26730 Towne Centre Dr Suite 202
Foothill Ranch CA 92610
Medical School: University Of California, Ucla School Of Medicine - 1976
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: G63764
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Awards & Recognitions
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:95822||Description:Eeg coma or sleep only||Average Price:$468.00||Average Price Allowed
|HCPCS Code:95819||Description:Eeg awake and asleep||Average Price:$410.00||Average Price Allowed
|HCPCS Code:95816||Description:Eeg awake and drowsy||Average Price:$363.00||Average Price Allowed
|HCPCS Code:99214||Description:Office/outpatient visit est||Average Price:$122.12||Average Price Allowed
|HCPCS Code:99354||Description:Prolonged service office||Average Price:$109.63||Average Price Allowed
|HCPCS Code:99356||Description:Prolonged service inpatient||Average Price:$100.00||Average Price Allowed
|HCPCS Code:99232||Description:Subsequent hospital care||Average Price:$79.00||Average Price Allowed
|HCPCS Code:99231||Description:Subsequent hospital care||Average Price:$44.00||Average Price Allowed
|HCPCS Code:99222||Description:Initial hospital care||Average Price:$145.00||Average Price Allowed
|HCPCS Code:99221||Description:Initial hospital care||Average Price:$107.00||Average Price Allowed
|HCPCS Code:99204||Description:Office/outpatient visit new||Average Price:$175.00||Average Price Allowed
HCPCS Code Definitions
- Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient Evaluation and Management service)
- Electroencephalogram (EEG); including recording awake and asleep
- Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management service)
- Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive 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, 45 minutes are spent face-to-face with the patient and/or family.
- Electroencephalogram (EEG); recording in coma or sleep only
- 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.
- 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.
- Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and 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 problem(s) requiring admission are of moderate severity. Typically, 50 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.
- Electroencephalogram (EEG); including recording awake and drowsy
Medical Malpractice Cases
Medical Board Sanctions
Cardiovascular Disease (Cardiology)
Cardiovascular Disease (Cardiology)
*These referrals represent the top 10 that Dr. Chang has made to other doctors
Activity, balance, learning, and exposure (ABLE): a new intervention for fear of falling. - International journal of geriatric psychiatry
Fear of falling is an important problem among older adults, even those with relatively low rates of objective fall risk, who are often overlooked as targets for intervention.We developed and pilot tested a new intervention, Activity, Balance, Learning, and Exposure (ABLE), in a sample of 10 older adults with excessive fear of falling. The ABLE intervention integrates exposure therapy and cognitive restructuring with a home safety evaluation and an exercise program and is conducted in the home. In this pilot project, ABLE was jointly conducted by a physical therapist and a psychologist with expertise in geriatric anxiety disorders.The intervention was feasible and acceptable and resulted in decreases in fear and activity avoidance for most participants. One participant experienced an injurious fall.We learned a number of important lessons resulting in modifications to the inclusion criteria, assessments, and intervention over the course of this pilot study. Results suggest that ABLE has promise for treating excessive fear of falling in the elderly and support testing the intervention in a larger randomized trial. Copyright Â© 2015 John Wiley & Sons, Ltd.Copyright Â© 2015 John Wiley & Sons, Ltd.
Use of a High-Density Protein Microarray to Identify Autoantibodies in Subjects with Type 2 Diabetes Mellitus and an HLA Background Associated with Reduced Insulin Secretion. - PloS one
New biomarkers for type 2 diabetes mellitus (T2DM) may aid diagnosis, drug development or clinical treatment. Evidence is increasing for the adaptive immune system's role in T2DM and suggests the presence of unidentified autoantibodies. While high-density protein microarrays have emerged as a useful technology to identify possible novel autoantigens in autoimmune diseases, its application in T2DM has lagged. In Pima Indians, the HLA haplotype (HLA-DRB1*02) is protective against T2DM and, when studied when they have normal glucose tolerance, subjects with this HLA haplotype have higher insulin secretion compared to those without the protective haplotype. Possible autoantibody biomarkers were identified using microarrays containing 9480 proteins in plasma from Pima Indians with T2DM without the protective haplotype (n = 7) compared with those with normal glucose regulation (NGR) with the protective haplotype (n = 11). A subsequent validation phase involving 45 cases and 45 controls, matched by age, sex and specimen storage time, evaluated 77 proteins. Eleven autoantigens had higher antibody signals among T2DM subjects with the lower insulin-secretion HLA background compared with NGR subjects with the higher insulin-secretion HLA background (p<0.05, adjusted for multiple comparisons). PPARG2 and UBE2M had lowest p-values (adjusted p = 0.023) while PPARG2 and RGS17 had highest case-to-control antibody signal ratios (1.7). A multi-protein classifier involving the 11 autoantigens had sensitivity, specificity, and area under the receiver operating characteristics curve of 0.73, 0.80, and 0.83 (95% CI 0.74-0.91, p = 3.4x10-8), respectively. This study identified 11 novel autoantigens which were associated with T2DM and an HLA background associated with reduced insulin secretion. While further studies are needed to distinguish whether these antibodies are associated with insulin secretion via the HLA background, T2DM more broadly, or a combination of the two, this study may aid the search for autoantibody biomarkers by narrowing the list of protein targets.
Anatomic Evaluation of the Sacroiliac Joint: A Radiographic Study with Implications for Procedures. - Pain physician
Sacroiliac joint (SI) pain is increasingly being recognized as a source of low back pain. Injections and percutaneous type procedures are performed to treat symptomatic joints. However, there are limited studies available assessing the anatomy of the SI joint in vivo among patients with pain.The purpose of this study was to provide more precise information on the dimensions and orientation of the SI joint using a new technique for the radiographic evaluation of this joint.Observational study.Emergency departmentThree dimensional computed tomographic (CT) reconstructions of the pelvis were formatted from 100 SI joints in 50 patients who had clinically indicated abdominal/pelvic scans. These images were manipulated to evaluate the SI joint in multiple planes and measure its dimensions, area, and relationship to anatomic landmarks such as the anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS).Of the 50 patients, 23 were men and 27 women. Their mean age was 47.6 years (Â± 18.1). The SI joint consists of a superior limb which measures 39.7 mm (Â± 4.8) in length, and an inferior limb which measures 54.3 mm (Â± 5.1), oriented at an angle of 100.1Â° (Â± 8.1) to one another. The mean area of the joint was 1276.8 mm2 (Â± 189.8). The horizontal distance from the ASIS to the front of the superior SI joint is 75.4 mm (Â± 8.4). The horizontal distance from the PSIS to the back of the superior SI joint is 43.9 mm (Â± 5.6). The joint stretches 7.5 mm (Â± 5.9) cephalad and 38.1 mm (Â± 6.4) caudal to the PSIS, and 35.4 mm (Â± 8.8) cephalad and 10.2 mm (Â± 11.4) caudal to the ASIS.CT scans were performed with patients lying supine, while most SI joint procedures are performed with a patient prone. However it is doubtful that the bony anatomic landmarks would change appreciable in this largely immobile joint. These patients were seen in the emergency department for a variety of conditions related to abdominal and pelvic pain, and not exclusively for SI joint pain.Treatment of the SI joint by surgeons and interventionalists is hampered by the limited number of anatomic studies in the literature. Our study presents the SI joint as a 2-limbed structure, sitting from slightly above the level of the PSIS rostrally to slightly below the level of the ASIS caudally. Palpation of these landmarks may assist in directing physicians to the joint. To begin an interventional pain procedure, with a patient lying prone, this data supports tilting the x-ray image intensifier 10 degrees caudal past the vertical anteroposterior (AP) view for optimal approach of the SI joint's inferior limb. The needle entry should be about 44.1 mm (1.75 inches) caudal to the PSIS. The image intensifier should have a 12 degree left lateral oblique view for injection of the right SI joint, and a 12 degree right lateral oblique view for the left SI joint.Sacroiliac joint; arthritis, sacroiliac; anatomy; injections, intra-articular; tomography, x-ray computed; imaging, three-dimensional; pain management; back pain; radiology.
Return to Learn: A review of cognitive rest versus rehabilitation after sports concussion. - NeuroRehabilitation
Cognitive rest is the recommendation for all patients with acute sports concussion.A comprehensive literature search was conducted for the research question "What is the optimal cognitive load for patients with a sports concussion?"Seven studies met the inclusion criteria. The optimal cognitive load for patients after sports concussion is yet to be determined.Additional controlled trials of cognitive rehabilitation are needed to establish best clinical practice. The authors suggest memory training, cognitive behavioral therapy, and environmental interventions as areas of future research for sports concussion injuries.
Three decades of citation classics: the most cited articles in the field of physical medicine and rehabilitation. - PM & R : the journal of injury, function, and rehabilitation
With the American Academy of Physical Medicine and Rehabilitation recently celebrating its 75th anniversary, it is an opportune time to assess the impact and influence that physiatric articles and research have had on the field, as well as the greater scientific community. One useful metric of scientific impact is citation count, which is the most common method for analyzing the magnitude of scientific recognition of an individual article. This study presents 2 reading lists of influential physiatric academic journal articles drawn from the Web of Science index based on citation count. The first list contains the top 25 most-cited articles during the last 3 decades from the American Journal of Physical Medicine and Rehabilitation, the Archives of Physical Medicine and Rehabilitation, and PM&R. The second list contains the top 10 articles in 20 different physiatric topical areas. This topical list was generated via an expanded search without limitation of time span or journal. This allowed for the identification of influential physiatric articles not found in the field's 3 major publications from the United States. Although citation index is not a direct measure of quality or importance, it offers one form of quantitative assessment of scientific impact. This assessment contributes to the identification of trends, which illustrate the evolution of scope and focus of physiatry research. The lists of most-cited articles presented in this review can be used to provide historical context to physiatry's existing body of research, direct future evidence-based research efforts, and help guide educators as they select resident reading lists or journal club materials.Copyright Â© 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Single-subject-based whole-brain MEG slow-wave imaging approach for detecting abnormality in patients with mild traumatic brain injury. - NeuroImage. Clinical
Traumatic brain injury (TBI) is a leading cause of sustained impairment in military and civilian populations. However, mild TBI (mTBI) can be difficult to detect using conventional MRI or CT. Injured brain tissues in mTBI patients generate abnormal slow-waves (1-4Â Hz) that can be measured and localized by resting-state magnetoencephalography (MEG). In this study, we develop a voxel-based whole-brain MEG slow-wave imaging approach for detecting abnormality in patients with mTBI on a single-subject basis. A normative database of resting-state MEG source magnitude images (1-4Â Hz) from 79 healthy control subjects was established for all brain voxels. The high-resolution MEG source magnitude images were obtained by our recent Fast-VESTAL method. In 84 mTBI patients with persistent post-concussive symptoms (36 from blasts, and 48 from non-blast causes), our method detected abnormalities at the positive detection rates of 84.5%, 86.1%, and 83.3% for the combined (blast-induced plus with non-blast causes), blast, and non-blast mTBI groups, respectively. We found that prefrontal, posterior parietal, inferior temporal, hippocampus, and cerebella areas were particularly vulnerable to head trauma. The result also showed that MEG slow-wave generation in prefrontal areas positively correlated with personality change, trouble concentrating, affective lability, and depression symptoms. Discussion is provided regarding the neuronal mechanisms of MEG slow-wave generation due to deafferentation caused by axonal injury and/or blockages/limitations of cholinergic transmission in TBI. This study provides an effective way for using MEG slow-wave source imaging to localize affected areas and supports MEG as a tool for assisting the diagnosis of mTBI.
Body posture and backpack loading: an upright magnetic resonance imaging study of the adult lumbar spine. - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Axial loading of the spine while supine, simulating upright posture, decreases intervertebral disc (IVD) height and lumbar length and increases lumbar lordosis. The purpose of this study is to measure the adult lumbar spine's response to upright posture and a backpack load using upright magnetic resonance imaging (MRI). We hypothesize that higher spinal loads, while upright and with a backpack, will compress lumbar length and IVD height as well as decrease lumbar lordosis.Six volunteers (45 Â± 6 years) underwent 0.6 T MRI scans of the lumbar spine while supine, upright, and upright with a 10 % body weight (BW) backpack. Main outcomes were IVD height, lumbar spinal length (distance between anterior-superior corners of L1 and S1), and lumbar lordosis (Cobb angle between the superior endplates of L1 and S1).The 10 % BW load significantly compressed the L4-L5 and L5-S1 IVDs relative to supine (p < 0.05). The upright and upright plus 10 % BW backpack conditions significantly compressed the anterior height of L5-S1 relative to supine (p < 0.05), but did not significantly change the lumbar length or lumbar lordosis.The L4-L5 and L5-S1 IVDs compress, particularly anteriorly, when transitioning from supine to upright position with a 10 % BW backpack. This study is the first radiographic analysis to describe the adult lumbar spine wearing common backpack loads. The novel upright MRI protocol described allows for functional, in vivo, loaded measurements of the spine that enables the study of spinal biomechanics and therapeutic interventions.
Anterior-posterior transcranial ultrasound to measure cranial oscillations. - Aviation, space, and environmental medicine
We aimed to provide information on whether or not the correlation between body tilt and the pulse amplitude of transcranial ultrasonic time-of-flight waveform can be observed in the anterior-posterior skull direction. Also, we asked the question whether or not the skull pulsation can be detected since the cranial bones involved are thicker.The experimental model of body tilt that alters intracranial pressure by shifting body fluid headward was employed. Transcranial ultrasound waveforms were examined in 15 healthy volunteers positioned at five tilt angles of +30 degrees, 0 degrees, -30 degrees, -60 degrees, and -90 degrees from the horizontal body position. A pulse-echo transducer was placed on the middle forehead and ultrasound waveforms were recorded. Synchronized variations in the ultrasonic time-of-flight with heartbeats were monitored using the pulsed phase locked loop technique for the output voltage of the ultrasound transducer. Simultaneous effects of body tilt on cardiovascular parameters were also evaluated.Pulse amplitudes of ultrasonic time-of-flight waveforms were found to vary with body tilt. Repeated-measures ANOVA and regression analysis showed a negative correlation between body tilt angle and pulse amplitude. The regression line has the equation: pulse amplitude = (1.158-0.01023 x tilt angle) x 10(-4) voltage. There was no such relationship between head-down body tilt and altered mean blood pressure or heart rate.An increase in the pulse amplitude of the anterior-posterior transcranial ultrasonic time-of-flight waveform can be detected when the head-down body tilt angle increases.
Older age increases short-term surgical complications after primary knee arthroplasty. - Clinical orthopaedics and related research
Age is a known risk factor for complications after knee arthroplasty; however, age-related risks for a variety of complications of total and partial knee arthroplasties have not been well quantified.Our study addressed three questions to better understand age-related risk of complications: (1) At what age do different types of complications increase? (2) Is the increase in complications with age resulting from age-related patient comorbidities, sociodemographic characteristics, and surgical conditions? (3) What is the probability of complications at different ages for an average patient?The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2009 was used to analyze complications for 8950 patients. Complications included NSQIP events, and complications described by the 2003 National Institutes of Health (NIH) consensus statement on total knee arthroplasty as well as 30-day mortality, deep vein thrombosis, return to the operating room, extended length of stay, and technical aspects of the surgery itself. Logistic regression analysis was performed.Mortality was higher for those aged 85 and older. NSQIP complications increased starting at age 70 years and NIH complications at 85 years. Age remained an independent risk factor for multiple complications with controls. The predicted risk for an average patient ranged from 4% (40-64 years old) to 17% (90 years or older) for NSQIP complications and 2.8% to 8.8% for NIH complications.Age is an important independent predictor of surgical complications after knee arthroplasties. Surgeons can share these quantified age-specific risks with patients to guide management decisions.
The Ilizarov method of external fixation: current intraoperative concepts. - AORN journal
The Ilizarov method of external fixation is used to treat fractures, complex lower extremity deformities, osteomyelitis, and soft tissue contractures and to lengthen limbs. Tremendous improvements in the Ilizarov method have occurred during the past 60 years, improving intraoperative care and limb salvage management concepts. Improved instrumentation has increased the quantity and complexity of the tray systems required for these procedures. Perioperative nurses must be well versed in optimal preparation and function of Ilizarov fixation systems to ensure safe patient care during Ilizarov external fixation procedures.Copyright 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved.
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