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For randomised clinical trials, the Jadad scale (Jadad et al., 1996), as used to assign a quality score ranging from 0 to 5, based on randomisation, blinding, and withdrawal reporting

Medicare's NCCI guidelines are strict without this modifier, the E/M will be bundled into the injection and denied

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It may deplete the body of glutathione (to cleanse the cyanide molecule attached to it), which the body needs to lower the high homocysteine levels prevalent in PA

If only a small amount of the intestine is affected, it may be that actually the stools look completely normal and you're not aware of that