Understanding variations in pediatric asthma care processes in the emergency department using visual analytics.

Health care delivery processes consist of complex activity sequences spanning organizational, spatial, and temporal boundaries. Care is human-directed so these processes can have wide variations in cost, quality, and outcome making systemic care process analysis, conformance testing, and improvement challenging. We designed and developed an interactive visual analytic process exploration and discovery tool and used it to explore clinical data from 5784 pediatric asthma emergency department patients.

Impulse oscillometry: interpretation and practical applications.

Simple spirometry and body plethysmography have been routinely used in children aged > 5 years. New techniques based on physiologic concepts that were first described almost 50 years ago are emerging in research and in clinical practice for measuring pulmonary function in children. These techniques have led to an increased understanding of the pediatric lung and respiratory mechanics. Impulse oscillometry (IOS), a simple, noninvasive method using the forced oscillation technique, requires minimal patient cooperation and is suitable for use in both children and adults. This method can be used to assess obstruction in the large and small peripheral airways and has been used to measure bronchodilator response and bronchoprovocation testing. New data suggest that IOS may be useful in predicting loss of asthma control in the pediatric population. This article reviews the clinical applications of IOS, with an emphasis on the pediatric setting, and discusses appropriate coding practices for the clinician.

New coding in the International Classification of Diseases, Ninth Revision, for children's interstitial lung disease.

The term "children's interstitial lung disease" (chILD) refers to a heterogeneous group of rare and diffuse lung diseases associated with significant morbidity and mortality. These disorders include neuroendocrine cell hyperplasia of infancy, pulmonary interstitial glycogenosis, surfactant dysfunction mutations, and alveolar capillary dysplasia with misalignment of pulmonary veins. Diagnosis can be challenging, which may lead to a delay in recognition and treatment of these disorders. Recently, International Classifications of Diseases, Ninth Revision codes have been added for several of the chILD disorders. The purpose of this article is to give an overview of the chILD disorders and appropriate diagnostic coding.

Infant pulmonary function testing: overview of technology and practical considerations--new current procedural terminology codes effective 2010.

Infant pulmonary function testing has evolved from a research technique into a diagnostic tool. As such, new current procedural terminology (CPT) codes have been created and are available for use as of January 1, 2010. The technology now available has a range of applications. Through a series of vignettes, this article illustrates the methodology of the tests, some of their applications, and how to code and bill for the procedures.

Bundled babies and bundled billing: how to properly use the new pediatric critical care codes.

CMS introduced new pediatric critical care codes and renumbered neonatal and pediatric critical care Current Procedural Terminology (CPT) codes in January 2009. Unlike the time-based critical care codes used for adult care, services for many children use bundled codes for all critical care services by a single physician during a calendar day. New codes have been added for 24- to 60-month old children. CPT codes for critical care of neonates and children 28 days to 24 months were renumbered. This article discusses the changes and the impact on physicians providing critical care services.