IDSA News - October 2009
The Emerging Infections Network (EIN) is a forum for infectious diseases consultants and public health officials to report information on clinical phenomena and epidemiological issues with public health significance. Any diagnostic or therapeutic recommendations and all opinions presented are those of the individual contributor. They do not necessarily represent the views of EIN, IDSA (EIN’s sponsor), or the Centers for Disease Control and Prevention (CDC), which funds the EIN. The reader assumes all risks in using this information.
With the influenza season picking up steam, EIN members are discussing seasonal and H1N1 flu vaccination, including the use of inactivated and live attenuated influenza vaccine (LAIV). A member from Chicago started a recent discussion by asking if the intranasal form of the H1N1 vaccine and seasonal LAIV could be given simultaneously.
A respondent from Seattle posted an excerpt from a clinician question-and-answer guide from the Centers for Disease Control and Prevention (CDC), whose existing recommendations are that two inactivated vaccines—or an inactivated and a live vaccine—can be given any time before, after, or at the same visit as each other. CDC advises, “Live attenuated seasonal and live 2009 H1N1 vaccines should NOT be administered at the same visit until further studies are done. If a person is eligible and prefers the LAIV formulation of seasonal and 2009 H1N1 vaccine, these vaccines should be separated by a minimum of four weeks.”
A respondent from the CDC also referenced the agency’s recently posted Top 10 list of frequently asked questions—and answers—about the use of influenza vaccine, covering practical considerations for immunization programs and providers, including the use of both live and inactivated forms of seasonal and H1N1 vaccine.
Several EIN members also replied to a member in Arizona who asked about the vaccination of health care workers (HCWs) with the live form of the H1N1 vaccine at institutions with bone marrow transplant (BMT) units:
“We will not give LAIV to the nursing staff and other ‘regular’ BMT HCWs, but our BMT docs are concerned about other HCWs getting LAIV,” the member wrote. “Are you giving LAIV to other staff (e.g., EKG/X-ray/CT techs, phlebotomists, etc.) who go to different areas of the hospital, including the BMT unit? If so, should they (or the patient) wear a surgical mask during the encounter for a period of time after getting LAIV? Is it safe to take care of a BMT patient beyond seven days after receiving LAIV? From my reading, it does not seem like there’s viral shedding beyond seven days in healthy adults.”
A respondent in Florida wrote, “We do not allow any HCWs or employees to get live attenuated flu [vaccine] in our cancer hospital to prevent the rare possibility of transmission.”
A Tennessee member shared this response: “I am in charge of infection control at a children’s cancer hospital. We have been administering LAIV to health care workers here for five years without adverse effects.” Per guidelines from CDC’s Advisory Committee on Immunization Practices, the member continued, “we restrict vaccine from HCWs who will be taking care of inpatient bone marrow transplant patients in the seven days following receipt of vaccine but do not have any other exclusions related to [immunocompromised hosts].”
“In addition, we have conducted two clinical trials in the last three years administering LAIV to children with cancer, including leukemia, and have not seen any adverse events or prolonged shedding in recipients,” the member added. “We believe use of LAIV in hospitals is safe and is a useful adjunct vaccine to offer in the effort to improve HCW vaccination rates.”
Another EIN discussion involved timing. “Now that H1N1 LAIV is becoming available, say you have [an] otherwise healthy child in your office, and it is not recommended to give both seasonal and H1N1 LAIV at the same visit,” a Connecticut EIN member posted. “Which do you give first, knowing that you will have to wait one month between doses of live vaccine? Would you give H1N1 LAIV and wait a month for seasonal LAIV or vice versa?” Some practices have not gotten their allotment of inactivated seasonal influenza vaccine, the member added.
“If you were going to do both vaccines as live intranasal, I’d do the H1N1 first because it's circulating now, and seasonal flu (mostly H3N2) hasn’t arrived yet,” a Minnesota member replied. “Giving nasal H1N1 and [intramuscular] seasonal vaccine simultaneously seems a desirable approach as it only requires one visit, provided you’ve gotten supplies of both vaccines.” Several other respondents also suggested giving the LAIV form of the H1N1 vaccine first, if necessary, citing the current prevalence of H1N1.
CDC’s website and IDSA’s influenza webpage offer additional information for physicians and other health providers about the H1N1 and seasonal influenza vaccines, including vaccination information statements and the latest clinical guidance.
The Emerging Infections Network (EIN) is a provider-based sentinel network designed to help the public-health community detect trends in emerging infectious diseases.
A joint project of IDSA and the Pediatric Infectious Diseases Society (PIDS) with funding from the Centers for Disease Control and Prevention (CDC), EIN tracks emerging infectious diseases and keeps the public-health community up to date with new disease trends, difficult cases, and other issues affecting members’ clinical practices. The Network provides a great opportunity for members to share knowledge quickly across large geographical distances. Both IDSA and PIDS members are eligible to join. Click here for more information or to join EIN.
IDSA offers two e-mail services to help members stay informed of updates from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). Content normally includes a range of topics, including new drug approvals and warnings. Recent alerts have included:
IDSA members can sign up for these services online. (You must be logged in to have access to this link.)
Is Your Facility Experiencing Antibiotic Shortages?
Report these to FDA and IDSA.
During this challenging influenza season, new billing codes have been developed for the administration of the H1N1 vaccine. Medicare will pay physicians for administering the H1N1 vaccine this year, including when it’s given to patients who also receive the seasonal influenza vaccine. But the agency won’t reimburse physicians for the actual H1N1 vaccine because the vaccine will be supplied to providers for free.
To bill Medicare for administering the H1N1 vaccine, use code G9141 (influenza A, H1N1, immunization administration—including counseling the patient or family). It is not necessary to place the H1N1 vaccine code (G9142) on the claim. For more information on Medicare coverage and reimbursement rules for the H1N1 and seasonal influenza vaccines, see this CMS fact sheet and related article.
The American Medical Association (AMA) has also developed a current procedural terminology (CPT) vaccine administration code, 90470, specific to the 2009 H1N1 virus, and revised existing code 90663 to report either the intranasal or intramuscular formulations of the H1N1 virus. For purposes of safety tracking, it has been requested that National Drug Codes (NDCs) be added to the claim sheet. For more information about CPT codes for the H1N1 vaccine, see this AMA webpage and fact sheet. While many private payers are likely to cover administration of the vaccine using these codes, physicians should contact individual insurers for specific billing instructions.
To obtain a supply of the H1N1 vaccine, physician offices will need to contact their state health departments. See the Centers for Disease Control and Prevention (CDC) for a list of state contacts.
For other questions about CPT coding, use IDSA’s “Ask the Coder” e-mail portal to contact a certified professional coder. (You must be logged in to access this link.)
Eric Goosby, MD, the Obama administration’s global AIDS coordinator, will be the keynote speaker at a symposium on “HIV in the Developing World,” Saturday, Oct. 31, at the 47thAnnual Meeting of IDSA, one of several global health-related sessions scheduled during the meeting, Oct. 29-Nov. 1, in Philadelphia.
During the 10:30 a.m. to noon session, Dr. Goosby will give an update on the U.S. response to the global AIDS epidemic. The United States has led worldwide efforts to curb the spread of HIV/AIDS through the President’s Emergency Plan for AIDS Relief (PEPFAR), first enacted in 2003 and reauthorized last year. Dr. Goosby is charged with implementing the newly reauthorized program.
The symposium will also feature presentations by Quarraisha Abdool Karim, MD, of the Mandela School of Medicine and Columbia University, and Mark Cotton, MD, of Stellenbosch University in South Africa, who are expected to discuss the deadly intersection of HIV and tuberculosis in the developing world, the importance of reducing HIV infection in women, and HIV treatment and prevention in infants and children.
A second global health symposium, “HIV and Tuberculosis,” scheduled for Saturday, Oct. 31, 5:30 to 7:30 p.m., will focus on the twin epidemics of HIV and TB. William J. Burman, MD, medical director of the infectious diseases clinic of Denver Public Health, will detail the promise of new TB drugs and how innovations on the horizon could change the treatment of this ancient disease.
Other presenters will include Richard Chaisson, MD, FIDSA, of Johns Hopkins University; Gerald Friedland, MD, FIDSA, of Yale University; and Madhukar Pai, MD, of McGill University. Dr. Friedland will discuss the threat of drug-resistant TB, while Dr. Pai will address the challenge of diagnosing TB infection in HIV-positive patients.For more information, visit the Annual Meeting website and the online program planner, which you can use to search for specific sessions and speakers, creating your own, day-by-day, personalized itinerary for the meeting. You can also follow IDSA on Twitter for important meeting updates.
Physician-scientists working on the front lines of the HIV/AIDS epidemic have urged the White House to set bold new HIV treatment targets for the PEPFAR program, the President’s Emergency Plan for AIDS Relief. Earlier this month, the Center for Global Health Policy joined with a coalition of other advocacy groups—including Health GAP, amfAR (the Foundation for AIDS Research), the Treatment Action Group, and The AIDS Institute—in calling for PEPFAR to reach 6 million people with treatment by 2013 and 7 million by 2014.
"The rapid scale up to provide antiretrovirals to millions of people through PEPFAR and other programs has made AIDS a manageable chronic disease in many resource-constrained environments,” said Kenneth Mayer, MD, co-chair of Global Center’s Scientific Advisory Committee, in a press release. “However, the majority of people who need life-saving treatment are not receiving it. With data suggesting that earlier treatment may prevent long-term consequences of HIV disease and may make HIV-positive people less infectious, there is increased urgency to expand access to these medications.”
The Global Center and its partners also sent a memo to U.S. Global AIDS Coordinator Eric Goosby, MD, detailing this HIV treatment imperative and noting that these aggressive new targets will allow the United States to continue its strong leadership in combating global AIDS. The targets can easily be reached if the funding for global AIDS, included when lawmakers reauthorized PEPFAR last summer, as the Lantos-Hyde Act, is actually provided.
It seems there are still more questions than answers about how the President’s Emergency Plan for AIDS Relief (PEPFAR) will achieve a key milestone: recruiting and retaining 140,000 new health care workers over the next five years in countries hard hit by the AIDS epidemic.
Congress included that provision when lawmakers reauthorized PEPFAR last year, part of a broader effort to strengthen developing countries’ health systems. But turning that promise into a reality is a tall order, given the severity of current workforce shortages, the time, effort, and expense involved in training new doctors and nurses, and the brain drain of health care professionals from resource poor countries to more affluent ones. You can read more about this issue at the Center for Global Health Policy’s blog, ScienceSpeaks.
During a recent presentation at the Global Health Council, Karin Turner, a senior USAID official whose portfolio includes health system strengthening and heath care workforce issues for Southern Africa, said there was still some “fogginess” on how this effort would unfold in the context of PEPFAR’s pivot to focus more on health system strengthening.
Some of the uncertainties Turner highlighted:
Read more about this topic and other global health news at sciencespeaks.wordpress.com.
New Reports Highlight Antibiotic Resistance, Ways to Spur Drug Development
Two recent European reports, reminiscent of IDSA’s 2004 “Bad Bugs, No Drugs” report, describe the growing problem of antimicrobial resistance in Europe and highlight possible strategies, including incentives, to stimulate the development of new antibiotics. Both were part of an international conference sponsored by the European Union (EU) and held Sept. 17 in Stockholm.
The first report, drafted by the European Center for Disease Prevention and Control and the European Medicines Agency, analyzes the growing gap between the resistance problem in the EU and the diminishing antibacterial pipeline. The report outlines the scope of the burden posed by drug resistance in Europe, where approximately 25,000 people die each year from just five infections: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium, third-generation cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae, and carbapenem-resistant Pseudomonas aeruginosa. These five infections result in about 2.5 million extra hospital days and more than 900 million Euros (approximately $1.4 billion) in additional hospital costs, according to the report’s authors, who call for a European and global strategy to combat antibiotic resistance.
The other major report, from the London School of Economics and Political Science (LSEPS), outlines potential policy options, including financial and other incentives to spur antibacterial drug and related diagnostic research and development. The analysis, which generated media coverage on the websites of CNN and TIME magazine, includes strategies such as direct research funding and tax incentives, intellectual property mechanisms and monetary prizes, and possible regulatory tools, among other possible ways to encourage the much needed research and development in this area.IDSA is looking for opportunities to leverage the EU’s advances in this policy area to motivate greater U.S. action and already has called upon the Food and Drug Administration (FDA) to commission a study similar to the LSEPS report that will analyze policy options in this country. In early November, EU and U.S. political leaders plan to meet to discuss these issues at a summit in Washington, D.C., where President Obama and the Swedish prime minister (Sweden currently holds the EU presidency) are expected to agree to establish a joint transatlantic task force on antimicrobial resistance. IDSA will continue to monitor these discussions and weigh in as appropriate. For more information about the Society’s efforts to address antibiotic resistance, see IDSA’s website.
The Centers for Disease Control and Prevention (CDC) in mid-October issued its latest guidance on preventing the transmission of novel H1N1 influenza in health care settings. CDC emphasized a multipronged approach, but affirmed its earlier recommendation that health care workers (HCWs) in close contact with patients with confirmed or suspected cases of H1N1 wear N95 respirators.
CDC advises health care facilities to use a hierarchy of controls, including personal protective equipment as one element, to prevent the transmission of influenza and help facilities get the most benefit from respirator supplies, the availability of which CDC acknowledges is already an issue at many institutions. In its guidance, CDC highlights the fundamental importance of immunizing HCWs against H1N1. After immunizations, CDC’s hierarchy of controls, from highest rank to lowest priority, include:
While the guidance calls for HCWs to wear N95 respirators, fit-tested to meet Occupational Safety and Health Administration (OSHA) requirements, when caring for H1N1 patients, it also details other options when respirators are in short supply. These include prioritizing respirator use, keeping in mind the duration and intensity of exposure, personal risk factors for complications of infection, and vaccination status. Under these priority conditions, CDC advises, HCWs who do not receive respirators should wear surgical masks. The updated guidance notes that the recommendations will be updated as necessary as new information becomes available.
IDSA shares the practical concerns about CDC’s guidance regarding the use of respirators voiced by the Society for Healthcare Epidemiology (SHEA), which issued a press release in response to CDC’s updated recommendations. Both SHEA and IDSA have stressed the importance of a range of infection control measures, including immunization against influenza, to prevent the transmission of H1N1, most notably in statement presented at a recent Institute of Medicine forum. IDSA also recently adopted a strengthened policy supporting mandatory immunization of HCWs as the most effective way to protect both patients and HCWs against H1N1 and seasonal influenza (see IDSA News article).
To read more about CDC’s latest recommendations, see this story from the Center for Infectious Disease Research and Policy.
IDSA continues to weigh in regarding new physician payment methods being considered by policymakers, including how ID physicians’ services could be incorporated into accountable care organizations (ACOs). Under the ACO model, a group of physicians or possibly a hospital would be responsible for quality and the overall annual Medicare spending for their patients. Earlier this month, IDSA sent a letter to the Medicare Payment Advisory Commission (MedPAC) to clarify the Society’s position and to explain how ID physicians’ infection control services could be incentivized through the establishment of ACOs, gainsharing arrangements, or other new and emerging payment methodologies that foster physician and hospital collaborations. The letter followed an earlier meeting with MedPAC staff to discuss ACOs, resource use reporting, and Medicare’s proposal to eliminate payments for consultations (see IDSA News article).
Congress this month passed a four-year extension of the Ryan White HIV/AIDS Program, which helps ensure that more than half a million low-income, uninsured, or underinsured people living with HIV/AIDS have access to care. The legislation, which President Obama is expected to sign into law shortly, would implement three policies supported by the HIV Medicine Association (HIVMA) and the Ryan White Medical Providers Coalition (RWMPC):
HIVMA and RWMPC issued a press release applauding Congress’ extension of the program and plan to work with the HIV/AIDS community and federal officials to implement the legislation in the coming months. For a summary of the bill, visit this webpage.
IDSA and HIVMA members have elected the following members to positions on the boards of directors:
Thomas G. Slama, MD, FIDSA
Indiana University School of Medicine
Cynthia L. Sears, MD, FIDSA
Johns Hopkins University School of Medicine
Andrew T. Pavia, MD, FIDSA
University of Utah
Salt Lake City, UT
Wesley C. Van Voorhis, MD, PhD, FIDSA
University of Washington
Johan S. Bakken, MD, PhD, FIDSA
St. Luke’s ID Associates
Judith A. Aberg, MD, FIDSA
New York University School of Medicine
New York, NY
Judith S. Currier, MD, MSc, FIDSA
University of California, Los Angeles, Center for Clinical AIDS Research & Education
Los Angeles, CA
Kathleen A. Clanon, MD
Alameda County Medical Center
Theresa L. Barton, MD
University of Texas Southwestern
IDSA and the Education and Research Foundation offer awards to individuals to honor outstanding achievements in the field of infectious diseases. Award recipients are pioneers in the study of newly emerging diseases, inspiring and supportive teachers, and those who paved the way for lifesaving vaccines.
Alexander Fleming Award
The Alexander Fleming Award is granted in recognition of a career that reflects major contributions to the acquisition and dissemination of knowledge about infectious diseases.
Arnold S. Monto, MD, FIDSA, is one of the world’s foremost experts in respiratory illnesses. Dr. Monto is professor of epidemiology at the University of Michigan School of Public Health and the principal investigator in many studies funded by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). His contribution is seminal in our understanding of the pathogenesis, treatment, and prevention of influenza virus infections—his work is now the gold standard for dealing with influenza outbreaks and our understanding of the herd immunity caused by targeted influenza vaccination.
Oswald Avery Award
The Oswald Avery Award recognizes outstanding achievement in an area of infectious diseases by an individual member or fellow of IDSA who is 45 or younger.
Jean-Laurent Casanova, MD, PhD, is recognized for his pioneering work in the discovery, development, and scientific and clinical understanding of the field of innate immunity. Dr. Casanova is a professor of pediatrics and head of the Laboratory of Human Genetics of Infectious Diseases at The Rockefeller University in New York. Dr. Casanova’s research has revolutionized our understanding of the genetics involved in the predisposition and susceptibility to pediatric infectious diseases.
The Mentor Award was created to recognize individuals who have served as exemplary mentors and is presented to an IDSA member or fellow who has been exceptional in guiding professional growth of infectious diseases professionals.
Richard L. Guerrant, MD, FIDSA, is a world-renowned expert on enteric infections. Dr. Guerrant is the Thomas H. Hunter Professor of International Medicine in the division of infectious diseases and international health at the University of Virginia School of Medicine in Charlottesville. He has mentored more than 150 students and fellows and shaped the careers of academic and scientific leaders in tropical medicine, such as Drs. James M. Hughes, Jonatahan I. Ravdin, Ted Steiner, Cynthia L. Sears, and Cirle Warren.
The Society Citation is a discretionary award given in recognition of exemplary contribution to IDSA, an outstanding discovery in the field of infectious diseases, or a lifetime of outstanding achievement in a given area—either in research, clinical investigation, or clinical practice.
Warren D. Johnson Jr., MD, FIDSA, is a well-known researcher on tropical medicine. Dr. Johnson is B.H. Kean Professor of Tropical Medicine and director of the Center for Global Health at Weill Medical College of Cornell University in New York. He has contributed greatly in reducing infant mortality from diarrheal diseases in Port-au-Prince, Haiti. He has trained several generations of researchers from Haiti, Brazil, Tanzania, and the United States, impacting the health of these countries. His research has been pivotal in understanding the natural history and therapy of leishmaniasis and leptospirosis in Brazil, and the epidemiology of AIDS and isosporiasis in Haiti.
Clinical Teacher Award
The Clinical Teacher Award honors a career involved in teaching clinical infectious diseases to fellows, residents, or medical students and recognizes excellence as a clinician and motivation to teach the next generation.
Joshua Fierer, MD, FIDSA, a committed clinician and teacher, has mentored more than 15 fellows as an individual mentor in his laboratory and co-mentored numerous trainees from around the world, including Drs. Theo Kirkland, Mark Swancutt, Ferric Fang, and Lars Eckman. His mentees describe him as a compassionate, good-humored mentor with an encyclopedic knowledge of infectious diseases. Dr. Fierer is professor of medicine and pathology in residence at the University of California in San Diego.
Named to honor the memory of Dr. Chatrchai Watanakunakorn, this award is given annually by the IDSA Education and Research Foundation to an IDSA member or fellow in recognition of outstanding achievement in the clinical practice of infectious diseases.
Lawrence J. Eron, MD, FIDSA, a recognized early pioneer in telemedicine, is known among his peers as a “doctor’s doctor.” Colleagues and residents describe Dr. Eron as a consummate clinician, loved by his patients and admired by other physicians, who often consult him about infectious diseases. He is a great communicator, sensitive to the needs of his local community, and a thoughtful leader involved in the improvement of health care, always ready to promote cost-effective quality care. Dr. Eron is an associate professor of medicine at the University of Hawaii in Honolulu.
The awards will be presented during the Opening Plenary Session at the 47th Annual Meeting of IDSA in Philadelphia on Oct. 29. More information about this year's Society Award winners is available online.
The IDSA Education and Research Foundation (ERF) and the National Foundation for Infectious Diseases (NFID) have joined forces to offer the IDSA ERF/NFID Joint Research Awards. Our goal is to support needed research by promising young researchers who may not otherwise find funding as federal and other institutional research support becomes more difficult to obtain.
Merle A. Sande/Pfizer Fellowship Award in International Infectious Diseases
Jennifer Downs, MD, an infectious disease fellow at Weill Medical College of Cornell University, will focus on Tanzania’s Lake Zone region, where she will screen 350 women for female genital schistosomiasis to establish its prevalence and collect data on disease associations (human papillomavirus (HPV) and HIV), the utility of antigen tests, symptoms, and social and psychiatric ramifications. The second phase of the study will involve a cohort study of 75 women diagnosed with female genital schistosomiasis (FGS), who will be treated with one dose of praziquantel and followed for six months to assess for resolution.
Astellas Young Investigator Awards
William J. Muller, MD, PhD, assistant professor of pediatrics in the Feinberg School of Medicine at Northwestern University, will develop and test vaccine candidates for herpes simplex virus (HSV) infections, and seek better understanding of the immune responses needed to control mucosal viral infections and chronic viral infections.
Manuela Raffatellu, MD, assistant professor in the department of microbiology and molecular genetics at the University of California at Irvine, has focused on elucidating the many complexities of Salmonella interaction with both immunocompetent and immunocompromised hosts. Dr. Raffatellu’s goal is to establish new paradigms on how mucosal pathogens interact with the host.
ASP Young Investigator Award in Geriatrics
H. Keipp B. Talbot, MD, MPH, will be identifying immune correlates in older adults that will serve as endpoints to measure the effectiveness of novel influenza vaccines. Specifically, her study aims to define which cellular and humoral immune responses correlate with protection from influenza infection in adults 50 years of age or older. Dr. Talbot is assistant professor of medicine in the division of infectious diseases and assistant director of research of the Center for Quality Aging at Vanderbilt University.
Wyeth Young Investigator Award in Vaccine Development
Mark Daniel Hicar, MD, PhD, a clinical fellow in pediatric infectious diseases at Vanderbilt Children’s Hospital, will investigate the functional aspects of the HIV antibodies he has identified, defining the biochemical and structural features of HIV envelope trimer-specific antibodies and their relation to neutralization and binding of the envelope protein.
More information about the 2009 Joint Research Award Winners is available online.
Carol J. Baker, MD, FIDSA, has been appointed chair of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). Dr. Baker previously served as a member of the committee. Her appointment is effective immediately and continues through June 2010. Dr. Baker is a professor of pediatrics and molecular virology and microbiology at Baylor College of Medicine and is the executive director of Texas Children's Center for Vaccine Awareness and Research. An IDSA past president, she is also chair of IDSA’s special Lyme disease review panel.Gregory C. Gray, MD, MPH, FIDSA, has been named professor and chair of the Department of Environmental and Global Health at the University of Florida’s College of Public Health and Health Professions. He has served as director of the Center for Emerging Diseases at the University of Iowa College of Public Health for the past eight years. Dr. Gray serves on the IDSA National and Global Public Health Committee.
Bamford, Laura, MD
Berroya, Maye, MD
Bland, Christopher, PharmD
Brosgart, Carol, MD
Daniels, Robert, PharmD
Duharte-Vidaurre, Luis, MD
Gaitanis, Melissa, MD
Goldman, David, MD
Golightly, Linnie, MD
Jimenez, Humberto, PharmD
Kibirige-Shacklett, Catherine, PhD
Lacy, Melinda, PharmD
Nguyen, Minh-Hong, MD
Nguyen, Bach-Yen, MD
Pedneault, Louise, MD
Sanabria, Jose, MD
Sopirala, Madhuri, MD
Srivastava, Vipul, MD
Sudduth, Elizabeth, MD
Theiler, Regan, MD, PhD
Tignor, Matthew, MD
Tsuzuki, Daisuke, MD, PhD
Weinstein, Lenny, DO
Adudans, Steve, MD, MSc
Beieler, Alison, PA-C
Boulden, Melissa, MS, PA-C
Edozien, Anthony, MD
Farley, John, MD, MPH
Forrester, Jennifer, MD
Gilbert, Michael, MD
Jacobs, Alice, MD
Johnson, Livette, MD
Joseph, Jonathan, MD
McDaniels, Deborah, NP
Rudnick, Marlene, MD
Simon, Matthew, MD
Speidel, Katie, PharmD
Stagnar, Cristy, MS
Tunca Gonen, Berivan, MD
Verma, Nishant, MD, MBBS
Al-Dabbagh, Mona, MD
Blatz, Peter, MD
Bobula, Steven, MD
Bond, Brooke, MD
Bowman, Michael, MD
Calvo, Katya, MD
Carlson, Misty, DO, MPH
Chattergoon, Michael, MD, PhD
Cheikh, Eyad, MD
Cho, Oh-hyun, MD
Chong, Yong Pil, M
Erritouni, Mohamed, MD
Faiad, Graciela, MD
Farabishahadel, Alireza, MD
Han, Alice, MD
Heysell, Scott, MD, MPH
Iuliano, A. Danielle, MPH, PhD
Kainth, Mundeep, DO
Kelesidis, Theodoros, MD
Kessler, Jason, MD
Khalid, Ayesha, MD
Kim, Jong Hun, MD
Kumar, Rakesh, MD
Little, Malaika, MD
Lontok, Josephine, MD
Moodley, Amaran, MD
Ozer, Egon, MD, PhD
Patel, Shephali, MD
Qureshi, Nadia, MD
Ramsahai, Shweta, MD
Selke, Henry, DO
Seshabhattar, Praveen, MD
Somersan, Selin, MD
Sureshkumar, Dorairajan, MD
Thomas, Tania, MD, MPH
Welc, Christina, DO
Yong, Lee, MD
Have a tough coding question? Picking the right code level is often difficult due to a lack of familiarity with the rules governing inpatient consultations, subsequent hospital visits, prolonged services, and incident-to billing. “Ask the Coder” can help. If you have a question about evaluation and management (E&M) or current procedural terminology (CPT) service codes, simply fill out the form on the “Ask the Coder” portal, and your question will be sent to a certified professional coder for a response.The answers provided through “Ask the Coder” are provided on an “as is” basis. Readers must use their own independent professional judgment in making coding decisions. The reader assumes all risks in using this information. The service is for IDSA members and their office staff.