- Email: [email protected]
GI coding and billing answerline in second year1
Gastroenterology News Anil K. Rustgi, Section Editor
Gene Family Analysis Uncovers New Therapeutic Targets for Colorectal Cancers
they are central regulators of signaling pathways that control differentiation, transcription, cell cycle progression, apoptosis, motility, nvestigators from the Johns Hop- and invasion. “They are also attractive genes bekins University and the Howard Hughes Medical Institute have com- cause a number of tyrosine kinases pleted what is believed to be the first have already been implicated in cansystematic analysis of a disease-re- cer, and for a few there exist drugs lated gene family. Their analysis, re- that can inactivate them,” Velported in the May 9, 2003 issue of culescu says. Drugs such as Gleevec, Science, indicated the existence of Herceptin, and other inhibitor-class gene mutations linked to a minimum compounds that block proteins proof 30% of colorectal cancers, which duced by mutated TK genes have been shown in both human clinical trials and animal studies to halt cancer progress. Using highthroughput sequencing technologies and bioinformatics from the human genome project, the study identified 46 soD. Williams Parsons, M.D., Ph.D., Victor E. Velculescu, M.D., Ph.D., and matic, or tuAlberto Bardelli, Ph.D. mor-specific could serve as therapeutic targets. mutations in this family of genes The research team, headed by only after sifting through more than Dr. Victor E. Velculescu, Assistant 4 million DNA base pairs. “This sugProfessor of Oncology at the Uni- gested that a significant fraction of versity’s Sidney Kimmel Compre- colorectal cancers have mutations in hensive Cancer Center, studied at least one tyrosine kinase gene,” 182 human colorectal cancers to Velculescu says. identify mutations in the tyrosine Although few TK genes had been kinase (TK) gene family. TK genes previously linked to human cancer, are considered attractive targets for until now, no study has revealed therapeutic intervention because how many or how often members of
the TK gene family are altered in a particular cancer type, notes Velculescu. “Our findings open the door to individualized analysis and treatment of colorectal cancer. With this new work, one could imagine personalized therapeutics, based on mutations in different kinase genes and designed to match the mutated TK pathways present in each patient’s particular tumor DNA.” “Without the sophisticated new technologies and knowledge developed through the Human Genome Project, it would have been impossible for us to systematically sort through the massive amount of normal DNA sequences to find the few critical mutants,” says Dr. Alberto Bardelli, postdoctoral fellow at the Kimmel Cancer Center and first author of the study. Similar large-scale sequencing-based approaches can now be used to identify mutations in other cancers, he says. Velculescu says his team is using a variety of assays, including assays for increased kinase activity, to evaluate the biochemical consequences of these mutations. “The key observation here is that we’ve been able to show there is a clear genetic selection occurring in these cancers for these particular mutations. Future experiments will be aimed at determining what the consequences are for these mutations in cells, but perhaps more importantly, working on developing new drugs that could specifically target these kinases, drugs that may one day be used in the clinic.”
GI Coding and Billing AnswerLine in Second Year
procedures and new technology to billing issues. “Every AGA member is entitled to 2 free calls per month. Above that there is a minimal charge,” says Cecile Katzoff, Vice President for Con-
I
ow in its second year, the AGA’s GI Coding and Billing AnswerLine continues its free “hotline” in-
N
GASTROENTEROLOGY 2003;125:4 – 6
formation service to members, including physicians and administrators. Begun in January 2002, the service responded to 1434 calls last year alone on a wide variety of questions ranging from how to code complicated
Gastroenterology News continued
sulting Services and Director of the AGA Center for GI Practice Management and Economics. “We also may receive noncoding questions related to establishing fees.” According to Katzoff, more frequent questions to the AnswerLine include: “how to code the visit preceding a screening colonoscopy; how to code capsule endoscopy; questions regarding diagnosis coding; billing multiple procedures administered during the same endoscopy; conscious sedation–is it billable, when is it billable; and questions about definitions of billing categories–what’s a ‘new patient,’ ‘consultation,’ etc. And, increasingly, questions about HIPPA.”
The service strives to respond to questions that can be answered within a few minutes. “Anything more extensive, I will direct people to training sessions we (AGA) offer, products we sell that can be helpful.” In terms of number of calls per day, “Usually we get 5 to 8 calls a day, some days are busier than others, with mid-week the busiest, at times 10 calls per day,” Katzoff says. “When the new coding books come out at the beginning of the year, people call with questions about the new codes and when to begin using them.” The AnswerLine has a grant from GI Pathology Partners, PC, in Mem-
phis, Tennessee, to help defray some of the cost. “Our service has been well received.” Katzoff notes that callers “have said they are very grateful to have a resource that can help them with what is often a very difficult environment.” The service can be accessed toll-free, (888) 241 6552. “Callers will get a recording requesting information and we will respond within 48 hours or 2 business days; that’s our commitment,” Katzoff says. “We also receive faxes (301) 652-3890, and e-mails: [email protected]”
This Month at the NIH: NIDDK Special Emphasis Program Announcements
aside of funds is usually not indicated. Recently, NIDDK announced that a subset of Program Announcements will be placed in a special higher priority category, “Special Emphasis PAs” (see http://grants1.nih.gov/grants/ guide/notice-files/NOT-DK-03-001. html). Funds have been set aside to support applications that are responsive to these PAs that have received scores beyond the general payline. These funds are separate from those for Requests for Applications and other initiatives. In addition to the criterion for responsiveness to the PA, applications must be of sufficiently high merit and program relevance to warrant funding beyond the payline. Specific PAs on the Special Emphasis list will change over time, along with NIDDK’s funding priorities. Therefore, it is important that potential applicants refer to the following web site for the most current list of the PAs in this special category: http://www.niddk.nih.gov/fund/ crfo/specialpas.htm. The list of all
active NIDDK PAs is located at: http://www.niddk.nih.gov/fund/crfo/ pas.htm. Currently three NIDDK Special Emphasis PAs may be of interest to the Digestive Diseases Research community: Endoscopic Clinical Research in Pancreatic and Biliary Diseases PAR 03-033 Release Date: November 21, 2002 Intestinal Failure, Short Gut Syndrome and Small Bowel Transplantation PA 02-163 Release Date: September 9, 2002 Liver and Pancreatic Disease in HIV Infection PA 01-117 Release Date: July 17, 2001 Further specific details regarding these special emphasis program announcements can be found at the website listed above for special emphasis PAs. Stephen P. James National Institutes of Health
n a regular basis, NIDDK and other NIH institutes publish announcements in the NIH Guide to Grants and Contracts (available online at http://grants.nih.gov/grants/ guide) which indicate specific areas of research that the Institutes have designated as having a high priority. A request for applications (RFA) usually is a one-time solicitation with a focused research goal, a single receipt date, a plan on the part of the Institute to set aside a specific amount of funds, and sometimes a plan to review applications in a special review panel, rather than in standing study sections. Another type of announcement, called a program announcement (PA), differs from an RFA in that the areas of research are often more broad, there are typically multiple receipt dates for multiple years, and a specific set
O
Stories by Les Lang
5
Gene Family Analysis Uncovers New Therapeutic Targets for Colorectal Cancers
they are central regulators of signaling pathways that control differentiation, transcription, cell cycle progression, apoptosis, motility, nvestigators from the Johns Hop- and invasion. “They are also attractive genes bekins University and the Howard Hughes Medical Institute have com- cause a number of tyrosine kinases pleted what is believed to be the first have already been implicated in cansystematic analysis of a disease-re- cer, and for a few there exist drugs lated gene family. Their analysis, re- that can inactivate them,” Velported in the May 9, 2003 issue of culescu says. Drugs such as Gleevec, Science, indicated the existence of Herceptin, and other inhibitor-class gene mutations linked to a minimum compounds that block proteins proof 30% of colorectal cancers, which duced by mutated TK genes have been shown in both human clinical trials and animal studies to halt cancer progress. Using highthroughput sequencing technologies and bioinformatics from the human genome project, the study identified 46 soD. Williams Parsons, M.D., Ph.D., Victor E. Velculescu, M.D., Ph.D., and matic, or tuAlberto Bardelli, Ph.D. mor-specific could serve as therapeutic targets. mutations in this family of genes The research team, headed by only after sifting through more than Dr. Victor E. Velculescu, Assistant 4 million DNA base pairs. “This sugProfessor of Oncology at the Uni- gested that a significant fraction of versity’s Sidney Kimmel Compre- colorectal cancers have mutations in hensive Cancer Center, studied at least one tyrosine kinase gene,” 182 human colorectal cancers to Velculescu says. identify mutations in the tyrosine Although few TK genes had been kinase (TK) gene family. TK genes previously linked to human cancer, are considered attractive targets for until now, no study has revealed therapeutic intervention because how many or how often members of
the TK gene family are altered in a particular cancer type, notes Velculescu. “Our findings open the door to individualized analysis and treatment of colorectal cancer. With this new work, one could imagine personalized therapeutics, based on mutations in different kinase genes and designed to match the mutated TK pathways present in each patient’s particular tumor DNA.” “Without the sophisticated new technologies and knowledge developed through the Human Genome Project, it would have been impossible for us to systematically sort through the massive amount of normal DNA sequences to find the few critical mutants,” says Dr. Alberto Bardelli, postdoctoral fellow at the Kimmel Cancer Center and first author of the study. Similar large-scale sequencing-based approaches can now be used to identify mutations in other cancers, he says. Velculescu says his team is using a variety of assays, including assays for increased kinase activity, to evaluate the biochemical consequences of these mutations. “The key observation here is that we’ve been able to show there is a clear genetic selection occurring in these cancers for these particular mutations. Future experiments will be aimed at determining what the consequences are for these mutations in cells, but perhaps more importantly, working on developing new drugs that could specifically target these kinases, drugs that may one day be used in the clinic.”
GI Coding and Billing AnswerLine in Second Year
procedures and new technology to billing issues. “Every AGA member is entitled to 2 free calls per month. Above that there is a minimal charge,” says Cecile Katzoff, Vice President for Con-
I
ow in its second year, the AGA’s GI Coding and Billing AnswerLine continues its free “hotline” in-
N
GASTROENTEROLOGY 2003;125:4 – 6
formation service to members, including physicians and administrators. Begun in January 2002, the service responded to 1434 calls last year alone on a wide variety of questions ranging from how to code complicated
Gastroenterology News continued
sulting Services and Director of the AGA Center for GI Practice Management and Economics. “We also may receive noncoding questions related to establishing fees.” According to Katzoff, more frequent questions to the AnswerLine include: “how to code the visit preceding a screening colonoscopy; how to code capsule endoscopy; questions regarding diagnosis coding; billing multiple procedures administered during the same endoscopy; conscious sedation–is it billable, when is it billable; and questions about definitions of billing categories–what’s a ‘new patient,’ ‘consultation,’ etc. And, increasingly, questions about HIPPA.”
The service strives to respond to questions that can be answered within a few minutes. “Anything more extensive, I will direct people to training sessions we (AGA) offer, products we sell that can be helpful.” In terms of number of calls per day, “Usually we get 5 to 8 calls a day, some days are busier than others, with mid-week the busiest, at times 10 calls per day,” Katzoff says. “When the new coding books come out at the beginning of the year, people call with questions about the new codes and when to begin using them.” The AnswerLine has a grant from GI Pathology Partners, PC, in Mem-
phis, Tennessee, to help defray some of the cost. “Our service has been well received.” Katzoff notes that callers “have said they are very grateful to have a resource that can help them with what is often a very difficult environment.” The service can be accessed toll-free, (888) 241 6552. “Callers will get a recording requesting information and we will respond within 48 hours or 2 business days; that’s our commitment,” Katzoff says. “We also receive faxes (301) 652-3890, and e-mails: [email protected]”
This Month at the NIH: NIDDK Special Emphasis Program Announcements
aside of funds is usually not indicated. Recently, NIDDK announced that a subset of Program Announcements will be placed in a special higher priority category, “Special Emphasis PAs” (see http://grants1.nih.gov/grants/ guide/notice-files/NOT-DK-03-001. html). Funds have been set aside to support applications that are responsive to these PAs that have received scores beyond the general payline. These funds are separate from those for Requests for Applications and other initiatives. In addition to the criterion for responsiveness to the PA, applications must be of sufficiently high merit and program relevance to warrant funding beyond the payline. Specific PAs on the Special Emphasis list will change over time, along with NIDDK’s funding priorities. Therefore, it is important that potential applicants refer to the following web site for the most current list of the PAs in this special category: http://www.niddk.nih.gov/fund/ crfo/specialpas.htm. The list of all
active NIDDK PAs is located at: http://www.niddk.nih.gov/fund/crfo/ pas.htm. Currently three NIDDK Special Emphasis PAs may be of interest to the Digestive Diseases Research community: Endoscopic Clinical Research in Pancreatic and Biliary Diseases PAR 03-033 Release Date: November 21, 2002 Intestinal Failure, Short Gut Syndrome and Small Bowel Transplantation PA 02-163 Release Date: September 9, 2002 Liver and Pancreatic Disease in HIV Infection PA 01-117 Release Date: July 17, 2001 Further specific details regarding these special emphasis program announcements can be found at the website listed above for special emphasis PAs. Stephen P. James National Institutes of Health
n a regular basis, NIDDK and other NIH institutes publish announcements in the NIH Guide to Grants and Contracts (available online at http://grants.nih.gov/grants/ guide) which indicate specific areas of research that the Institutes have designated as having a high priority. A request for applications (RFA) usually is a one-time solicitation with a focused research goal, a single receipt date, a plan on the part of the Institute to set aside a specific amount of funds, and sometimes a plan to review applications in a special review panel, rather than in standing study sections. Another type of announcement, called a program announcement (PA), differs from an RFA in that the areas of research are often more broad, there are typically multiple receipt dates for multiple years, and a specific set
O
Stories by Les Lang
5