depth knowledge of pharmacotherapy, the lack of appropriate billing codes for pharmacists' services, and the lack of detailed knowledge and understanding by pharmacy practitioners of nondistributive reimbursement mechanisms, processes, and terminology. The types of services provided are usually described by the American Medical Association's Current Procedural Terminology (CPT) codes for the face-to-face provision of patient care services by a pharmacist. As of January 1, 2006, pharmacists have been able to indicate the appropriate diagnosis code from the International Classification of Diseases, 9th Revision (ICD-9) (ICD-10 will replace the ICD-9 on October 1, 2007), and CPT code when billing under a major medical plan that recognizes the pharmacist as a patient care service provider. Understanding the billing and reimbursement terminology will aid pharmacist communication with third-party payers, Medicare, and Medicaid. A glossary of the most commonly encountered terms in billing and reimbursement procedures for cognitive services is provided. Also included are lists of Web-based reimbursement resources and references on reimbursement for cognitive services by the pharmacist. CONCLUSION: An understanding of terminology is important in receiving reimbursement for cognitive services.
Currently, chemotherapy, immunotherapy, and radiotherapy are the standard treatment for un-resectable solid malignant tumors. New "virtual scalpel" methods, such as MRI guided focused ultrasound, can target tumor tissues for destruction without the need for a resection and its possible complications. Unfortunately, the current state of the art cannot guarantee the safe and full destruction of all the targeted tissues. The main hypothesis is that for cancer patients, even incomplete tumor volume reduction will increase the efficiency of some systemic therapies as well as of natural healing mechanisms, and thus, may improve the quality of life and the prognosis. It is conjectured that partial tumor volume destruction will reduce the releases of endocrine substances from tumor cells, thus, improving the overall systemic condition. Furthermore, it may improve the efficiency of chemotherapy and immunotherapy and possibly trigger a natural immune response. The decrease of tumor volume may also slow down the process of invasion and metastasis. It is recommended that as a standard practice of palliative care, any un-resectable tumor volume will be considered for destruction with virtual scalpel techniques such as MRI guided focused ultrasound. Furthermore, it is suggested that this process is synergetic with chemotherapy and immunotherapy.
PURPOSE: Treatment options for chronic myeloid leukemia (CML) are discussed. SUMMARY: In the 1980s busulfan and hydroxyurea were the standards of care. These were subsequently replaced by interferon alpha (IFN alpha) based therapy. Currently, bone marrow transplant survival has improved, making this also a viable option. Five-year progression-free survival averaged above 70% for chemotherapeutic options. Transplant survival at 56 months was approximately 60%; however, these survivors were generally cured of disease. The recognition of the role for BCR-ABL in CML has led to the development of specific kinase inhibitors such as imatinib. Clinical trial evidence has demonstrated a clear superiority of imatinib over interferon plus cytarabine, making this the new standard of care in first-line treatment of CML. Resistance to imatinib has been observed, in addition to relapse. The data suggest that the probability of response may be estimated as early as six months after initiation of imatinib therapy. Although combinations of imatinib with IFN alpha show small improvements compared to imatinib therapy alone, the biggest improvements were seen when imatinib doses were doubled. Unfortunately, not all patients can tolerate this increase in dose. The most common mechanism for imatinib resistance is the presence of a mutated BCR-ABL kinase. Several of these mutants have been cloned and characterized. CONCLUSION: Molecular-targeted BCR-ABL kinase inhibitors, such as imatinib, are now first-line treatment for CML. Allogeneic stem cell transplant is still the only proven curable treatment for CML in patients with an appropriate donor. Next generation BCR-ABL kinase inhibitors hold promise for patients with mutated BCR-ABL kinase that confer resistance to imatinib.