ENT Practices and Physicians Who Twitter...

Did you know Fauquier ENT maintains one of the most comprehensive list of ENT physicians who twitter and are otherwise involved with social media not only in the United States, but in the world?

Check out the full list here. There are 76 and growing!

If you are an ENT practice or ENT physician not on the list, please let me know by DM @FauquierENT and I'll add you!

If you are a resident in otolaryngology, feel free to let me know as well.

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ASHA Recognizes Dr. Chang for His Educational Videos

ASHA, the American Speech-Language-Hearing Association, recently recognized the contributions that Dr. Chang has provided in ENT videos he has created for educational purposes.

In their recent newsletter on October 12, 2010, an article written by Judith Maginnis Kuster, MS, CCC-SLP, wrote an article titled "Videos on the Web". On page 24, she wrote:

Check out the videos she is talking about here.

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Not All Facial Fractures Require Repair... Ask Anaheim Duck's Getzlaf

Anaheim Ducks forward Ryan Getzlaf suffered multiple nasal and sinus fractures when he took a puck to the forehead during a win over Phoenix on December 28, 2010.

He visited a maxillofacial surgeon and had a CT scan which revealed those fractures were non-displaced and stable. A further evaluation determined that the bone breaks remained stable and that surgery was not be required.

This case illustrates that most facial fractures do NOT require surgical repair.

The key elements that lead towards a decision for surgery are the following (not all-inclusive, but general pointers):

- Any functional deficit including inability to open and close the jaw.
- Change in your occlusion (the way your teeth come together).
- Double vision (blurry vision does not count).
- Cosmetic deformity due to facial fracture (bruising and swelling does not count).
- Change in your ability to breath.

The two main specialties able to assess whether surgery is required or not is ENT and Plastic Surgery as well as some oral surgeons.

Read more about Ryan Getzlaf's injuries here.

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Fauquier Hearing Aid and Hearing Testing Services Offered at Fauquier ENT

Even though our office has been offering hearing tests and hearing aid services in Fauquier County for over a decade, many people are still surprised when they learn they can get hearing tests, hearing aids, ear plugs, and other ear & hearing services in our office. The additional benefit is having a ENT specialist also present in the same office.

Furthermore, we offer a comprehensive suite of other related services including non-sedated ABR (auditory brainstem response) hearing testing to specialized custom ear plugs for hunters and musicians.

We evaluate all different ages from 1 day old infants to the 99 year old hearing impaired patient.

The full list of Fauquier Hearing services we provide include:

Comprehensive Hearing & Audiometric Evaluations

• Hearing Testing from Birth to Adult
• Newborn Hearing Screening and Follow-up
• Otoacoustic Emmission Testing (OAE)
• Auditory Brainstem Response Testing (ABR)
• Tone Burst Auditory Brainstem Response (TB-ABR)
• Bone Conduction ABR Auditory Brainstem Response (BC-ABR)
• Auditory Steady State Response (ASSR)
• Electrocochleography (ECoG)
• Central Auditory Processing Evaluations (CAPD)

Hearing Aid Services

• Hearing Aid Evaluations and Consultation
• Hearing Aid Dispensing
• Advanced Digital and Wireless Hearing Aid Technology
• Aural Rehabilitation Counseling
• Hearing Aid Service and Repair
• Hearing Aid Accessories and Batteries
• Resources for Parents of Deaf and Hard of Hearing Children

Balance Evaluations

• Electronystagmography (ENG)
• Vestibular Evoked Myogenic Potentials (VEMP) for Meniere's Disease
• Vestibular Rehabilitation Counseling
• Canalith Repositioning 

Hearing Conservation

• Custom Swim Plugs
• Custom Hearing Protection
• Musicians Filtered Earplugs
• Earplugs for Hunters
• Custom Earmolds for iPods, Cell phones, Headsets
• Assistive Listening Devices and Technology 

For more information, please go to our webpage here.

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Video of Monkey Behaving Like a ENT Doctor

All I can say is look at time 0:41 - 1:25 in the video clip below. If you can't see the video below, click here.

Coming soon to an otolaryngology office near you...

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Dr. Chang a Northern Virginia Top Doctor for 2011

Northern Virginia Magazine published their annual list of Top Doctors for 2011 in their February 2011 edition. Dr. Chang was listed as one of Northern Virginia's Top Doctor in the field of Otolaryngology (page 68).

Of note, Dr. Chang was nominated by his doctor peers opposed to nomination by a small panel.

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Dr. Chevalier Jackson, Laryngologist Extraordinaire

On Jan 10, 2011, the New York Times published an article on Dr. Chevalier Jackson, a pioneer in the field of laryngology, who is perhaps best known for his extensive collection of foreign bodies he removed from patients, young and old, with little or no anesthesia. His genius is documented in a new biography called "Swallow" by Mary Cappello.

Among other achievements by Dr. Jackson was passage of the Federal Caustic Poison Act of 1927, esophageal dilatation in kids, and treatment of many poor children without pay.

Perhaps the one thing Dr. Jackson was mistaken on was the discouragement of high tracheostomies or cricothyrodotomies back in 1921.

Of note, Dr. Jackson's foreign body collection (2000+ items) is now owned by the Mütter Museum of the College of Physicians of Philadelphia... a fantastic museum I may add.

Read the NYT article here.

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ICD-10 Coding Primer for Otolaryngologists

If you are a physician... you probably already know what I am talking about...

ICD is the "International Statistical Classification of Diseases and Related Health Problems" used by physicians to code a given medical problem whenever a patient sees a doctor. This "code" is what is submitted to insurance companies along with medical charges.

Periodically, ICD undergoes an update and in the United States, it is about to undergo a MAJOR update come October 1, 2013 to version ICD-10-CM. The current ICD being used in the Unites States is ICD-9-CM.

What are these changes as it relates to otolaryngolgists?

First the basics:

Differences in organization & structure, code composition, and level of detail.
ICD-9-CM	ICD-10-CM
Consists of three to five characters First digit is numeric or alpha (E or V) Second, third, fourth, and fifth digits are numeric Always at least three digits Decimal placed after the first three characters	Consists of three to seven characters First digit is alpha All letters used except U Second and third digits are numeric Fourth, fifth, sixth, and seventh digits can be alpha or numeric Decimal placed after the first three characters

ICD-10-CM codes may consist of up to seven digits, with the seventh digit extensions representing visit encounter or sequelae for injuries and external causes.

ICD-9-CM Code Format	ICD-10-CM Code Format

SO... here are some examples of how the code changes from ICD-9-CM to ICD-10-CM:

Diagnosis	ICD-9-CM	ICD-10-CM
Right Earwax	380.4	H61.21
Left Earwax	380.4	H61.22
Bilateral Earwax	380.4	H61.23
Unspec Earwax	380.4	H61.20
Right Acute Otitis Externa	380.1	H60.311
Left Acute Otitis Externa	380.1	H60.312
Bilateral Acute Otitis Externa	380.1	H60.313
Unspec Acute Otitis Externa	380.1	H60.319

As you can see, what used to be a single code like 380.4 for earwax is now split into as many as 4 different codes based on side. Such increased specificity goes across the board for pretty much every diagnosis.

ICD-10-CM has numerous other new features allowing for a greater level of specificity and clinical detail.

• Combination codes for conditions and common symptoms or manifestations
• Combination codes for poisonings and external causes
• Added laterality
• Added extensions for episode of care
• Expanded codes (injury, postoperative complications)
• Expanded detail relevant to ambulatory and managed care encounters
• Changes in timeframes specified in certain codes
• External cause codes no longer a supplementary classification

ICD-10-CM also includes added standard definitions for two types of excludes notes. Excludes1 indicates not coded here. The code being excluded is never used with the code. The two conditions cannot occur together. For example, B06 Rubella [German measles] has an Excludes1 of congenital rubella (P35.0).

Excludes2 indicates not included here. The excluded condition is not part of the condition represented by the code. It is acceptable to use both codes together if the patient has both conditions. For example, J04.0, Acute laryngitis has an Excludes2 of chronic laryngitis (J37.0).

An additional feature is the expansion of codes for certain conditions like postoperative complication codes. Here's one if you accidentally leave behind a neuro paddy in the nose after sinus surgery causing nasal obstruction:

• T81.524 codes for "obstruction due to foreign body accidently left in body following endoscopic examination"

Code extensions (seventh character) have been added for injuries and external causes to identify the encounter: initial, subsequent, or sequela. The extensions are:

• A Initial encounter
• D Subsequent encounter
• S Sequelae

So that's a primer on how ICD-10-CM coding WILL affect otolaryngologists. A lot more time will be spent on coding than now.

The American Academy of Family Physicians has produced a superbill comparing ICD-9 and ICD-10. What took only 2 pages with ICD-9 will take up 9 pages once ICD-10 goes into effect. Sigh!

Click for ICD-9 and ICD-10 Superbill

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Pediatric ENT Care of Warrenton, Virginia (Fauquier County)

Recently, there has been some confusion regarding whether our office deals with adults only or do we see kids as well... Strangely enough, we also get asked by parents whether our office sees adults when seeing a pediatric patient.

To clear up any confusion, our office does see kids AND adults... starting from birth to the elderly.

Dr. Chang who joined the office in October 2005, was named one of America's Top Physicians by the Consumer's Research Council of America in 2008 as well as a Northern Virginia Top Doctor for 2011 (to be published in February 2011).

Some common problems and procedures for which Dr. Chang sees kids specifically include:

- Tongue Tie Release (starting from ONE DAY OLD!)
- Tonsillectomy
- Adenoidectomy
- Sinus Surgery starting with adolescents
- Ear Tube placement
- Hearing Loss
- Nasal Obstruction
- Nasal Congestion
- Snotty Nose
- Speech Delay
AND many other issues...

Our office has even created videos on a few common pediatric procedures including tonsillectomy, adenoidectomy, earwax removal, ear tubes placement. Watch the video below on tonsillectomy.

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New Video Uploaded on Earwax Removal Under the Microscope

Our office has produced a new video on earwax removal under a microscope that we have uploaded onto our YouTube Channel.

Click here to watch it or watch it below!

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Fauquier ENT Social Media Update

I have had a few readers comment that our office should offer twitter, have a facebook page, or some other social media outlet...

My answer is that we actually already do! So here's the full list along with subscribers (as of June 8, 2010) for each and link.

YouTube Channel (1,865 Subscribers)
http://www.YouTube.com/FauquierENT

We get about 250,000 hits a day on YouTube!!!

Facebook Page (80 Friends)
http://www.facebook.com/FauquierENT

Twitter (267 Followers)
http://twitter.com/fauquierent

Blog (~35 Subscribers)
http://fauquierent.blogspot.com



Thanks to all who follow/friend/subscribe already!!!

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Fauquier ENT Blog Included in the Webicina Collection for Otolaryngology!

I was pleased to learn that Fauquier ENT Blog (what you are reading now) has been included in the Otolaryngology section of Webicina, an aggregator of quality medical information, online courses and workshops.

Check it out here!

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RANDOM: Washington Post Cartoon Making Fun of ENT

A patient of mine brought the funnies from the Oct 28, 2009 Washington Post of a cartoon by John McPherson poking fun at ENT.

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Crazy Pumpkin Carvings Related to ENT

In celebration for Halloween today, I have found a few crazy pumpkin carvings courtesy of Extreme Pumpkins.




Here is the one that I carved, complete with snotty tissues:




If you have another relevant one, please comment and include a link to a picture. Enjoy!

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