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coloradopa

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coloradopa last won the day on February 13 2009

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  1. We had the Pfizer first then Moderna. Anecdotally more with Pfizer. Statistically the same (around 35,000 vaccines). For what its worth I got the Moderna vaccine during the clinical trial and had virtually no side effects. I also like the fact that Moderna is open about how the viral variants work and are working on a booster that will address the South African variant. Haven't heard much from Pfizer.
  2. Incident to is relatively simple. The physician must see the patient and form the plan for each new problem. If a patient is new, then the physician must see the patient. If the patient develops a new problem then the physician must see the patient. The AAPC has a good article on this: https://www.aapc.com/blog/44912-seven-incident-to-billing-requirements/
  3. We had a bunch of APPs get theirs tonight. They are recommending not working the next day. I signed up and then asked to be unblinded from the Moderna study. Found out I received the Moderna vaccine in September. My N = 1 minimal side effects.
  4. I'm in the Moderna trial. The PIs are pushing to get the volunteers who got placebo vaccine first. Supposedly they will unblind when the first vaccine is released, so probably by December.
  5. I'll repeat what our ID folks said. You are at higher risk getting COVID in the community than you are in the hospital.
  6. it doesn't really have anything to do with taxes. It was aimed at the gig economy such as Uber. Physicians were exempted for locums purposes. The California nurses were pretty adamant that nurses not be exempted (probably makes strike breaking harder) so PAs and NPs got swept up in the mess.
  7. Its actually pretty normal for private insurance. PAs and NPs are generally not credentialed by most private insurance companies. This is slowly changing in some parts of the country. Generally the instruction from the insurance company is to bill under the supervising/collaborating physician. If you want to be sure, call the insurance company and ask; how do I bill for PA services? The answer will almost certainly be to bill under the supervising/collaborating physician.
  8. We basically staff 1 APP per 5-6 bed during the day and 1 app per 10-12 beds during the night. We work 13.3 hour shifts (basically pay 1.3 hours for sign out and catching up). Full time is 3 shifts per week. We don't allow 24 hour shifts unless in an emergency. We have a few evening shifts for surgical ICUs that get a lot of admissions between 3 and 11.
  9. 1. Then do critical care. I work in a academic transplant ICU. I run my patient list with a ton of autonomy. I do as many procedures as I want to do. I pick up as much extra work as I want. On the other hand OR? One patient, maybe get to do lines. Are you ACT or not? How much autonomy? Big sick cases probably not going to do. Pushing Propofol in endoscopy is not my idea of high intensity. 2. Are you sure? Most CRNAs and Anesthesiologists get along pretty well but there is a lot of bad blood in some places. Now they have a "nurse anesthesiologist" in Florida. 3. Depends. Here,
  10. First the disclaimer, you are responsible for your coding nothing here constitutes legal advice. There are two issues. One is do you need an office visit for the injection and the other is what is the appropriate code. For issue one it depends on medical necessity. The various medicare guidelines recommend testing testosterone levels then reassessing every 3-6 months as well as testing HCT every 3-6 months. Testosterone has a number of significant side effects and complications. If the treatment plan requires assessing the patient for side effects and complications prior to each inje
  11. Here is the medscape article. Interesting and entirely predictable. https://www.medscape.com/viewarticle/903840
  12. This is an article that it pays to look at the comments: Dr. Jonathan Anagnostou| AnesthesiologyDec 2, 2016 What about clinical practices or health systems which employ certified coders? carolyn buppert| Nurse Practitioner (NP)Dec 9, 2016 @Dr. Jonathan Anagnostou Yes, certified coders who are employed to code or to audit clinicians' coding would be in a position to code or to change a code prior to submitting for payment. This is similar to what happens in our institution. The organization is also at risk for billing subm
  13. We don't have Procalcitonin so my experience with this is limited. However, 40% of sepsis is culture negative. The negative lactate is a bit of a puzzle but I have seen this in hypothermic patients. Once you resuscitate them and get them warmed up the lactate will probably go up. In our shop the patient would get 7 days of broad spectrum antibiotics unless they have something we could target. By the time the cultures come back negative the patient is either dead or getting better and nobody wants to stop abx.
  14. This is septic shock until proven otherwise. It smells of GNR sepsis. This is a relatively common presentation for someone with untreated sepsis for a while. Especially when found down. would be willing to bet that the urine comes back dirty. A couple of things. When you have a pH like that and found down I would check a CK. You could have a superimposed rhabdo. It really wouldn't change management much except to go to dialysis early. On the subject of lack of tachycardia. Two answers either temp or the patient is on a beta blocker (fairly common depending on age). For that matter a
  15. I don't know if we have any PAs that split between ED and CCM but some of the CCM PAs moonlight in the ED. For us we work 3 days a week so there is time work elsewhere. We also staffed up critical care beds in the ED. Critical care in the ED is more difficult just due to the nurse staffing in our institution. On the other hand we do have PAs splitting jobs between departments. One of my coworkers is 1/2 time CCM and 1/2 time with our ID department doing sim training in Serious communicable disease (Ebola). She works six shifts a month then spends the rest of the month flying around the country
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