Be Prepared To Assign POA Indicators.
Coders must understand POA indicators and the affect on Medicare reimbursement under IPPS.
Reporting related to reporting the Present on Admission (POA) indicator. This column will go into more detail on the reporting requirements for the POA indicator and will also discuss the Centers for Medicare and Medicaid Services (CMS) identified Hospital-acquired Conditions (HAC) and their codes that, if not present on admission, will not be considered in determining the MS-DRG assignment.
POA Indicator:
POA is defined as present at the time the order for inpatient admission occurs. The purpose of the POA indicator is to differentiate between conditions present at the time of admission from those conditions that develop during the inpatient admission. Going forward you cannot code a Medicare inpatient case without also assigning the POA indicator. Therefore, coders must become as proficient in the assignment of the POA indicator as they are in capturing complications and comorbidities (CCs) and major CCs (MCCs).
Reporting Requirements.
The Deficit Reduction Act of 2005 (DRA) requires that CMS implement the reporting of the POA indicators for all diagnoses reported on Medicare claims for inpatient acute care discharges beginning Oct. 1, 2007. Critical access hospitals, Maryland waiver hospitals, long-term care hospitals, cancer hospitals and children's inpatient facilities are exempt from this requirement.
Hospitals that improperly submit the POA indicator for discharges on or after Jan. 1, 2008, will receive remittance advice remark code N36.3 informing them that they failed to report a valid POA indicator: "Alert: in the near future we are implementing new policies/procedures that would affect this determination." According to CMS when you see this remark code on your remittance advice, it is to alert you that there is a problem with your submission of POA.
Beginning with discharges on or after April 1, 2008, fiscal intermediaries will return claims to hospitals that do not include a valid POA indicator for each diagnosis on the claim. Hospitals will then have to supply the correct POA indicator and resubmit the claim.
POA Reporting Guidelines.
The POA indicator is required for the principal and all secondary diagnoses to determine whether a selected condition developed during a hospital stay. Specific instructions on how to select and report the correct POA indicator are included in the "ICD-9-CM Official Guidelines for Coding and Reporting" and in CMS Transmittal 1240.
The POA guidelines are to be used as a supplement to the ICD-9-CM Official Guidelines to facilitate the assignment of the POA indicator for each diagnosis and external cause of injury code reported on the UB-04 and 837 Institutional claim forms. CMS does not require a POA indicator for external cause of injury codes unless they are reported as an "other diagnosis."
Conditions that develop during an outpatient encounter, including emergency department, observation or outpatient surgery, are considered as POA. Medical record documentation from any provider involved in the care and treatment of the patient may be used to determine whether a condition was POA or not. In this context, the term provider means a physician or any qualified health care practitioner who can legally establish the patient's diagnosis.
A list of categories and codes exempt from POA reporting is provided in the guidelines. These codes are exempt because they represent circumstances that do not represent a current disease or injury or are always POA.
Assigning the POA Indicator.
The POA indicator is reported using one of the following variables:
Y = Yes = present at the time of inpatient admission
N = No = not present at the time of inpatient admission
U = Unknown = the documentation is insufficient to determine if the condition was present at the time of inpatient admission
W = Clinically Undetermined = the provider is unable to clinically determine whether the condition was present at the time of inpatient admission or not
1 = Unreported/Not used - Exempt from POA reporting - This code is the equivalent code of a blank on the UB-04, however, it was determined that blanks were undesirable when submitting this data via the 4010A1. The "ICD-9-CM Official Guidelines for Coding and Reporting" instructs the use of a Blank for reporting the POA for exempt codes. However, Medicare does require that "1" be reported.
When to assign Y
Assign Y for any condition the provider explicitly documents as being POA. Assign Y for conditions that were diagnosed prior to admission. For example: hypertension, diabetes mellitus, asthma. Assign Y for conditions diagnosed during the admission that were clearly present but not diagnosed until after admission occurred. Diagnoses subsequently confirmed after admission are considered POA if at the time of admission they are documented as suspected, possible, rule out, differential diagnosis or constitute an underlying cause of a symptom present at admission. Assign Y for any condition that develops during an outpatient encounter prior to a written order for inpatient admission. For example, a patient undergoes outpatient surgery. During the recovery period, the patient develops atrial fibrillation and the patient is subsequently admitted to the hospital as an inpatient. Assign Y on the POA field for the atrial fibrillation because it developed prior to a written order for inpatient admission.
When to assign N
Assign N for any condition the provider explicitly documents as not present at the time of admission. For example, a patient is admitted to the hospital for a coronary artery bypass surgery. Postoperatively he developed a pulmonary embolism. Assign N on the POA field for the pulmonary embolism. This is an acute condition that was not POA. If the final diagnosis contains a possible, probable, suspected, or rule out diagnosis, and this diagnosis was based on symptoms or clinical findings that were not POA, assign N.
When to assign U
Assign U when the medical record documentation is unclear as to whether the condition was POA. U should not be routinely assigned and should be used only in very limited circumstances. Coders are encouraged to query the providers when the documentation is unclear.
When to assign W
Assign W when the medical record documentation indicates that it cannot be clinically determined whether or not the condition was POA.
Combination Codes
If the combination code only identifies the chronic condition and not the acute exacerbation assign Y. For example, acute exacrbation of CHF Assign N if any part of the combination code was not POA. For example, obstructive chronic bronchitis with acute exacerbation and the exacerbation was not POA; viral hepatitis B progresses to hepatic coma after admission Assign Y if all parts of the combination code were POA. For example, patient with diabetic nephropathy is admitted with uncontrolled diabetes.
Obstetric Conditions.
If the obstetrical code includes more than one diagnosis and any of the diagnoses identified by the code were not POA assign N. For example, pre-eclampsia or eclampsia superimposed on preexisting hypertension assigned with code 642.7X. If the pregnancy complication or obstetrical condition was not POA assign N. For example, patient admitted in active labor. After 12 hours of labor it is noted that the infant is in fetal distress and a Cesarean section is performed. Assign N for the fetal distress.
Perinatal conditions
Newborns are not considered to be admitted until after birth. Therefore, any condition present at birth or that developed in utero is considered POA and should be assigned Y. This includes conditions that occur during delivery. For example, injury during delivery and meconium aspiration.
Congenital conditions and anomalies
Assign Y for congenital conditions and anomalies. Congenital conditions are always considered POA. For example, congenital hydrocephalus.
Codes exempt from reporting
Codes exempt from reporting are listed in the coding guidelines and are reported with the POA indicator of 1. These codes are exempt because the codes do not represent a current disease or injury or are always POA. For example, old MI, late effects of cerebrovascular disease and normal delivery.
Why is POA Important?
POA is an important because it helps differentiate between comorbidities and hospital-acquired complications. It is also important because CMS has determined that for some hospital-acquired conditions reimbursement may be affected.
Hospital-acquired Conditions
Why is Congress requiring hospitals to go to all the trouble of reporting the POA indicator? The DRA also includes a requirement that by Oct. 1, 2007, Medicare choose at least two conditions that are: High cost, high volume or both Assigned to a higher paying MS-DRG when present as a secondary diagnosis Reasonably preventable through application of evidence-based guidelines.
Beginning Oct. 1, 2008, codes representing these conditions will not be considered when calculating the MS-DRG assignment unless they were POA. In many cases, omission of these codes would result in a MS-DRG with a lower payment weight being assigned to the case. As a result, some hospital-acquired conditions could end up costing facilities much more. The POA condition, resulting in lower reimbursement, only applies when the selected conditions are the only CCs or MCCs present on the claim. If any other CC or MCC, not subject to the hospital-acquired infection provision, is present on the claim, the case will continue to be assigned to the higher-paying CC or MCC MS-DRG, and the MS-DRG assignment will not be affected.
CMS partnered with the Centers for Disease Control and Prevention (CDC) to identify potential high-volume, hospital-acquired conditions that hospitals could have reasonably prevented. Beginning on Oct. 1, 2008, cases with the following conditions will not be paid at a higher rate unless the conditions were POA.
1. Serious Preventable Event - Object Left in Surgery: CMS identifies "objects left in during surgery" as a serious preventable event. This means that this event should never occur during the health care encounter. This event is identified by diagnosis code 998.4, Foreign body accidentally left during a procedure.
2. Serious Preventable Event - Air Embolism: Air embolisms are also identified as a serious preventable event. This event is reported with diagnosis code 999.1, Complications of medical care, NOS, air embolism.
3. Serious Preventable Event - Blood Incompatibility: Although this event is rare, associated charges per case are high. There are prevention guidelines for avoiding the delivery of incompatible blood or blood products and this event should never occur. Blood incompatibility is identified by diagnosis code 999.6, Complications of medical care, NOS ABO incompatibility reaction.
4. Catheter-Associated Urinary Tract Infections (UTI): Catheter-associated UTIs are the most common hospital-acquired infection, accounting for more than 1 million cases in hospitals and nursing homes nationwide. It is estimated that hospital-acquired UTIs require one extra hospital day per patient at an estimated annual cost of $424 million to $451 million. These conditions are reported with code 996.64 Infection and inflammatory reaction due to indwelling urinary catheter and one of the following UTI codes; 112.2, 590.10, 590.11, 590.2, 590.3, 590.80, 590.81, 590.9, 595.0, 595.3, 595.4, 595.81, 595.89, 595.9, 597.0, 597.80, 599.0.
5. Pressure Ulcers: Pressure ulcers, also known as decubitus ulcers, are both a high cost and high volume condition, with more than 322,946 reported cases in FY 2006 with an average hospital charge of $40,381. CMS believes that selection of this condition will result in a closer examination of the patient's skin on admission, resulting in better quality of care. This diagnosis is identified by diagnosis codes 707.00 through 707.09
6. Vascular Catheter-Associated Infection: This condition appears to be both high cost and high volume, and there are prevention guidelines available. A new code was created effective Oct.1, 2007, to report this condition, 999.31, Infection due to central venous catheter.
7. Surgical Site Infection-Mediastinitis after Coronary Artery Bypass Graft (CABG) Surgery: In its analysis of FY 2006 discharges, CMS identified 108 cases with a secondary diagnosis of mediastinitis in patients who had CABG surgery. These patients had average hospital charges of more than $300,000. This condition is identified in cases where there is both diagnosis code 519.2, Mediastinitis, and one or more of the CABG procedures codes 36.10 through 36.19 on the same claim.
8. Hospital-Acquired Injuries-Fractures, Dislocations, Intracranial Injury, Crushing Injury, Burn and Other Unspecified Effects of External Causes: CMS has not yet determined the codes that will be used to identify these conditons. They will be included in the FY 2009 proposed IPPS rule for comment.
Conditions being considered for FY2009CMS also indicated that they are evaluating the following conditions. They may be included in the FY 2009 proposed IPPS rule for comment
1. Ventilator Associated Pneumonia (VAP)
2. Staphylococcus Aureus Septicemia
3. Deep Vein Thrombosis (DVT)/ Pulmonary Embolism (PE).
This article only discussed the Medicare requirements for POA and hospital-acquired conditions. There are some state specific requirements regarding the reporting of the POA indicator. To ensure compliance with any state-specific POA reporting requirement it is important to check with the appropriate state hospital association.
Take some time now to review in detail the FY 2008 ICD-9-CM Official Guidelines for Coding and Reporting related to POA at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide07.pdf . You may also want to review the CMS Web site on Hospital-acquired Conditions at www.cms.hhs.gov/HospitalAcqCond/.
Tuesday, April 12, 2011
Subscribe to:
Post Comments (Atom)
Who is the author of this article? I need to cite my resource.
ReplyDeleteIt’s difficult to find knowledgeable people with this topic, however, you seem like you know what you are talking about! Thanks for sharing this valuable blog with us.
ReplyDeleteCPC Certification
I am hoping the same best effort from you in the future as well. In fact your creative writing skills has inspired me. medical
ReplyDeleteI really appreciate DR AKHIGBE,my name is LAURIE HUGHES . I will never stop testifying DR AKHIGBE , Happiness is all i see now I never thought that I will be cured from HIV virus again. DR AKHIGBE did it for me I have been suffering from a deadly disease (HIV) for the past 2 years now, I had spent a lot of money going from one place to another, from churches to churches, hospitals have been my home every day residence. Constant checks up have been my hobby not until this faithful day, I saw a testimony on how DR AKHIGBE helped someone in curing his HIV disease in internet quickly I copied his email which is drrealakhigbe@gmail.com just to give him a test I spoke to him, he asked me to do some certain things which I did, he told me that he is going to provide the herbal cure to me, which he did, then he asked me to go for medical checkup after some days, after using the herbal cure and i did, behold I was free from the deadly disease,till now no HIV in me again he only asked me to post the testimony through the whole world, faithfully am doing it now,all the testimony of DR AKHIGBE is true please BROTHER and SISTER, MOTHER and FATHER he is great, I owe him in return. if you are having a similar problem just email him on drrealakhigbe@gmail.com or you can whats App his mobile number on +2348142454860 He can also cure these diseases like HIV and AIDS HERPES,DIABETICS,CANCER, HEPATITIS A&B,CHRONIC DISEASES, ASTHMA, HEART DISEASES, EXTERNAL INFECTION, EPILEPSY, STROKE, LUPUS,ECZEMA,BACK PAIN,JOINT PAIN. .ETC .please email drrealakhigbe@gmail.com...or whats APP him ..+2348142454860 he is a real good and honest man.
ReplyDeleteIt is no secret that I have a very deep and personal relationship with God. I have pushed and resisted that relationship this past year through all the bullshit I have had to go through living with Herpes but once again, God is bigger than my stubbornness and broke through that outbreak cold sore and all I had Genital Herpes. For me personally, hearing over and over how I am not good enough has really invaded my mind in the worst way possible. I completely shut down and I was just waking up like is this how life going to end this temporary herpes outbreak “fuck everybody with herpes if you know what I mean” but let's be honest here...
ReplyDeleteIt is a cowardly to say no to herbal medicine. It is fear based. And it is dishonest to what my heart wants. Don't build a wall around yourself because you are afraid of herbals made or taking a bold step especially when it's come to health issues and getting cure. So many young men/ women tell me over and over that Dr Itua is going to scam me but I give him a try to today I feel like no one will ever convince me about herbal medicine I accept Dr Itua herbal medicine because it's cure my herpes just two weeks of drinking it and i have been living for a year and months now I experience outbreak no more, You can contact him if you need his herbal medicine for any such diseases like, Herpes, Schizophrenia,Cancer,Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity Syndrome Fibrodysplasia Ossificans Progressiva.Fatal Familial Insomnia Factor V Leiden Mutation ,Epilepsy Dupuytren's disease,Desmoplastic,Diabetes ,Coeliac disease,Creutzfeldt–Jakob,,Lyme Disease,Epilepsy, ,ALS,Hepatitis,Copd,Parkinson disease.Genetic disease,Fibrodysplasia disease,Fibrodysplasia Ossificans Men/Woman infertility, bowel disease ,Huntington's disease ,Diabetes,Fibroid. disease,Lupus,Lipoid Storage diseases( Gauchers disease),Polycystic Disease.,Cerebral Amyloid Angiopathy, Ataxia,Cirrhosis of Liver,Arthritis,Amyotrophic Lateral Sclerosis,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic,HIV, Epilepsy, Infertility, Love Spell,. Email..drituaherbalcenter@gmail.com then what's app.+2348149277967.... My advice to any sick men/women out there is simple... Be Always an open book. Be gut wrenching honest about yourself, your situation, and what you are all about. Don't hold anything back. Holding back will get you nowhere...maybe a one way ticket to lonelyville and that is NOT somewhere you want to be. So my final truth...and I'm just starting to grasp this one..
All thanks to this great herbal doctor who cured me from (LUPUS DISEASE) his name is dr imoloa. I suffered lupus disease for over 8 years with pains like: joints, Skin rash, Pain in the chest, swollen joints and many more. The anti-inflammatory drugs couldn’t cure me, until I read about his recommendation. 2 months ago, I contacted him through his email address. drimolaherbalmademedicine@gmail.com . and he sent me the herbal treatment through DHL courier service and he instructed me on how to drink it for good two weeks. after then, And I was confirmed cured and free at the hospital after taken his powerful herbal medications You too can be cured with it if interested, he also uses his powerful herbal healing medicine to cure disease like:parkison disease, vaginal cancer, epilepsy, Anxiety Disorders, Autoimmune Disease, Back Pain, Back Sprain, Bipolar Disorder, Brain Tumour, Malignant, Bruxism, Bulimia, Cervical Disk Disease, cardiovascular disease, Neoplasms, chronic respiratory disease, mental and behavioural disorder, Cystic Fibrosis, Hypertension, Diabetes, asthma, Inflammatory autoimmune-mediated arthritis. chronic kidney disease, inflammatory joint disease, back pain, impotence, feta alcohol spectrum, Dysthymic Disorder, Eczema, skin cancer, tuberculosis, Chronic Fatigue Syndrome, constipation, inflammatory bowel disease, bone cancer, lungs cancer, mouth ulcer, mouth cancer, body pain, fever, hepatitis A.B.C., syphilis, diarrhea, HIV/AIDS, Huntington's Disease, back acne, Chronic renal failure, addison disease, Chronic Pain, Crohn's Disease, Cystic Fibrosis, Fibromyalgia, Inflammatory Bowel Disease, fungal nail disease, Lyme Disease, Celia disease, Lymphoma, Major Depression, Malignant Melanoma, Mania, Melorheostosis, Meniere's Disease, Mucopolysaccharidosis , Multiple Sclerosis, Muscular Dystrophy, Rheumatoid Arthritis, Alzheimer's Disease Contacts him today and get permanently cure. contact him via... email- drimolaherbalmademedicine@gmail.com /whatssapp-+2347081986098.
ReplyDeleteMy father was diagnosed with amyotrophic lateral sclerosis (ALS) in the summer of 2013; His initial symptoms were quite noticeable. He first experienced weakness in his right arm and his speech and swallowing abilities were profoundly affected. We all did our best to seek help for this disease no medications they prescribe worked ,we were all scared we might lost him due to his condition, as he had been his brother's caregiver a few years earlier for the same disease before he past. doctor recommend nuatural treatment from total cure herbal foundation for his ALS we have no choice to give a try on natural organic treatment ,this herbal cure has effectively reverse my father condition ,losing his balance which led to stumbling and falling stop after the completing the herbal supplement which include his weakness in his right arm and his speech, natural herbs from totalcureherbsfoundation .co m home remedy is the best although their service is a little bit expensive but it worth it, they save lives.
ReplyDeleteI'm 59 years old and female. I was diagnosed a couple of years ago with COPD and I was beyond scared! My lung function test indicated 49% capacity. After having had flu a year ago, the shortness of breath, coughing and chest pains continued even after being treated with antibiotics. I've been smoking two packs a day for 36 years. Being born without a sternum caused my ribs to be curled in just one inch away from my spine, resulting to underdeveloped lungs. At age 34 I had surgery and it was fixed. Unfortunately my smoking just caused more damage to my already under developed lungs. The problem was having is that I enjoy smoking and don't want to give up! Have tried twice before and nearly went crazy and don't want to go through that again. I saw the fear in my husband and children's eyes when I told them about my condition then they start to find solution on their own to help my condition.I am an 59 now who was diagnose COPD emphysema which I know was from my years of smoking. I started smoking in school when smoking was socially acceptable. I remember when smoking was permitted in hospitals. It was not known then how dangerous cigarettes were for us, and it seemed everybody smoked but i was able to get rid of my COPD lung condition through the help of total cure herbal foundation my husband bought, totalcureherbsfoundation.com has the right herbal formula to help you get rid and repair any lung conditions and cure you totally with their natural organic herbs,it class products at affordable prices. Purchase these medicines and get the generic medicines delivered in USA, UK & Australia,I wish anybody who starts smoking at a young age would realize what will eventually happen to their bodies if they continue that vile habit throughout their life.
ReplyDeleteWHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are Clara David I’m a citizen of USA, My younger sister was sicking of
ReplyDeletebreast cancer and her name is Sandra David I and my family have taking her
to all kind of hospital in USA still yet no good result. I decided to go to
the internet and search for cancer cure so that was how I find a lady
called peter Lizzy she was testifies to the world about the goodness of a
herbal man who has the roots and herbs to cure all kind of disease and the
herbal man email was there. So I decided to contact the herbal man @herbalist_sakura for my younger sister help to cure her breast cancer. I contacted him and told him
my problem he told me that I should not worry that my sister cancer will be
cure, he told me that there is a medicine that he is going to give me that
I will cook it and give it to my sister to drink for one week, so I ask how
can I receive the cure that I am in USA, he told me
That I will pay for the delivery service. The courier service can
transport it to me so he told me the amount I will pay, so my dad paid for
the delivery fee. two days later I receive the cure from the courier
service so I used it as the herbal man instructed me to, before the week
complete my sister cancer was healed and it was like a dream to me not
knowing that it was physical I and my family were very happy about the
miracle of Doctor so my dad wanted to pay him 5 million us dollars the
herbal man did not accept the offer from my dad, but I don't know why he
didn't accept the offer, he only say that I should tell the world about him
and his miracle he perform so am now here to tell the world about him if
you or your relative is having any kind of disease that you can't get from
the hospital please contact dr.sakuraspellalter@gmail.com or whats app him
+2348110114739 you can follow him up on Instagram @herbalist_sakura for the cure, he will help you out with the
problem. And if you need more information about the doctor you can mail me
davidclara223@gmail.com
I am BOBBIE MARTIN from USA i was tested positive of Copd disease, and there was no remedy, my younger sister told me that she has been reading about DR_anuge healing people with his herbal medicine then she introduce him to me and he agreed to help me. he only ask for my medical report and he send me some medication and i used it as instructed and now my medical report show negative all thanks to dr_anuge. if you have fall a victim of this deadly virus you should contact him via.. dranuge@gmail.com or WhatsApp him +2348164866838
ReplyDeleteHere are what people have to say about the Gummi Candy Twin Cherries by Haribo sweets. CBD for sleep
ReplyDeleteFINALLY FREE FROM HERPES VIRUSESI thought my life had nothing to offer anymore because life became meaningless to me because I had Herpes virus, the symptoms became very severe and bold and made my family run from and abandoned me so they won't get infected. I gave up everything, my hope, dreams,vision and job because the doctor told me there's no cure. I consumed so many drugs but they never cured me but hid the symptoms inside me making it worse. I was doing some research online someday when I Came across testimonies of some people of how DR Ebhota Cured them from Herpes, I never believed at first and thought it was a joke but later decided to contact him on the details provided and when I messaged him we talked and he sent me his herbal medicine and told me to go for a test after two weeks. Within 7 days of medication the symptoms disappeared and when I went for a test Lo and behold IT was negative by the Doctor Who tested me earlier. Thank you DR Ebhota because I forever owe you my life and I'll keep on telling the world about you. If you are going through the same situation worry no more and contact him via email drebhotasolution@gmail. com or WhatsApp him via +2348089535482.he also special on curing 1. HIV/AIDS2. HERPES 3. CANCER 4.ALS 5. HEPATITIS B 6.DIABETES 7. HUMAN PAPILLOMA VIRUS DISEASE(HPV)8. ALZHEIMER 9. LUPUS (Lupus Vulgaris or Lupus Erythematosus
ReplyDeleteHerbal medicine is the best Greetings I am here to testify how great man called Dr OMO helped me out with herbs and roots which he prepared for me in use of curing my fibroids and Getting pregnant after 8 years of try to conceive with fibroids I takes his product (cure for my fibroid made with herbal medicine Root) for (14) days before I am to known I was totally pregnant after 2months of using dr omo herbs he also have Herbal medical for all types of diseases, and i promise him that i will tell the world about his Great job he ask me to drink from the herbal medicine before meeting my husband I did and after 2months I was pregnant thank you for your great job he can also help you if you have a low sperm count you want to convince a baby fast PCOS ,infections, swollen Legs,Diabetes,stomach ucler ,THYROID, COPD, Endometriosis, breast cancer,HIV?AID,ALS, yeast infection, Gonorrhea, Chronic Sinus, HPV low testosterone, Herpes, blocked fallopian tubes Liver parasites ovarian Arthritis, Cysts, pile, ASTHMA, Crowns and all other type of diseases,WEAK ERECTION, STRETCH MARK REMOVER , breast cancer, Parkinson's, male-enhancement Cream, BARENESS/INFERTILITY, HEPATITIS B pile, Get lost period back, stop period pain, Email : dromo596@gmail.com WhatsApp him on +2349033505260 thank you for all your work..
ReplyDeleteI grew up with asthma; I suffered sinus and respiratory infections my entire life. I started smoking at 16. When I was in my early 40s, my asthma was becoming increasingly worse. I was diagnosed with COPD at age 47. I am now 55. I quit smoking four years ago. The disease does not improve. My good days were far, i was scared that i wont survive it but i was so lucky to receive a herbal products from my step father who bought it while coming from South Africa for Rugby league, this herbal remedies saved me from this disease, at first it helps fight the symptoms of diseases and i was seeing good outcome, i had to use it for 13 weeks just as they Dr was prescribed and i was totally cure of asthma and COPD, (multivitamincare org ) do not hesitate to purchase from them they deliver across worldwide.
ReplyDeleteI want to share my testimonies to the general
ReplyDeletepublic on how this great man called Dr OLOKUN who cure my herpes. I have been a HERPES patient for over 9 Months and i have been in pains until i came across this lady when i traveled to Africa for business trip who happer and she told me that there is this great herbal doctor that help her tocure her herpes and she gave me his email address for me to contact and i did as she instructed. The man Dr OLOKUN told me how much to buy the
herpes herbal medication and how i will get it, which i did. And to my
greatest surprise that i took the Herpes herbal medicine for just two week as he
instructed and behold i went for a herpes test, to my greatest surprise for the
doctor confirmed me to be herpes free and said that i no longer have
herpes in my system and till now i have never felt any pains nor herpes again, so i
said i must testify the goodness of this man to the general public. So if
you are there surfing from this Herpes problems or any deadly disease or
other disease for i will advice you to contact him on his working
email: drolokuntemple@gmail.com OR on his cell phone +2348132537313 whatsapp number
+2348132537313
My husband had MND ALS, first symptom was weakness in his fingers, one day, we had a dream life with early retirement and then, when we went to find out about the weakness, our whole world almost changed. There are so many things that can be said abt the suffering and frustration of people with ALS, we look back now and realize in many ways how lucky we were to found Multivitamin herbal cure that was able to get rid of my husband ALS disease totally, we had time to enjoy life and above all we all had time to also share this great testimony , many people lose loved ones without closure. I can’t imagine going thru all that you or your family had to live with daily, do not hesitate to contact w w w multivitamincare .org for ALS cure.❤💙💚
ReplyDelete