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It is the most commonly billed E/M code in outpatient medicine, used for follow-up visits, stable chronic disease management, and minor acute problems

GPs can prescribe B12 injections following appropriate investigation, which should include: Full blood count to identify macrocytic anaemia Serum B12 and folate levels to confirm deficiency (using laboratory-specific reference ranges) Methylmalonic acid and/or homocysteine when B12 results are borderline Intrinsic factor antibodies if pernicious anaemia is suspected Additional tests depending on clinical presentation (e.g., thyroid function, coeliac serology) When both B12 and folate deficiency are present, B12 should be replaced before folate to avoid precipitating subacute combined degeneration of the spinal cord

Application of the method to Crohns disease patients treated with infliximab

Paradoxically, it also stimulates ghrelin, the hunger hormone, which can significantly increase appetite