Asthma is a chronic lung condition that is characterized by difficulty in breathing, wheezing, and mucus accumulation. People with asthma have extra sensitive or hyper-responsive airways. During an asthma attack, the airways become irritated and react by narrowing and constricting, causing increased resistance to airflow, and obstructing the flow of the air passages to and from the lungs.

Some research indicates that the symptoms of asthma may get worse when you have heartburn or acid reflux. Acid reflux occurs when your undigested stomach content moves back up into your esophagus.

Acid reflux can cause painful heartburn which you can relieve with antacid medicines or natural remedies. Antacids simply neutralize your stomach's acid, which reduces the burning sensation in your esophagus tube. It is best to use natural remedies first because neutralizing stomach acid is a temporary method and only serves to suppress the cause of acid reflux.

For acid reflux, it is best to use digestive enzymes. Take a good digestive enzyme with every meal you eat. The next step would be to learn how to eat so you don't get acid reflux or heartburn.

Acid reflux happens mostly in people who are older and overweight. But sometimes it can happen in children and in all types of people.

In some studies, researchers have injected acid into the esophagus of people with asthma, and it had a significant impact on their asthma and increased their asthma symptoms.

There is also evidence to suggest that people who have asthma get acid reflux more often than people without asthma. This is probably because of the big pressure changes in the chest during breathing in people with asthma. These high pressures could force liquid to travel the wrong way up the esophagus.

In these cases, asthma sufferers seem to lose out twice: they suffer from asthma and they may suffer from acid reflux more often than non-asthma sufferers.

However, this is not the whole story. If acid reflux really was an important cause of asthma worsening, then treatments against acid reflux should make the asthma better, however, this is generally not the case.

In the meantime, if you have asthma and you also have acid reflux, it could just be that careful treatment of your reflux will make your breathing better.

If your asthma is bad and no one knows why, some doctors would check whether you have or had acid reflux by conducting tests to measure the acidity in your stomach. If the result showed a tendency for acid reflux, then your doctor should help you eliminate this condition.

Using a doctor who uses natural methods to treat acid reflux is the best way to go. Using drugs to eliminate acid reflux when you are already taking drugs for asthma is asking for addition health problems in the future. Drugs do not cure acid reflux but cause the condition to worsen. It is best to use natural remedies and diet to eliminate acid reflux and heartburn.

Remember that while reporting for inhaler demo/evaluation is the type of device the provider is using; however do not stop with just that. Documentation requirements and qualifying modifiers are just as important while coding for inhaler services.

When you are confused why some payers would reject your payments for certain inhaler claims, the following areas could teach you to a better understanding of how inhaler services work out.

94664: Your ticket to Diskus Demo Pay

The Advair Diskus happens to be an "aerosol generator"; if the nurse or for that matter medical assistant taught someone to use an Advair Diskus -- or any other diskus - you should code 94664 (Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

Here's an instance: A pulmonologist begins a patient with asthma on Advair. Post this, a nurse teaches the patient ways to use the Diskus. According to CPT guidelines, you should code 99201-99215 for the office visit and 94664 minus a modifier.

What's more, CMS transmittal R954CP also points out that modifier 25 (Significant, separately identifiable Evaluation/Management service by the same physician on the same day of the procedure or other service) applies only to Evaluation/Management services carried out with procedures that carry a global fee, which 94664 doesn't have.

Nevertheless, many payers will pay for the service only if you add modifier 25 to the visit code. It is always best to check with major insurers' policy first.

Bundle dose in teaching session

During the teaching session, the patient may administer medication dose. Both services (treatment + teaching) are bundled into one CPT: 94640 so you should not report them separately.

The reason is that the administration was carried out as part of the demonstration/evaluation.

In case of separate education, end it with modifier 59

Think that during an outpatient visit, an asthmatic patient is wheezing and having trouble breathing, which requires one or more bronchodilator treatments for intervention: 493.01 (Extrinsic asthma; with status asthmaticus); 493.02 (Extrinsic asthma; with [acute] exacerbation); 493.21, (Chronic obstructive asthma; with status asthmaticus); or 493.22 (Chronic obstructive asthma; with [acute] exacerbation).

The patient did not use his MDI device, nebulizer, and the like, properly before the visit; as such he was given an education about the use of these devices post the treatment.

Report it: At the outset, code 94640 (adding modifier 76, Repeat procedure or service by same physician, to separate line items of 94640 for multiple treatments) apart from the proper E/M code minus a modifier, unless the payer needs modifier 25 with the Evaluation/Management. The code 94664 with modifier 59 (Distinct procedural service) since the patient needed additional instruction for his daily medication.

This is unlike the medication provided for immediate intervention (94640).

In a nutshell, if the patient required separate education after getting an inhalation treatment on the same day, you'd bill both services (treatment and education) adding modifier 59 to 94664.

Pocket through medical necessity support

If payers wouldn't reimburse your 94664 claim, you'd need to support it with documentation indicating medical necessity to compensate around national rate (0.47 RVUs multiplied by 2011 conversion factor of 33.9764). For example, you might need to state in the plan of treatment portion of the written record that the patient needs a teaching session on the use of his MDI, diskus, nebulizer, and the like. What's more, do not forget to write down why the session is required.

For more on this and for other specialty-specific articles to assist your otolaryngology coding, sign up for a good medical coding resource like Coding Institute.

COPD is one of the most difficult health conditions to live with and to actually control. COPD refers to chronic obstructive pulmonary disorder which in fact is a respiratory condition that prevents the body from getting enough oxygen. As oxygen is the key to all life it is of the utmost importance to ensure that enough oxygen is being received by the body. In cases of those individuals with COPD they may at many times not get enough oxygen and as a result they need to be very careful in monitoring their heath in order to make sure that they are getting enough oxygen. COPD can continue to get worse through time should the individual not closely monitor their vital signs. However, the problem always was that individuals are always on the move and need a device where they can monitor their health on the go.

Such a device is a portable pulse oximeter that can help those individuals living with COPD. A pulse oximeter is a medical device very much suited for helping those individuals living with the condition. Although many consider the device to be those big machines that were found the hospital, the new pulse oximeter devices are quite portable. They are powered by a set of batteries and the individual living with the health condition just takes the device with them and can measure their oxygen levels instantly. The other great part of it is that they can also actually measure their oxygen levels on a continuous basis. A pulse oximeter works quite effectively to measure the pulse rate as well as the blood oxygen saturation of an individual The device is only a fraction of the size of a typical cell phone and thus it is extremely portable. It also is very accurate and instantly gives a reading of the oxygen saturation as well as pulse rate within seconds. By inserting your finger inside the portable device an infrared light passes through you finger. Hemoglobin absorbs light at different frequencies and as such the infrared light that goes through the finger bounces back to the oximeter device computer with a number that represents the oxygen levels of the body. This number means the world to people who live with conditions that require accurate monitoring of the oxygen levels in the body. Oximeter devices continue to break ground not only in the hospital setting but also the home setting as well. No longer do individuals need to be at their physicians office or a hospital in order to take advantage of such a device to monitor their health. The newest generations of devices are not only extremely small and portable but they also are extremely affordable. So individuals living with various health conditions that are necessary to measure their oxygen levels can now use the device in the comfort of their home without ever having to worry about not monitoring their health on a continuous basis. The portability also allows them to take the device wherever they desire to go.

Do you suspect your teen is in an abusive dating relationship? Some teens feel that having a boyfriend or girlfriend proves their own worth. They may feel so strongly about having a relationship that a bad relationship is better than no relationship at all. Teens are also highly susceptible to a general and common belief that not having a romantic relationship means there is something wrong mentally, emotionally or physically. Boys and girls can share these same feelings. It is not only girls at risk.

Positive role models in healthy relationships are important for teens to learn the necessary skills in dating relationships. Without positive role models teens may not realize their behaviors in dating relationships are abusive or that they are in an abusive dating relationship. If mom endured pain with dad, this type of scenario can be passed onto teens in their relationships. If dad hit, slapped or yelled at mom, then Charlie will be more likely to slap, hit yell or demean his girlfriend, Suzy. The same goes the other way around, if mom makes all the decisions, and rules the roost so to speak, or decides she can go where she pleases while dad sits home and babysits, then Suzy is more likely to behave much the same in her relationships. Abuse wears many hats and appears in many different faces. Abuse can be subtle or very obvious resulting in broken bones, bruises and even death.

When talking to teens, focus on what healthy relationships are. Partners should respect each other’s opinions, decisions and personal privacy. When decisions and choices are to be made both partners should be able to express feelings, desires and wants. It is never healthy for one person to have a great amount of control over another person. Each person needs space for personal and separate identities. No one should have to give up their individuality to be part of a couple. Each partner needs separate time and space to pursue independent activities and engage in other friendships. Healthy relationships have strong foundations of trust and honesty.

Discuss with your teen the reality that a true caring partner is concerned about the well-being of the other partner and wants what is best for that person. A caring partner is able to share joy about the success of the other partner instead of expressing jealousy. A true caring partner will be of support in times of trouble. Define healthy relationships to your teens as being a place where both partners feel safe emotionally and physically.

If you observe teens exhibiting behavior other than mutual respect in dating relationships give them the opportunity to talk about appropriate behavior toward significant others. Any indication of situations escalating into abuse or dating violence should quickly be reported to agencies that can help.

Review some of the tips below to help you build a strong and trusting relationship with teens:

• Always respect your teen. Avoid ridicule or humiliation. If you have more than one teen, avoid playing favorites between them. If you want cooperation, never allow a teen to perceive you do not like him or her.

• It is rude to talk about other people, whether it is family members, a friend, enemies or what have you. Be a role model in showing respect to other adults and everyone.

• In dealing with teens, be sure roles are well established and that it is clear you are the adult.

• Don’t pretend to be a teen yourself and just hanging out with other teens. Teens will see right through a pretense. They respect adults who act like adults, and they actually need this more from an adult than one who tries to be just one of the gang.

• If you tell a teen you will do something, by all means keep your word. They in turn will learn to keep their word with you and others. This is setting an example of “strong character.” Teens need to know they can depend on you in whatever circumstances they face.

• Be patient when trying to build a trusting relationship with a teen. Allow them to bond with you at their own pace.

• Take time to genuinely listen to a teen’s concerns and dreams. Develop skills that will help teens to solve their own problems and avoid telling what you think they should do in any given situation.

• Let your teen know you believe in him or her and in their own personal abilities. They will learn to believe in themselves and develop a strong self confidence within themselves.

This article is FREE to publish with the resource box.

One of the things that we tend not to clean is our bed mattress. Usually, we just buy new ones and throw or give away the old ones. But if they are not clean, we also pass whatever lives inside the mattress to the new owners. What if the new owners are sick? Or if they have children? Or someone inside their house are already sick? That mattress that we just gave away might worsen their illness.

If you keep buying new ones instead of cleaning the mattresses, it would cost you tons of money. And if it is dirty, there are a lot of diseases that we can get from it. How? Because of the organisms that lives on dirty mattresses. What are those organisms? Bed bugs, dust mites, and molds.

BED BUGS
This insects feed on any warm-blooded hosts which includes us and our pets. As of now, there are no related disease that you can get from their bites. However, due to its itchy bites, we may get stressed, anxiety, and insomnia. Especially, if we get bitten a lot of times. We can also get skin infection and scars from scratching the bed bug bites.

They are fond of living in places like the sofa, furniture, and mattress. They love to be near the hosts that they feed on. Bed bugs do not like a lot of light so they only feed at night when the hosts are already in their deep sleep.

DUST MITES
They are microscopic bugs that live and feed on dead skin cells that are shed by us and our pets. They may seem harmless to most of us but a single dust mite produces 20 wastes (feces) each day which contains a protein that makes people get an allergic reaction and induce asthma to people who are asthmatic.

MOLDS
They are fungi that lives indoors and outdoors. They love warm, damp, and humid places. There are so many types of molds that some of them produces mild health problems while others can produce serious health problems which could eventually lead to death.

Some of the common symptoms are coughing, sneezing, difficulty to swallow, spitting, burning throat and lungs, asthmatic signs, nausea, diarrhea, kidney and liver pain, coated and discolored tongue, memory loss, vision problems, headaches, anxiety and depression, balance problems, chronic fatigue, excessive sweating, nose bleeding, easily bruised, infertility, sudden weight changes, cancer, hair loss, brittle nails, muscle pain and stiffness, irregular heart beat, seizures, numbness of the face, hypersensitivity, and anaphylaxsis.

Keep in mind that not all people develop 'all' the symptoms. Babies, elderly, and people with immune problems are the most susceptible in developing serious conditions. Excessive mold build up needs to be taken care of immediately. It can lead to toxicity, allergies, building and structure problems, and death.

Here are some examples of common molds that lives indoors and outdoors:
Aspergillus spp is the most common fungi in our environment. It has more than 160 different mold species. Exposure to them can cause skin rashes, hair loss, vomiting, and more.

Stachybotrys chartarum is a greenish-black and slimy mold that can be found indoors where water damage goes unnoticed. They can live anywhere like inside the wallpaper, walls, ceiling tiles, etc. This type releases a very toxic mycotoxin. Exposure to this fungi can cause memory loss, acid reflux, nose bleeds, flu symptoms, headache, seizures, and more.

To simplify, the types of molds are:
Allergenic molds are not dangerous to our health in low amounts of exposure but they can cause allergic and asthmatic symptoms.

Mycotoxic molds are known to cause serious health problems. The symptoms ranges from irritation, auto-immune diseases, cancer, and death.

Pathogenic molds can also cause serious illness to people with immune deficiencies. Example of them are people taking chemotherapy and people with AIDS/HIV. If you suspect that you have the symptoms, seek professional help and guidance. You should also have your family and pets checked by their doctors for mold toxicity.

It is important to have your house, building, or office checked. If you are going to do it yourself, be sure to wear rubber gloves, masks, and goggle or eyes shields. Look around for these three organisms (bed bugs, dust mites if there are excessive dust, and molds) in bed mattresses, upholstery, furniture, basement, attic, ceiling, and anywhere you suspect.

If you found large quantities or if you do not know how to look for them, call a reputable cleaning company or any company that specializes in their removal. Remember, cleaning and maintaining our home, buildings, and offices can improve our health and our budget.

Last researchers pointing that women who suffer during pregnancy certain complications could be more likely to develop a special kind of premature cardiovascular disease, according to these studies published, mothers with maternal placental syndrome have double risk of developing cardiovascular disease in a early state, and if we talk about maternal placental syndromes we could mention it syndromes such as; pre-aclampsia and high blood pressure for instance.

In cases where pitifully the baby died or his growth was restricted, the odds will increase further, so the risk of developing a premature cardiovascular disease after a maternal placental syndrome is higher, this will very probably in the case where the fetus is adversely affected.

A piece of advise for mothers in order to prevent, is measure their blood pressure to see if it is at a normal level, this could be 4 or 6 months after the birth, other cardiovascular disease risk factors could be obesity, raised cholesterol levels, smoking and insulin resistance. To say, the maternal placental syndrome should be considered as an additional risk factor for cardiovascular disease.

The link between placenta problems in pregnancy and heart disease has been assessed by scientists in a recently study with more than 1.000.000.- healthy women, about 75.000.- were diagnosed with maternal placental syndrome, 7.5 %.

The big problem is that there is a pandemic of obesity in our midst, whoever could think that we must ensure that women are a healthy weight before they enter their reproductive years.

In conclusion, this article tell us about the importance to reduce our premature cardiovascular disease risks, and that may be done with preventive controls' blood pressure for instance or with a healthy weight before, during and after pregnancy and controlling the other risk factors for cardiovascular disease, but the most important in my personal opinion is to learn all aspects involving in pregnancy and maybe this article could be a little bit useful by someone in this beautiful process.

Indo 00004000 or air pollution and not smoking cheap cigarettes is the most important cause of chronic obstructive pulmonary disease (COPD) in India, reported a prevalence study conducted by Pune-based Chest Research Foundation (CRF) in collaboration with the KEM Hospital, Pune, and the Imperial College, London.

In the West and other wealthier countries, smoking is the single most important causative factor of COPD. The CRF study found that the prevalence of the respiratory disease was 6.9 per cent in the Indian population. Among those identified with COPD, only 7 per cent were tobacco smokers while the remaining 93 per cent were non-smokers.

Almost 700 million people in India suffer from high levels of indoor air pollution affecting women and young children as 75 per cent homes use biomass fuel like wood, crop residue and dung cakes. Other research declared that exposure to wood smoke through home heating and cooking or through ambient neighborhood pollution may further increase the risk of COPD and related pulmonary problems in smokers. The age factor was particularly disturbing.

"Approximately 23 per cent of COPDs occurred in people less than 40 years of age. It was believed that COPD starts after 40 in people who have been smoking for over 15-20 years. In India, where the exposure to indoor air pollution begins from childhood, it occurs in younger people," said chest physician Sundeep Salvi, director of the CRF. Statistics show that on March 2010 were found 10 causes of deaths in Maharashtra, and COPD was the main cause of these deaths. What can help at this moment is a national COPD control program. "We have such programmes for malaria, filariasis, tuberculosis and AIDS. The mortality is far too high in COPD than any of these diseases.

Policy makers should take up the issue and act fast, "said Salvi. "Even though there is no similar report from other states in India, it seems likely that COPD may be one of the leading causes of death in other states too. The WHO had compiled a nationwide analysis in 2002, and reported that deaths due to chronic respiratory diseases accounted for the second largest cause of death, with COPD as the main cause of respiratory deaths," said Salvi.

He spearheaded the study along with social scientist Sanjay Juvekar from KEM Hospital and Peter Barnes, an eminent professor of respiratory medicine at Imperial College, London (UK). The study was conducted in 22 rural villages in Pune district with a population of over 1 lakh.