The medical necessity for treatment of port-wine stains.
ABSTRACT Port-wine stains are congenital vascular malformations that can be disfiguring and may lead to psychosocial as well as medical complications. The 585-nm pulsed dye laser is very effective in treating port-wine stains. Laser treatment is often viewed by insurance companies as a "cosmetic procedure" and not "medically necessary". Consequently many patients are denied coverage for treatment of their disfiguring birthmarks.
To determine variability of insurance coverage for laser treatment of port-wine stains from state to state. Natural history, progression, and potential complications of port-wine stains are reviewed and rationale for consistent insurance coverage for laser treatment of port-wine stains is given.
A questionnaire was mailed to 40 dermatologic surgeons in 22 states and the District of Columbia. We reviewed the literature regarding port-wine stains and their potential complications, and health care policy guidelines regarding "medical necessity" and "cosmetic procedures".
Insurance coverage for laser treatment of port-wine stains varies from state to state.
Based on current health care policy guidelines, laser treatment of port-wine stains should be regarded, and covered, as a medical necessity by all insurance providers.
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ABSTRACT: An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein. Dermatologists have been responsible for multiple advances and refinements in dermatologic office-based surgery over many decades. Dermatologists receive extensive training in office-based surgical procedures during residency, fellowships, and continuing medical education courses. The last update on this subject appeared in the Journal in 1999. This article will document the multitude of advances that have occurred since 1999.Journal of the American Academy of Dermatology 10/2013; · 5.00 Impact Factor
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ABSTRACT: Zusammenfassung Eine adquate Wrdigung der dermatologischen Lasertherapie fr medizinische Indikationen ist durch deren Erfolge in der sthetischen Medizin bislang nur in unzureichendem Mae geschehen. Im Zuge dessen wird die Anerkennung und somit auch der Einsatz der Methode fr eine Reihe dermatologischer Krankheitsbilder durch die Krankenkassen verwehrt. Medizinische Indikationen fr den Einsatz des Lasers finden sich in den verschiedensten Teilgebieten der Dermatologie. Diese reichen von pigmentierten Hautvernderungen (z.B. Becker-Nvus), benignen Tumoren und organoiden Nvi (z.B. Adenoma sebaceum), Dyschromien (z.B. Schmutzttowierungen), entzndlichen Dermatosen und Erkrankungen des Bindegewebes (z.B. kutaner Lupus erythematodes) ber Narben, Hypertrichose, Prkanzerosen bis hin zu vaskulren Hautvernderungen (z.B. Hmangiome und Naevi flammei). Im Folgenden werden durch den Laser beeinflussbare Dermatosen aufgefhrt und deren therapeutische Mglichkeiten diskutiert.Der Hautarzt 01/2003; 54(7):594-602. · 0.54 Impact Factor
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ABSTRACT: To identify the sensitivity and specificity of risk factors for the development of glaucoma in patients with port wine stain (PWS). A retrospective case-control study involving a large cohort of patients with PWS. A total of 216 patients (total of 252 eyes) with unilateral or bilateral PWS seen in the eye department in Great Ormond Street Hospital, London, United Kingdom. We studied the anatomic distribution of PWS and the incidence of choroidal hemangioma, episcleral hemangioma, iris heterochromia, and Sturge-Weber syndrome (SWS). We analyzed the sensitivity and specificity of these features as risk factors for glaucoma. Development of glaucoma. Mean age at presentation was 2.9 years (3 weeks to 18.8 years). Mean follow-up was 3.2 years (0-15 years). A total of 180 patients (83.3%) had unilateral lesion, and 36 patients (16.7%) had bilateral lesion. Thirty-one patients (14.3%) had isolated V1 lesion, 35 patients had V2 lesion only (16.2%), and 93 patients (43%) had both V1 and V2 involved. On the last visit, 46 eyes (18.3%) in 39 patients had glaucoma; their mean age was 3.25 years. Glaucoma was more common if PWS was bilateral (P=0.0001), both upper and lower lids were involved (P < 0.0001), and episcleral hemangioma (P < 0.0001), iris heterochromia (P=0.004), or choroidal hemangioma (P < 0.0001) was present. Twenty-four patients had SWS; this was significantly associated with upper lid PWS (P=0.001) and bilateral PWS (P=0.0003). Glaucoma was more common in patients with SWS compared with those without (66.7% vs. 18%, P=0.01). Combined upper and lower lid PWS, episcleral hemangioma, SWS, and iris heterochromia are sensitive prognosticators for the development of glaucoma. Iris heterochromia is associated with the development of early glaucoma in patients with PWS. Patients at high risk of glaucoma should be seen more often in clinic. Patients who do not have combined lid involvement or episcleral hemangioma have a lower risk and can therefore be seen less often in clinic. The author(s) have no proprietary or commercial interest in any materials discussed in this article.Ophthalmology 07/2011; 118(11):2274-2278.e1. · 5.56 Impact Factor