451 Junction Rd
Madison WI 53717
Medical School: State University Of New York Downstate Medical Center - 1968
Accepts Medicare: Yes
Participates In eRX: Yes
Participates In PQRS: Yes
Participates In EHR: Yes
License #: 48941
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Awards & Recognitions
Dr. Arnold Wald is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:45385||Description:Lesion removal colonoscopy||Average Price:$2,220.00||Average Price Allowed
|HCPCS Code:45380||Description:Colonoscopy and biopsy||Average Price:$1,989.00||Average Price Allowed
|HCPCS Code:G0121||Description:Colon ca scrn not hi rsk ind||Average Price:$1,657.00||Average Price Allowed
|HCPCS Code:43235||Description:Uppr gi endoscopy diagnosis||Average Price:$1,149.00||Average Price Allowed
|HCPCS Code:91065||Description:Breath hydrogen test||Average Price:$273.00||Average Price Allowed
|HCPCS Code:99221||Description:Initial hospital care||Average Price:$285.00||Average Price Allowed
|HCPCS Code:99203||Description:Office/outpatient visit new||Average Price:$225.00||Average Price Allowed
|HCPCS Code:99232||Description:Subsequent hospital care||Average Price:$202.00||Average Price Allowed
|HCPCS Code:99214||Description:Office/outpatient visit est||Average Price:$202.00||Average Price Allowed
|HCPCS Code:99231||Description:Subsequent hospital care||Average Price:$148.00||Average Price Allowed
|HCPCS Code:99213||Description:Office/outpatient visit est||Average Price:$134.00||Average Price Allowed
HCPCS Code Definitions
- Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
- Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple
- Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
- Breath hydrogen or methane test (eg, for detection of lactase deficiency, fructose intolerance, bacterial overgrowth, or oro-cecal gastrointestinal transit)
- Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
- Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit.
- Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering or improving. Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit.
- Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit.
- Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
Medical Malpractice Cases
Medical Board Sanctions
*These referrals represent the top 10 that Dr. Wald has made to other doctors
Constipation: Advances in Diagnosis and Treatment. - JAMA
Chronic constipation accounts for at least 8 million annual visits to health care providers in the United States and is associated with large expenditures for diagnostic testing and prescription and nonprescription laxatives.Strong evidence for efficacy has been established for stimulant and osmotic laxatives, new intestinal secretogogues, and peripherally restricted Î¼-opiate receptor antagonists, the latter a major advance in the treatment of opioid-induced constipation (OIC). An algorithm provided to evaluate chronic idiopathic constipation (CIC) that is refractory to available laxatives focuses on the importance of defecation disorders and biofeedback therapies. When used appropriately, available stimulant laxatives such as senna and bisacodyl are both safe and effective when used long-term. There is a paucity of (and a strong desire for) studies that compare inexpensive laxatives with newer agents that work by other mechanisms.The choice of treatment for CIC and OIC should be based on cost as well as efficacy. The small subgroup of patients who do not respond to currently available laxatives requires further evaluation at experienced centers that are capable of performing studies of defecation and colonic transit.
Pediatric Rectal Exam: Why, When, and How. - Current gastroenterology reports
The digital rectal examination (DRE) is performed in children less often than is indicated. Indications for the pediatric DRE include diarrhea, constipation, fecal incontinence, abdominal pain, gastrointestinal bleeding, and anemia. Less well-recognized indications may include abdominal mass, urinary symptoms, neurologic symptoms, urogenital or gynecologic symptoms, and anemia. Indeed, we believe that it should be considered part of a complete physical examination in children presenting with many different complaints. Physicians avoid this part of the physical examination in both children and adults for a number of reasons: discomfort on the part of the health care provider; belief that no useful information will be provided; lack of adequate training and experience in the performance of the DRE; conviction that planned "orders" or testing can obviate the need for the DRE; worry about "assaulting" a patient, particularly one who is small, young, and subordinate; anticipation that the exam will be refused by patient or parent; and concern regarding the time involved in the exam. The rationale and clinical utility of the DRE will be summarized in this article. In addition, the components of a complete pediatric DRE, along with suggestions for efficiently obtaining the child's consent and cooperation, will be presented.
Increasing Discussion Rates of Incontinence in Primary Care: A Randomized Controlled Trial. - Journal of women's health (2002)
A minority of women with urinary incontinence (UI) and even fewer with fecal incontinence (FI) report having discussed it with a health care provider in the past year. Thus our aim was to evaluate whether the use of an electronic pelvic floor assessment questionnaire (ePAQ-PF) improves communication about incontinence in primary care.Women 40 years and older who were scheduled for an annual wellness physical at an internal medicine clinic between August 2007 and August 2008 were randomized to complete the ePAQ-PF prior to (nâ€‰=â€‰145) or after (nâ€‰=â€‰139) their visit. Clinicians of women in the intervention group received the ePAQ-PF report prior to the visit. Outcome measures from clinic note abstraction included mention of UI (primary) and FI. Participant-reported outcome measures included discussion of UI and FI and initiator of discussion.Discussions of UI was more common in the intervention group than the control group: (27% vs. 19%; odds ratio [OR], 1.6 95% confidence interval [95%CI] 0.9-2.8, particularly for women over 60 (33% vs. 12%; OR 3.8, 95%CI 1.2-11.8) and for women with UI (42% vs. 25%; OR 2.2, 95%CI 1.1-4.1). The intervention primarily led to an increase in clinician-initiated UI discussions which were more common in the intervention group (18% vs. 4%, OR 4.8, 95%CI 1.9-12.0) Participants in the intervention group more frequently reported discussion of FI (14% vs. 6%; OR 2.5, 95%CI 1.1-6.0) which was clinician initiated in over half the cases (9% vs. 3%; OR 3.5, 95%CI 1.1-11.0).Use of the ePAQ-PF prior to clinic visits increases discussion of UI and FI, particularly clinician-initiated discussion. These findings suggest that such instruments may increase the detection and treatment of this often "silent" affliction.
Constipation: pathophysiology and management. - Current opinion in gastroenterology
Continuing advances in pharmaceutical development are providing an expanding array of treatment approaches for patients with chronic constipation. More comprehensive characterization of pancolonic motility carries the promise of improved understanding of the pathophysiology of this common disorder. Chronic constipation which responds poorly to laxatives may result from the use of drugs such as opioids, or from defecation disorders and advanced colonic dysmotility.This article highlights improved characterization of pancolonic motility, evidence of efficacy of established and novel drugs for both idiopathic and opioid-induced constipation and a new algorithm for the evaluation of patients with chronic idiopathic constipation who respond inadequately to available laxatives.The articles cited in this review inform the reader of new developments in the evaluation and treatment of patients with chronic constipation.
Poor quality evidence to support the use of biofeedback for the treatment of functional constipation in adults. - Evidence-based nursing
Implications for practice and research: Currently, there is insufficient evidence to make conclusions regarding the efficacy and safety of biofeedback for patients with chronic constipation. Further, well-designed randomised controlled trials are needed to allow definitive conclusions to be drawn.
ACG clinical guideline: management of benign anorectal disorders. - The American journal of gastroenterology
These guidelines summarize the definitions, diagnostic criteria, differential diagnoses, and treatments of a group of benign disorders of anorectal function and/or structure. Disorders of function include defecation disorders, fecal incontinence, and proctalgia syndromes, whereas disorders of structure include anal fissure and hemorrhoids. Each section reviews the definitions, epidemiology and/or pathophysiology, diagnostic assessment, and treatment recommendations of each entity. These recommendations reflect a comprehensive search of all relevant topics of pertinent English language articles in PubMed, Ovid Medline, and the National Library of Medicine from 1966 to 2013 using appropriate terms for each subject. Recommendations for anal fissure and hemorrhoids lean heavily on adaptation from the American Society of Colon and Rectal Surgeons Practice Parameters from the most recent published guidelines in 2010 and 2011 and supplemented with subsequent publications through 2013. We used systematic reviews and meta-analyses when available, and this was supplemented by review of published clinical trials.
New treatments for fecal incontinence: update for the gastroenterologist. - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Fecal incontinence is one of the most emotionally devastating of all nonfatal conditions. Many patients do not respond satisfactorily to conservative measures, and there is a need for new and effective strategies when medical therapy fails. The development of sacral nerve stimulation and other forms of neuromodulation and the injection of biologically compatible substances into the anal sphincter complex have brought renewed enthusiasm for using these novel treatments in this underserved population. Because injectable bulking agents such as dextranomer in stabilized hyaluronic acid can be administered in an outpatient setting, this procedure is being marketed to both gastroenterologists and surgeons. This article reviews both sacral nerve stimulation and dextranomer bulking agents and compares their strengths and potential limitations in patients with fecal incontinence.Copyright Â© 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.
Dysmenorrhea in women with Crohn's disease: a case-control study. - Inflammatory bowel diseases
Dysmenorrhea and Crohn's disease (CD) have overlapping symptoms; however, their relationship is poorly understood. The aims of this study were to examine (1) the impact of dysmenorrhea on pain severity and pain medication use in CD and (2) the relationships between dysmenorrhea, CD activity, and health-related quality of life (HRQOL).This was a case-control study of menstruating women with and without CD. Subjects were assessed for dysmenorrhea, pain severity, medication use, menstrual distress, and HRQOL. CD activity scores were calculated. The correlation between menstrual distress and CD activity was assessed. Linear regression analysis was performed to determine the effects of dysmenorrhea and CD on pain severity.A total of 110 subjects were studied and 40% of cases had dysmenorrhea. Dysmenorrhea was associated with higher pain scores among cases. Compared with controls, cases with dysmenorrhea reported similar pain severity but lower nonsteroidal anti-inflammatory drug use. After adjusting for medication use, cases had significantly greater distress due to menstrual pain. CD activity scores were not higher in women with dysmenorrhea; however, menstrual distress scores correlated positively with disease activity. HRQOL was significantly lower in cases with dysmenorrhea by some measures.Dysmenorrhea is common in women with CD and has an additive effect on overall pain severity. It is not, however, associated with greater nonsteroidal anti-inflammatory drug use. Menstrual distress is positively correlated with CD activity scores and associated with lower HRQOL by some measures. Treatment of dysmenorrhea may improve the pain experienced by women with CD, the perception of CD activity, and the quality of life in women with CD.
Irritable bowel syndrome--diarrhoea. - Best practice & research. Clinical gastroenterology
IBS is a functional gastrointestinal disorder which has been subtyped according to bowel habits. This review presents recommendations for IBS-D which makes up about 1/3 of all patients and which is defined as IBS with loose or watery stools with â‰¥25% of bowel movements. Because IBS is a complex biopsychosocial illness, treatment cannot and should not be directed only to altered bowel habits. Evidence will be presented for dietary manipulations, probiotics and pharmacotherapies including tricyclic agents, antibiotics, serotonin antagonists and anti-diarrhoeal agents in the management of patients with IBS-D.Copyright Â© 2012 Elsevier Ltd. All rights reserved.
Safety and efficacy of immunomodulators and biologics during pregnancy and lactation for the treatment of inflammatory bowel disease. - Expert opinion on drug safety
The inflammatory bowel diseases (IBD) are chronic, idiopathic, inflammatory conditions of the gastrointestinal tract, that peak in incidence during the reproductive years. Therefore, the safety of IBD medications during pregnancy and lactation is of significant interest to patients. Unfortunately, the current pregnancy labeling used by the United States Food and Drug Association (FDA) is often misinterpreted and may mislead healthcare providers and their patients to believe that risk increases from Category A to B to C to D to X, which in fact, is not the case. In addition, the FDA categories do not always distinguish between risks based on human versus animal data, or between differences in frequency, severity, and type of fetal developmental toxicities.This article provides an in-depth review of the available safety data during pregnancy and lactation for the more potent immunosuppressants used to treat IBD: the immunomodulators and biologics. It also includes the authors' expert opinions on the use of these medications during these critical periods.The benefit-to-risk ratio for most immunomodulators and biologics used in the treatment of IBD favors medication continuation during pregnancy. Certain immunomodulators, however, can cause extreme fetal harm and should be used with caution. While human safety data regarding teratogenesis and some data on pregnancy outcomes exist for most IBD medications, long-term follow-up studies of children and young adults exposed to these drugs in utero are lacking. These studies are needed to determine if these drugs are of sufficiently low risk to be considered safe.
Map & Directions
451 Junction Rd Madison, WI 53717
451 Junction Rd
752 N High Point Rd Dean Medical Center