How to Deal With Insect Bites

Insect bites occur at all times of the year, but late summer, early fall is a particularly busy bite-time.  From mosquito’s, to ticks and even spiders, it’s sometimes hard to know if the bite requires medical intervention.

Most of the time, all a bite needs is cleaning and superficial care. It can become red, swollen, itchy and painful, but not necessarily a problem. If you receive a bite, clean it with soap and water.  Apply ice and if itchy, a topical anti-itch cream like Benadryl, Aspirin or an anti-inflammatory can help with pain and/or swelling if you are able to take them. A bite can remain red and swollen for several days.

The bites that require medical care are mostly those that have a secondary infection. This looks like an increased area of redness and swelling around the original bite area, usually occurs a day or two after the bite, and redness travels upwards from the bite.  These bites need evaluated to see if an antibiotic is necessary.

Spider bites can make people uneasy, but most will respond to the above-mentioned conservative care and do not need an antibiotic unless secondarily infected. The two biggest exceptions are the black widow and brown recluse bites. These bites are intensely painful, swollen, can cause systemic symptoms like nausea, cramping, lethargy and chills.  Black widow bites require anti venom, brown recluse bites require antibiotics and sometimes surgical removal of necrotic tissue.  There are many helpful photos on the internet to help you distinguish a ‘good’ from a ‘bad’ bite.

Tick bites cause the most anxiety for patients as everyone fears Lyme disease and it’s complications. If there is redness and swelling from a tick bite, see your doctor for discussion of what’s best to do.  Most of the time, the deer tick and not the dog tick, is the carrier for Lyme disease, but this is disputed. A rash that looks like a bulls-eye, red center surrounded by a cleared area and then a red ring is concerning and should be treated with an antibiotic for several weeks.  Many times we see Lyme disease in our office as a swollen joint, no history of rash or bite.  A recurrent, non-red but swollen joint that may or may not be painful, should be evaluated.

Insect bites can be a nuisance but are not necessarily a medical emergency. Treat supportively, but if any questions or concerns, check with your OIP caregivers!

Leave a Comment

Leave a Reply

Your email address will not be published. Required fields are marked *

MRI Upper Extremity (Shoulder, Upper Arm, Elbow, Forearm, Wrist, or Hand) Preauthorization Documentation Guidelines

1. Suspicious mass or tumor
      a. On initial evaluation or follow up
2. Staging of known cancer
3. Suspected or known infection (septic arthritis or osteomyelitis)
4. Suspected Osteonecrosis
5. Evaluation of Rheumatoid Arthritis or other autoimmune diseases
6. Evaluation of Post-op Complications
      a. Infection, delayed union, other
7. Suspected fracture with prior imaging non-diagnostic
8. Abnormal bones scan with non-diagnostic Xray
9. Significant injury with suspected ligament, cartilage, tendon, nerve or bone injury with non-diagnostic prior imaging
      a. Suspected massive rotator cuff tear
10. Evaluation of pain or more minor injury with initial imaging non-diagnostic:
      a. Pain lasting 3 months or greater
      b. Failed conservative therapy: Must include each one:
           i. Rest: modified activities or assistive devices/rigid splints or braces
           ii. Ice or heat
           iii. Medications and/or injections
           iv. Physical therapy or a physician directed home exercise program
           or chiropractic care
                1. Document instructions given
                2. Document compliance and results
                3. Document duration and dates

MRI Spine Preauthorization Documentation Criteria

1. Tumor, masses, or cancer: suspected or known
2. Neurological Deficits
3. Trauma or acute injury
       a. With neurological deficits
       b. With progressive symptoms during conservative treatment
4. Infection: known or suspected
5. Inflammation: Ankylosing Spondylitis
6. Pre-op Evaluation
7. Post-op Complications
8. Acute or Chronic Axial or radicular pain
       a. Pain lasting 6 weeks or greater
       b. ADLs must be affected
       c. Progressive neurological deficit or an abnormal EMG
             i. Must document specific dermatome, muscle weakness, reflex
abnormalities
       d. Failed conservative therapy: Must include each one:
             i. Rest: modified activities or bracing
             ii. Ice or heat
             iii. Medications, acupuncture or stimulators
                   1. Specific name of medication start date and duration and
                   results
             iv. Epidurals or other injections (not trigger point injections)
             v. Physical therapy or a physician directed home exercise program
             or chiropractic care
                   1. Document instructions given
                   2. Document compliance and results
                   3. Document duration and dates

MRI Pelvis Preauthorization Documentation Criteria

1. Musculoskeletal Pelvic MRI:
     a. Mass or tumor
    b. Significant injury to rule out fracture or other injury
    c. Osteonecrosis of hips
    d. Sacroiliitis
    e. Sacroiliac joint dysfunction
    f. Pain lasting 3 months or greater
    g. Failed conservative therapy: Must include each one:
            i. Rest: modified activities or assistive devices/rigid
            splints or braces
            ii. Ice or heat
            iii. Medications and/or injections
            iv. Physical therapy or a physician directed home
            exercise program or chiropractic care
                    1. Document instructions given
                    2. Document compliance and results
                    3. Document duration
    h. Persistent Pain not responsive to 4 weeks of conservative treatment

2. Prostate Cancer Evaluation, follow up, and surveillance

3. Mass or Tumors

4. Cancer detection, staging, or surveillance
    a. 3, 6, or 12 month follow up

5. Infection:
        a. Appendicitis
        b. Diverticulitis not responding to conservative care
        c. Inflammatory bowel disease
        d. Abscess suspected
        e. Fistula
        f. Abnormal fluid collection

6. Pelvic Floor failure

7. Uterine abnormalities

8. Undescended Testes

9. Pre-op Evaluation

10. Post-op Complication

MRI Lower Extremity (Hip, Knee, Leg, Ankle, or Foot) Preauthorization Documentation Guidelines

1. Suspicious Mass or Tumor
       a. On initial evaluation or follow up
2. Staging of known Cancer
3. Known or suspected infection
4. Suspected Osteonecrosis or Legg-Calve-Perthes Disease
5. Suspected SCFE, tarsal coaltion
6. Evaluation of Post-op complication:
       a. Infection, delayed union, other
7. Suspected fracture with prior imaging non-diagnostic
8. Abnormal bone scan with non-diagnostic xray
9. Significant injury with suspected ligament, cartilage, or bone injury
10. Evaluation of pain or more minor injury with initial imaging negative:
       a. Pain lasting 3 months or greater
       b. Failed conservative therapy: Must include each one:
             i. Rest: modified activities or assistive devices/rigid splints or braces
             ii. Ice or heat
             iii. Medications and/or injections
             iv. Physical therapy or a physician directed home exercise program orchiropractic care
                  1. Document instructions given
                   2. Document compliance and results
                   3. Document duration

MRI Chest Preauthorization Documentation Guidelines

1. Mediastinal or hilar mass
2. Myasthenia gravis with suspected thymoma
3. Brachial Plexus Dysfunction
4. Thoracic/Thoracoabdominal aneurysm
5. Suspected or confirmed Congenital Heart Disease
6. Thoracic Outlet Syndrome

MRI Brain Preauthorization Documentation Criteria

1. Suspected or known MS
2. Seizure disorder, known or suspected new or refractory
3. Suspected Parkinson’s disorder
4. Neurological symptoms or deficits
     a. Acute, new or fluctuating deficits
5. Mental status changes
6. Trauma to the head with neurological changes, vomiting, headache
7. Evaluation of headaches
      a. Chronic with change in pattern/character
      b. Sudden onset severe headache
      c. New onset headache in pregnancy
8. Suspected brain tumor or cancer
9. Known or suspected stroke
10. Suspected Infection
11. Suspected Congenital abnormality
12. New onset tinnitus or vertigo associated with visual changes

MRI Abdomen and MRCP Preauthorization Documentation Criteria

MRI
1. Suspicious Mass or Tumor
2. Surveillance of Mass, Tumor, or Cancer    
      a. 3, 6, 12 month follow up
3. Suspected infection:
      a. Appendicitis
      b. Peritonitis
      c. Pancreatitis
      d. Inflammatory bowel disease
      e. Cholecystitis
      f. Abscess
      g. Fistula
      h. Hepatitis C
4. Preoperative Evaluation
5. Post-op complication

MRCP
1. Suspected Congenital Abnormality
2. Chronic pancreatitis or related complications
3. Biliary tree symptoms
4. Pre-op Evaluation
5. Post-op complication or surveillance
6. Inconclusive abnormalities identified on other imaging