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E/M Course Answer Issue Incorrect against Rule Re DM and Onychomycosis

I just taken a Mod 8 Test / Qstn No. 1 of the Evaluation and Management Course. DX is: Onychomycosis and DM, I selected Answer C, however the online test is only accepting Answer A to be the correct answer.
However this goes against it’s Reasoning which states:

* There was no mention of diabetic neuropathy or ulcer
* There was no documentation that the onychomycosis is a diabetic complication
* Pt. was seen for foot check, and the onychomycosis was found during this check
* Resulting this to be coded as 1st Dx: Oychomycosis B35.1 and 2nd DX: DM E11.9

Please correct this issue or explain why the system is accepting Answer A rather than Answer C. Thank you for your help.

ojt

Medical Billing and Coding Forum

Medical Care For Onychomycosis

Onychomycosis, a superficial fungal infection that destroys the entire nail unit, has become a rather prevalent malady. Once contracted, it is extremely difficult to remove completely. Treatment of onychomycosis depends on the clinical type of the onychomycosis, the number of affected nails, and the severity of nail involvement.

A systemic treatment is always required in proximal subungual onychomycosis and in distal lateral subungual onychomycosis involving the lunula region. White superficial onychomycosis and distal lateral subungual onychomycosis limited to the distal nail can be treated with a topical agent. A combination of systemic and topical treatment increases the cure rate.

The use of topical agents should be limited to cases involving less than half of the distal nail plate or for patients unable to tolerate systemic treatment. They may be useful as adjunctive therapy in combination with oral therapy or as prophylaxis to prevent recurrence in patients cured with systemic agents.

Topical treatments alone are generally unable to cure onychomycosis because of insufficient nail plate penetration. Agents include amorolfine, ciclopirox olamine 8% nail lacquer solution, and bifonazole/urea. Ciclopirox and amorolfine solutions have been reported to penetrate through all nail layers but have low efficacy when used as monotherapy.

The newer generation of oral antifungal agents (itraconazole and terbinafine) has replaced older therapies in the treatment of onychomycosis. They offer shorter treatment regimens, higher cure rates, and fewer adverse effects. Fluconazole offers an alternative to itraconazole and terbinafine. Derivatives of fluconazole may also be available soon.

The efficacy of the newer antifungal agents lies in their ability to penetrate the nail plate within days of starting therapy. Evidence shows better efficacy with terbinafine than with other oral agents. To decrease the adverse effects and duration of oral therapy, topical treatments and nail avulsion may be combined with oral antifungal management.

The epidermis has 7 layers which protect and surrounds the true skin. Because the true skin is the reservoir of nourishment, it is the area where many dermatological problems exist, including fungal infections. This is why chemical solutions are often caustic and rather invasive, and usually more ineffective than effective.

Because the rate of recurrence remains high, even with newer agents, the decision to treat should be made with a clear understanding of the cost and risks involved, as well as the risk of recurrence. As most standard treatments for fungal infections are not effective against fungus which has worked its way under the nails, the antifungal effects of natural plant medicine are of increasing interest.

AntiNailFungus-Rx is concentrated with a wide spectrum of powerful antifungal plant extracts exhibiting a curative effect against nail fungus, as demonstrated by a wealth of scientific and clinical studies. AntiNailFungus-Rx helps end nail fungus infections by directly attacking and destroying fungus population infecting nails and nail beds.

Clinical evidence supports laboratory tests which show that theses extracts have penetrating antifungal actions which destroy fungi without causing tissue damage. However, this treatment is very potent and therefore only to be applied to finger/toe nails where skin and nails are hardened and less sensitive.

The mode of action of AntiNailFungus-Rx as an anti-fungal agent is particularly interesting not only in consideration of its ability to destroy fungus at very low concentrations, but is non toxic when applied topically, and represents a perfectly safe and effective nail fungus eliminator. It is ideal for eradicating fungus infections occurring in the nails of fingers or toes.

Results achieved with these products are more than convincing especially in view of the poor efficacy and side effects of treatments using classic synthetic medications. The use of medicinal plants is taking an increasingly greater role in the treatment of nail fungus as conventional medicine has few effective solutions.

Powerless, and faced with treatment failures, some doctors are actively seeking alternative effective treatments to resolve this inadequacy. Created by competent scientists, this nail fungus treatment provides real opportunities to safely eliminate nail fungus with encouraging measurable results. To learn more, please go to http://www.naturespharma.org.

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