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Leave the year, month and/or day blank when they cannot be estimated or are unknown a. Code the date of excisional biopsy as the date therapy initiated when it is the first treatment. Code the date of a biopsy documented as incisional when further surgery reveals no residual or only microscopic residual. Example: Breast biopsy with diagnosis of infiltrating duct carcinoma; subsequent re-excision with no residual tumor noted. Record the type of treatment in the appropriate data item, for example, Surgery of Primary Site, or Radiation. Code the date of admission to the hospital for inpatient or outpatient treatment when the exact date of the first treatment is unknown 6. When it is known the patient had first course therapy, but it is impossible to estimate the date d. Date flags replace non-date information that had previously been transmitted in date fields. Code Label Definition Blank A valid date value is provided in Date of Initial Treatment 10 No information No information whatsoever can be inferred 11 Not applicable No proper value is applicable in this context 12 Unknown A proper value is applicable but not known Coding Instructions 1. Leave this item blank if Date Therapy Initiated has a full or partial date recorded 2. Assign code 11 when no treatment is given during the first course, the first course is active surveillance/watchful waiting, or the initial diagnosis was at autopsy 4. Before this data item was implemented, active surveillance or watchful waiting was deduced from the codes in each of the treatment fields. Code Label Definition 0 No treatment given the patient did not receive any treatment 1 Treatment given the patient received treatment 2 Active surveillance the patient was under active surveillance or watchful waiting during the (watchful waiting) first course of treatment 9 Unknown if treatment It is unknown whether or not the patient received treatment given Coding Instructions 1. Assign code 1 when the patient receives treatment collected in any of the following fields a. This is either the date of the Surgery of Primary Site, Scope of Regional Lymph Node Surgery, or Surgical Procedure of Other Site, whichever is earliest.
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There is no documentation explaining why surgery was not done Example: the medical record has a recommendation that the patient have surgery. No further information is given; it is unknown if the patient refused surgery or if there were co-morbid conditions that prevented the surgical procedure. Code 7 means surgery is exactly what was recommended by the physician and the patient refused. If two treatment alternatives were offered and surgery was not chosen, code Reason no surgery of primary site as 1 [Surgery of the primary site was not performed because it was not part of the planned first-course treatment]. Assign code 8 when surgery is recommended, but it is unknown if the patient actually had the surgery Example: There is documentation in the medical record that the primary care physician referred the patient to a surgical oncologist. Follow-back to the surgical oncologist and primary care physician yields no further information. Assign code 8, it is known that surgery was recommended but there is no information on whether or not the patient actually had the surgical procedure. Determination of the date radiation started may require assistance from the radiation oncologist for consistent coding. Record the date of the first/earliest radiation treatment if radiation was given and recorded as part of the first course of therapy 2. Radiation date should be the same as the Date Therapy Initiated when radiation is the only treatment administered 3. Therefore, it is important to continue follow-up efforts to be certain the complete treatment information is collected. Code Label Definition Blank A valid date value is provided in Date Radiation Started 10 No information No information whatsoever can be inferred from this exceptional value (that is, unknown whether any radiation therapy was given) 11 Not applicable No proper value is applicable in this context. This event occurred, but the date is unknown (that is, radiation therapy administered but the date is unknown). Leave this item blank if Date Radiation Started has a full or partial date recorded 2. Assign code 11 if radiation was not planned or given as part of the first course of therapy or the initial diagnosis was at autopsy 4. Assign code 12 if the Date Radiation Started cannot be determined but the patient did receive first course of radiation 5. Assign code 15 if radiation treatment is planned but has not started and date is not available.
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Three secondary criteria were also used: the diagnosis of asthma made by a doctor, the use of asthma treatments during the last 12 months (questions asked in the follow-up questionnaire), and a hospital diagnoses of asthma (outpatient or emergency, based on a central admissions registry). The cross-tabulation of these different sources showed a good match between the data from the national prescription fle and the responses to the ques tionnaire. In addition, in the absence of information about breastfeeding, it is unclear whether these associations are attributable to prenatal or postnatal expo sures or a combination of both. However, since this category was included in the Update 2014 report, it is noted here for completeness. Demographic data were collected via questionnaire, and pure-tone audiograms were obtained. These disturbances include the epigenetic modifcation of imprinted genes (Somm et al. Other studies have focused on neurobehavioral outcomes following perinatal exposure, which is of relevance in understanding the possible consequences in the offspring of Vietnam veterans, particularly the offspring of female veterans. The specifc relevance of these fndings to neurobehavioral effects in humans exposed as adults is unclear. Another mode of epigenetic change is the modifcation of the spatial arrange ment of chromosomes, which can infuence gene expression and cell differ entiation. More studies are required before conclusions can be reached as to whether such outcomes in the offspring of exposed parents are replicable. In particular, it would be of interest to obtain information on neuro psychiatric conditions, such as attention-defcit hyperactivity disorder and other clinically defned neurodevelopmental outcomes in children who were exposed in utero. Effects in persons exposed in utero are not considered transgenerational because the fetus was likely exposed directly. In contrast, any adverse health effects in grandchildren associated with exposure would be considered to be transgenerational. Figure 8-1 illustrates the partitioning between intergenerational and transgenerational effects due to the exposure of a parent, delineating between those exposures that biologi cally persistent (like dioxin) and therefore dwell in the body long after exposure versus those that do not. Committees responsible for Updates 2012 and 2014 likewise failed to fnd any relevant human studies and affrmed the conclusion of inadequate or insuffcient evidence. Congress put forward and passed the Jeff Miller and Richard Blumenthal Veterans Health Care and Benefts Improvement Act in 2016, and it became Public Law 114-315.
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Medical Policy In Disease Protocols, Graded Exercise Stress Test Requirements, revise to clarify criteria. Medical Policy In Pharmaceutical (Therapeutic Medications), Acne Medications, revise policy to include language on use of topical acne medications, such as Retin A, and oral antibiotics, such as tretracycline. Neurologic, revise the Cerebrovascular Disease dispositions table to expand on criteria for Transient Ischemic Attack, Completed Stroke (ischemic or hemorrhagic), and Subdural, Epidural or Subarachnoid Hemorrhage. Administrative Add updated link for the International Standards on Personnel Licensing. Medical Policy In Pharmaceuticals, Malaria Medications, update policy information regarding the use of mefloquine. Medical Policy In Special Issuances, update policy for prednisone usage for treatment of Asthma, Arthritis, Colitis, and/ or Chronic Obstructive Pulmonary Disease. Medical Policy In Special Issuances, revise introductory language to clarify requirements for deferral. Medical Policy In Pharmaceuticals, add information page on Sleep Aids, including wait times. Spine and Other Musculoskeletal, revise Arthritis Worksheet to include link to steroid conversion calculator. General Systemic Pre-Diabetes, Diabetes, Metabolic Syndrome, and/or Insulin Resistance, revise Pre Diabetes Worksheet to include Polycystic Ovary Syndrome.
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