Current procedural terminology coding for Mohs micrographic surgery.

Accurate surgical current procedural terminology (CPT) coding allows for proper reimbursement, decreases the possibility of being audited, and decreases the likelihood of inadvertently misrepresenting a claim. The CPT codes describe the type of services provided to a patient. CPT modifiers provide information to insurance payers to assure that the provider is reimbursed correctly. When coding for reconstruction of a surgical defect, the appropriate code is determined by the type of reconstruction performed. Reconstructive procedures that are performed because of underlying tumors are reimbursed. Adequate documentation is essential, because this substantiates claims and promotes their timely processing.

Coombs-positive hemolytic anemia secondary to brown recluse spider bite: a review of the literature and discussion of treatment.

The bite of the brown recluse spider (Loxosceles reclusa) typically results in local, dermonecrotic skin lesions. Rarely, these bites may precipitate systemic disturbances of varying severity collectively known as systemic loxoscelism. The more severe systemic alterations attributed to the venom of this arachnid include hemolytic anemia, multiorgan failure, disseminated intravascular coagulation, or even death. Coombs-positive hemolysis associated with brown recluse spider bites has rarely been documented in the literature. We report 2 cases of systemic loxoscelism in young women associated with severe Coombs-positive hemolytic anemia and systemic symptoms requiring hospitalization. Both patients were treated with aggressive wound care, hematologic monitoring with blood transfusion, and intravenous fluid replacement. Recovery was excellent in both cases. We review the literature and discuss the controversies surrounding the treatment of more severe brown recluse bite reactions.