3800 S National Ave Suite 400
Springfield MO 65807
Medical School: Other - 2002
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
Taxonomy Codes:207R00000X 207RC0000X 208M00000X
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Dr. Nitin Verma is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:99222||Description:Initial hospital care||Average Price:$153.32||Average Price Allowed
|HCPCS Code:99223||Description:Initial hospital care||Average Price:$206.57||Average Price Allowed
|HCPCS Code:99232||Description:Subsequent hospital care||Average Price:$73.30||Average Price Allowed
HCPCS Code Definitions
- 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 high 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 high severity. Typically, 70 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: 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.
Medical Malpractice Cases
Medical Board Sanctions
Physical Medicine And Rehabilitation
Cardiovascular Disease (Cardiology)
*These referrals represent the top 10 that Dr. Verma has made to other doctors
An estimation of the prevalence of diabetes mellitus and diabetic retinopathy in adults in Timor-Leste. - BMC research notes
Once considered an affliction of people in high-income countries, diabetes mellitus is increasingly seen as a global epidemic. However, for many countries very little is known about the prevalence of diabetes and its complications. This study aims to estimate the prevalence of diabetes, and diabetic retinopathy, in adults in Timor-Leste.From March 2013 to May 2014, adult patients being assessed for cataract surgery at the Sentru Matan Nasional (National Eye Centre) in Dili, Timor-Leste had a point-of-care HbA1c measurement performed on the DCA Vantage device (Siemens Ltd) under a quality framework. A diagnostic cut-off of 6.5% (48 mmol/mol) HbA1c was used for diagnosis of diabetes. Ocular examination, blood pressure, demographic and general health data were also collected. Diabetic retinopathy assessment was carried out by ophthalmologists.A total of 283 people [mean age 63.6 years (range 20-90 years)] were tested and examined during the study period. Forty-three people (15.2%) were found to have diabetes, with a mean HbA1c of 9.5% (77 mmol/mol). Of these, 27 (62.9%) were newly diagnosed, with a mean HbA1c of 9.7% (83 mmol/mol) and a range of 6.6-14% (49-130 mmol/mol). Nearly half (48.1%) of people newly diagnosed with diabetes had an HbA1c over 10.0% (86 mmol/mol). Of those with known diabetes, only 68.8% were receiving any treatment. Mean HbA1c for treated patients was 9.9% (85 mmol/mol). Diabetic retinopathy was identified in 18.6% of people with diabetes, of whom half had no previous diagnosis of diabetes.This study estimates the prevalence of diabetes at 15% in adults in Timor-Leste, a substantial proportion of whom have evidence of diabetic retinopathy. This is consistent with regional estimates. With the majority of patients undiagnosed, and management of people known to have diabetes largely inadequate, point-of-care testing is a valuable tool to assist with diabetes case detection and management. Whilst only a preliminary estimate, our data provides important impetus for further investigation of the prevalence and impact of diabetes in Timor-Leste. It provides guidance that further investment is required in expanding testing, as well as in prevention and treatment.
Magnitude of peripheral neuropathy in cirrhosis of liver patients from central rural India. - Annals of Indian Academy of Neurology
Cirrhosis of liver is an important cause of morbidity and mortality and if associated with peripheral neuropathy (PN) it also poses a huge financial, psychological burden for the patients and their families.The aim of the present study was to study the magnitude of PN among subjects with cirrhosis of liver presenting to tertiary care teaching hospital in central rural India.A cross-sectional study was performed in a tertiary care teaching hospital.In all patients of cirrhosis of liver irrespective of etiology, aged 15 and above, undergone clinical assessment for peripheral nervous systems damage and confirmed by nerve conduction studies.We used chi square test to study associations. P value â‰¤0.05 was considered as significant. Crude odds ratios were computed to assess the strength of association between independent variables and dependent variables along with their 95% confidence intervals.We included 207 of cirrhosis of liver patients admitted in medicine department from November 2010 through November 2013. Nearly 83% patients were male and 63.2% patients were under the age of 45 years. Common features in these patients were ascites (71%) splenomegaly (63.3%) pedal edema (61.4%) icterus (46.4%) tingling (44.9%) gastrointestinal bleeding(39.1%), ataxia (26.6%), numbness(26.6%), distal motor weakness (21.7%) and paresthesia(20.8%). Among the manifestation of peripheral nerve involvement, loss of ankle reflex was the most common feature in 51.7%, followed by loss of temperature sense 29.5%, loss of vibration sense 20.8%, loss of touch 16.4%, loss of position sense 14.5% and loss of pain in 6.3% of the patients. Peripheral neuropathy was found in 53.6% [95% CI: 46.58- 60.56] study subjects on electrophysiological study.Analysis of electrophysiological study shows that the PN is very common in study subjects with cirrhosis of liver, especially in male subjects, during the middle age group.
Functional and visual acuity outcomes of cataract surgery in Timor-Leste (East Timor). - Ophthalmic epidemiology
To report functional outcomes following cataract surgery in Timor-Leste.Pre- and post-intervention study measuring visual function improvement following cataract surgery. Presenting visual acuity (VA) was measured and visual function documented using the Indian vision function questionnaire (IND-VFQ).All 174 persons undergoing cataract surgery from November 2009 to January 2011 in Timor-Leste were included. Mean age was 65.4 years; 113 (64.9%) were male, 143 (82.1%) were from a rural background and 151 (86.8%) were illiterate. Pre-operatively, 77 of 174 patients (44.3%, 95% confidence interval, CI, 37.0-51.7%) were blind (VA â‰¤3/60), 77 (44.3%, 95% CI 37.0-51.7%) were visually impaired (VA <6/18->3/60), while 20 (11.5%, 95% CI 7.4-16.9%) had presenting acuity â‰¥6/18 in the better eye. Following surgery, significant improvement in visual function was demonstrated by an effect size of 2.8, 3.7 and 3.9 in the domains of general functioning, psychosocial impact and visual symptoms, respectively. Four weeks following surgery, 85 patients (48.9%, 95% CI 41.5-66.3%) had a presenting VA â‰¥6/18, 74 (42.5%, 95% CI 35.3-45.9%) were visually impaired and 15 (8.6%, 95% CI 5.0-13.6%) were blind. IND-VFQ improvement occurred even in patients remaining visually impaired or blind following surgery.In this setting, cataract surgery led to a significant improvement in visual function but the VA results did not meet World Health Organization quality criteria. IND-VFQ results, although complementary to clinical VA outcomes did not, in isolation, reflect the need to improve program quality.
Guillain-Barre syndrome complicated by acute fatal rhabdomyolysis. - Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine
Guillain-Barre syndrome (GBS) is a heterogenous group of peripheral-nerve disorders with similar clinical presentation characterized by acute, self-limited, progressive, bilateral and relatively symmetric ascending flaccid paralysis, which peaks in 2-4 weeks and then subsides. The usual complications, which occur in a patient of GBS are pneumonia, sepsis, pulmonary embolism, respiratory insufficiency and cardiac arrest. The clinical course of GBS complicated by acute rhabdomyolysis is extremely rare. We present the case of GBS with marked elevation in serum creatine kinase, serum myoglobin levels and persistent hyperkalemia as a result of associated acute rhabdomyolysis.
Chemotherapeutic and targeted biological agents for metastatic bladder cancer: a comprehensive review. - International journal of urology : official journal of the Japanese Urological Association
The American Cancer Society estimates that 73â€‰510 new cases of bladder cancer will be diagnosed and 15â€‰000 deaths will result this year. The paper summarizes the clinical evidence for the use of platinum-based, non-platinum-based and new targeted biological agents, while reporting the future directions in the treatment of metastatic bladder cancer. For cisplatin-base regimens, the combination of methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) has been the mainstream treatment for both advanced and metastatic bladder cancers. It showed significant improvement in the complete response rate and overall survival time in comparison with single-agent cisplatin. For cisplatin-ineligible patients, namely patients with renal impairment, symptomatic cardiac disease and poor performance status, alternative therapies consisting of paclitaxel, gemcitabine and carboplatin were shown to be of benefit. Pemetrexed and vinflunine have also shown effectiveness, with small but demonstrable overall survival benefits. Gemcitabine-based doublet therapies (combined with paclitaxel, docetaxel, irinotecan, oxaliplatin or epirubicin) have all been shown to be effective and well-tolerated. Several new targeted therapies, such as gefetinib, sorafenib and lapatinib, have received attention in recent years; however, their effectiveness as single agents in a relapse setting have not been optimal and more studies are warranted.Â© 2014 The Japanese Urological Association.
The use of heterochromatic flicker photometry to determine macular pigment optical density in a healthy Australian population. - Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fÃ¼r klinische und experimentelle Ophthalmologie
To establish the normal macular pigment density (MPOD) in a healthy adult Australian sample using heterochromatic flicker photometry (HFP).Macular pigment density was measured using heterochromatic flicker photometry in a total of 201 subjects ranging in age from 21 to 84Â years with healthy macula. Fifty-seven of the healthy subjects also completed a food-frequency dietary questionnaire. Best-corrected visual acuity (BCVA) was measured using logMAR, chart and macular morphological profiles were assessed using high-resolution integrated Fourier-domain optical coherence tomography (OCT).The average MPOD value was 0.41â€‰Â±â€‰0.20 (range 0.07-0.79). There was no statistically significant difference between values in the left and right eye, with good interocular agreement (0.41 vs 0.40, râ€‰=â€‰0.893, pâ€‰<â€‰0.01). Age significantly predicted MPOD score (R (2)â€‰=â€‰0.07, pâ€‰<â€‰0.05). A subgroup analysis of patients who completed the dietary questionnaire revealed a close correlation between higher diet scores and higher MPOD (râ€‰=â€‰0.720 pâ€‰=â€‰0.031). There was no effect of smoking, gender, or iris colour on MPOD values. There was no significant correlation between BCVA, macular OCT profiles, and MPOD.Given that MPOD values are potentially affected by geographical variation, we have determined a mean MPOD value for healthy subjects in a population south of the equator, providing a reference point for future studies on Caucasian samples.
A case of subacute cutaneous lupus erythematosus as a result of ranibizumab (Lucentis) treatment. - Indian journal of ophthalmology
Cutaneous lupus erythematosus is a previously undiagnosed side-effect of ranibizumab. Here, we present a case of an 82-year-old female Caucasian patient with wet age-related macular degeneration. Following a single intraocular injection of Lucentis (ranibizumab), she developed a subacute cutaneous lupus erythematosus which, with treatment, took nearly 12 months to resolve. This shows that cutaneous lupus erythematosus is a potential side-effect of many medications, including ranibizumab, as in our case and, in an aging population where polypharmacy is a growing reality, clinicians should be aware of how to diagnose and best manage such cases.
Craniofacial duplication: a case report. - Journal of clinical and diagnostic research : JCDR
A craniofacial duplication or diprosopus is an unusual variant of conjoined twinning. The reported incidence is one in 180,000-15 million births and 35 cases have been reported till date. The phenotype is wide, with the partial duplication of a few facial structures to complete dicephalus. A complete duplication is associated with a high incidence of anomalies in the central nervous system, cardiovascular system, gastrointestinal system and the respiratory system, whereas no major anomalies are found in the infants with a partial duplication. A term baby with the features of a craniofacial duplication has been described, with the proposed theories on embryogenesis and a brief review of the literature.
Randomized controlled trial of intravitreal ranibizumab versus standard grid laser for macular edema following branch retinal vein occlusion. - American journal of ophthalmology
To assess the efficacy of intravitreal 0.5 mg ranibizumab for the treatment of center-involving macular edema secondary to branch retinal vein occlusion (BRVO) over 1 year compared with standard-of-care grid laser.A prospective randomized controlled clinical trial.A total of 36 patients with vision loss in 1 eye attributable to macular edema following BRVO were recruited from 5 institutions. Patients were randomized 1:1 to a treatment group that received 6 monthly injections of 0.5 mg ranibizumab and thereafter monthly as needed based on best-corrected visual acuity (BCVA) and central foveal thickness (CFT) assessments on optical coherence tomography scans, or a standard-of-care group that received monthly sham injections for the 1-year duration of the study. Grid laser was administered at 13 and 25 weeks in both groups if criteria for laser treatment were met. Main outcome measures included mean change in BCVA in Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores from baseline to month 12. Secondary outcomes included anatomic outcomes and the percentage of patients requiring grid laser in both groups.Mean BCVA change from baseline was significantly greater in the treatment compared with the standard-of-care group at 12 months (12.5 ETDRS letters vs -1.6 ETDRS letters, P = .032). The mean CFT was significantly reduced in the treatment compared with standard-of-care group (361.7 Î¼m vs 175.6 Î¼m, P = .025). At 13 and 25 weeks, more patients in the standard-of-care group (68.4%, 50.0%) received grid laser than in the treatment group (6.7%, 8.3%). No new ocular or systemic adverse events were observed.Compared with standard grid laser, intravitreal ranibizumab provided significant and sustained benefits in visual acuity gain and anatomic improvement in eyes with macular edema secondary to BRVO.Copyright Â© 2014 Elsevier Inc. All rights reserved.
Periodontal disease is an independent predictor of intracardiac calcification. - BioMed research international
Periodontitis is the most common chronic inflammatory condition worldwide and is associated with incident coronary disease.We hypothesized that periodontal disease would also be associated with cardiac calcification, a condition which shares many risk factors with atherosclerosis and is considered a marker of subclinical atherosclerosis.Cross-sectional study at two sites (USA and Japan) involving subjects with both clinical echocardiograms and detailed dental examinations. Semiquantitative scoring systems were used to assess severity of periodontal disease and echocardiographic calcification.Fifty-six of 73 subjects (77%) had cardiac calcifications, and 51% had moderate to severe periodontal disease (score > 2). In unadjusted analysis, a significant relationship between periodontal score and cardiac calcification (Spearman rhoâ€‰=â€‰0.4, P = 0.001) was noted, with increases in mean calcification score seen across increasing levels of periodontal disease. On multivariate logistic regression, adjusted for age, gender, race, glomerular filtration rate, and traditional risk factors, this association remained significant (P = 0.024). There was no significant interaction by study site, race, or gender.In a multiracial population, we found a significant association between the degree of periodontal disease, a chronic inflammatory condition, and cardiac calcification. Further, higher periodontal scores were associated with greater degrees of calcification.
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