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[embed]http://www.youtube.com/watch?v=yMoJlz4h1-E[/embed]ALS Ice Bucket Challenge

Treatment of Pain and Suffering in the Terminally Ill

In contrast, when asked, most end-stage terminally ill patients do not choose artificial sustenance if the risks and benefits are adequately explained. It is the consensus of experienced physicians and nurses that terminally ill patients dying of dehydration or lack of nutrition do not suffer if treated properly. Clinical experience with severely ill patients suggests the major symptom of dry mouth can be relieved by ice chips, methylcellulose, artificial saliva, or small sips of water insufficient to reverse progressive dehydration. Although most people who voluntarily undertake starvation do not stop fluids, the history of total starvation for weight control supports the findings in terminally ill patient that hunger ceases with the build-up of ketones after three or four days of starvation and with little if any effect on mentation. Most of these principles derive from basic ethical principle of autonomy, which gives to the competent patient the right to accept or refuse medical treatment based on his or her own personal evaluation of quality of life and the value of prolonged survival. 

First, it is the physicians obligation to give symptomatic relief of pain and other forms of suffering to the full extent possible, in order to minimize patient stress that would lead them to consider methods of ending their life. A further medical consideration regarding VTD is acceptance of the physicians role in relieving the suffering of a patient even when the patient has chosen to follow a course of treatment different from that recommended by the physician. More specifically with regard to patient capacity to decide to undertake VTD, some of the factors which are likely to be taken into consideration are the state of the disease process, if full relief from pain and suffering has been achieved, and the realization that a decision to stop food and fluid, unlike a request for PAS, is so readily reversible, thus allowing the patient to change his or her mind if suffering were to occur. It is hard for many healthy people to accept that a chronically or terminally ill patient might choose to die rather than continue life, but the rapidly increasing acceptance of PAS by the public bespeaks an increased acceptance of such a choice. Numerous courts have been asked to directly rule on the question of whether medications can be given to relieve the suffering of a patient who directs medical providers to forsake life-support systems, including nutrition and hydration. 

Invariably, the courts have found giving medications to these patients to be legally permissible as long as they are given with the intent of relieving suffering and not causing death. Third, a pact should be made by the patient with his or her physician to use appropriate therapy to minimize suffering during the dying process and to remain available to comfort the patient by physical presence as well as treatment of symptoms, including pain, dyspnea, and dryness of the mouth. 

Keywords: [“patient”,”physician”,”fluid”]
Source: http://preciouslegacy.com/chap13.html

Advanced trophic changes such as: Hair growth; Nail changes; Pigmentary changes; Skin texture or skin color. 11055 Trim skin lesion 11056 Trim skin lesion, 2 to 4 11057 Trim skin lesion, over 4 11719 Trimming of nondystrophic nails, any number 11720 Debridement of nail(s) by any method(s); one to five 11721 Debridement of nail(s) by any method(s); six or more G0127 Trim nail(s) Debridement of Toenails Nail debridement involves the significant reduction in the thickness and length of the nail to the tolerance of the patient with the aim of allowing the patient to ambulate without pain. Medicare coverage of toenail debridement is limited to two situations: Debridement of hypertrophic nails associated with systemic conditions, and Mycotic nails in the absence of systemic conditions. Associated with systemic conditions: In those patients who have systemic conditions in which a metabolic, neurological, or peripheral vascular disease results in decreased sensation or severe circulatory embarrassment in the patient’s legs or feet, debridement may be covered. Claims for services, when there is a complicating systemic disease, require the name of the physician who is actively treating the patient for the condition. Mycotic nails in the absence of systemic conditions: In the absence of systemic conditions, mycotic nail debridement may be covered in ambulatory and nonambulatory patients if conditions are met: A. 

For ambulatory patients, the treatment of mycotic nails is covered only when the physician attending the patient’s mycotic condition documents that: 1. B. For non-ambulatory patients, the treatment of mycotic nails is covered only when the physician attending the patient’s mycotic condition documents that: 1. Three out of the five following signs: Nail hypetrophy/thickening; Lysis or loosening of the nail plate; Discoloration; Subungual debris; and/or Brittleness. Fungal infections of the nail plates or mycotic nails are common disorders that increase with age. 

The medical necessity requirements for coverage of foot care is determined by the medical condition of the patient and by the nature of the service performed, not by the provider of service. Any information, including that contained in a form letter, used for documentation purposes is subject to carrier verification in order to ensure that the information adequately justifies coverage of the treatment with nail debridement. Coding Guidelines: For debridement of nails the following information must be present of each claim: a. Diagnosis code of covered indication; b. Systemic condition diagnosis code; c. 

Class finding modifier of Q7, Q8, or Q9; and d. Name and UPIN of referring/ordering physician actively treating the patient’s condition as well as the date last seen. 

Keywords: [“”,”Nail”,”patient”]
Source: http://www.qnotes.com/resources/Pod_Medicare_Foot_and_Nail_Care_Services.pdf
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