SCHOOL 5
PNG
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School
College of Health Care Professions, McAllen *
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Course
111
Subject
Medicine
Date
Feb 20, 2024
Type
PNG
Pages
1
Uploaded by ChancellorNightingale3025
Camille Fields, a 67-year-old female, came into our Allergy & Immunology Clinic with urticarial rash over a large portion of her body. Patient has a history of hysterectomy at age 35. She has current diagnoses of generalized osteoporosis, severe bone pain, and risk of bone fractures. After failure of prior treatments for osteoporosis (bisphosphonates, alendronate, and risedronic acid) and experiencing major side effects—gastrointestinal erosion with bisphosphonates and alendronate, and severe gastrointestinal bleeding, severe muscle and joint pain, fever, flu symptoms, conjunctivitis, episcleritis, and uveitis with risedronic acid—she was referred to Dr. Lantana for alternate therapies of her condition. All symptoms were intense and persistent. Dr. Lantana prescribed denosumab. He administered Prolia, 60mg subq into abdomen and told her to come back in 6 months. On the day after the first administration of denosumab, the patient developed a generalized urticarial rash (thighs, abdomen, bilateral breast area, back) accompanied by bilateral facial angioedema and pruriginous injuries in the area of drug administration (the abdomen). The symptoms started 2 h after the first administration and resolved completely after 15 days with the administration of antihistamines and oral corticoids and the application of local corticoids. She came here, to our office, to determine if the denosumab was the instigator of the allergic reaction, or if other sources were to blame. She agreed to a skin prick test (SPT) with denosumab, along with house dust mites, cat and dog dander, olive, grass pollen, and latex, which we performed today. A positive reaction was defined as a wheal with a diameter at least 3 mm larger than that obtained by a negative control, shown at the test spot of denosumab. We discussed a rapid desensitization protocol and she agreed. We began with an initial subcutaneous dose of 0.005 mg, which will gradually be increased in an 8-hour cycle until a cumulative dose of 60 mg. Be sure to list the codes, one code per box, in the correct order, from top to bottom. If there are 2 or more similar codes, list the code as <code>xn where n is the number of similar codes. Capitalization, punctuation, and spacing can impact whether or not your answer is correct. Follow coding best practices. Determine the most accurate procedure codes, using the CPT code set and modifier(s), if appropriate. You may not need all of the spaces provided. CPT code(s) and any | Anesthesia code(s) and any | HCPCS Level Il code(s) and any applicable modifier(s) applicable modifier(s) applicable modifier(s) 58552
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