The Voice of Podiatrists

October 15, 2006 #1,714 Editor-Barry Block, DPM, JD

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Team Approach Best: PA Podiatrist With Diabetes

Cooperation among physicians and patients is also important, said Dr. Adam Kruczay, a podiatrist in private practice in Tyrone. Kruczay, who’s had type 1 diabetes since April 1986, said people have walked into his office with a perceived foot problem and walked out with a diagnosis of diabetes.

Dr. Adam Kruczay

He said diabetes can cause nerve damage, a decrease in sensation to the feet, foot ulcers and problems with blood flow. “Really the big thing is a team approach,” he said. “Everybody needs to do things to treat the patient properly. People need to educate themselves about the problem, do things themselves, follow the instructions of a doctor and not overlook anything.”

Instead of ignoring a sore that won’t heal or trying to treat ailments at home, Kruczay said people need to see a doctor. “If you feel concerned with something, it needs to be addressed,” he said. “People will say they feel fine, but you can’t always go by how you feel. I’ve had diabetes for 20 years and I have no complications because I do the appropriate things.”

Source: Jennifer Babulsky, Altoona Mirror, [10/12/06]

Berlin & Partners Open 1st Baltimore Heliport

Steve Berlin, DPM and his partners (Selvin Passen, MD and Dan Noir) have recently opened the Baltimore City Heliport . Located near their Baltimore Marine Center, it juts out 575 feet into Baltimore harbor and has six landing pads. It is lighted for night flying and is the home base for Johns Hopkins Medical Center.

Dr. Steven Berlin

The private heliport recently received its commercial license from the State of Maryland and will most likely become a public heliport within the next year. A hanger, which will accommodate 4-6 helicopters is also planned.

CMS Decreases Rate of Improper Medicare FFS Reimbursements

Improved oversight and other efforts by CMS have helped reduce the rate of improper Medicare reimbursements for fee-for-service claims from 5.2% in 2005 to 4.4% in 2006 for a savings of $1.3 billion, according to agency Administrator Mark McClellan, CQ HealthBeat reports. As part of the efforts, CMS conducted reviews of about 160,000 randomly selected Medicare fee-for-service claims submitted between April 1, 2005, and March 31, 2006.

CMS also worked with Medicare contractors to improve system edits, update coverage policies and direct provider education efforts. From 2004 to 2005, CMS reduced the rate of improper Medicare reimbursements for fee-for-service claims from 10.1% to 5.2% for a savings of about $10 billion.

Source: CQ Healthbeat via American Health Line [10/13/06]

Query: Pediatric Melanoma

About 15-20 years ago, a dermatopathologist at a lecture said that a pigmented lesion in the band of skin between the dorsal and plantar surfaces of black people should be highly suspect for melanoma. I've never heard that before or since. Does anyone have any knowledge of this? I have an 8y/o female black patient who has a pigmented lesion there. I don't want to subject her to a biopsy simply because of the location unless there is some body of evidence supporting it.

Larry Aronberg, DPM, Lake Worth, FL

Query: Whitee Patches

I received a few herbal "Whitee" sample patches from Wei Labs in the mail and threw them in a drawer. I hurt my ankle and after 4 weeks, as a lark, put one of the patches on the sore spot. Within a week, 90 % of the pain and swelling was gone. I then put patches on 2 patients with inflammatory conditions and they both called back asking for more patches. Can anyone who has used these patches extensively share their experiences? If anyone has used the "Money Back if not Improved" offer that comes with the product, what response did you get?

Kevin McDonald, DPM, Kannapolis NC

Query: Billing CPT 11305 Bilaterally

When using CPT 11305 (shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less), can you bill it bilaterally (e.g., CPT 11305-RT, CPT 11305-LT-59)?

Michael Fein, DPM, Bethel, CT

Response: The CPT 1130x series codes are billed 'per lesion.' I would suggest using "LT" "RT" if there are two lesions on different feet; and using "-59" on the second lesion if the two lesions are located on one foot. It would not be appropriate to use the "-50" bilateral modifier using these codes.

Make sure that you are using CPT 1130x series codes properly. The guidelines for the code series notes that "Shaving is the sharp removal by transverse incision or horizontal slicing to remove epidermal and dermal lesions without a full-thickness dermal excision. This includes local anesthesia, chemical or electrocauterization of the wound. The wound does not require suture closure."

You should be aware that typically these codes are used by dermatologists not for palliative care of lesions, but more definitive treatments.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at http://www.codingline.com/subscribe.htm

RE: Fischer Auto Tank X-Ray Processor (Scott Kissell, DPM)
From: Ira Weiner, DPM

You may wish to check out the AGFA CP-1000. I have been using one for years, and have found it to be VERY reliable as well as practical. We drain into drums, which are removed by our x-ray company. It is a table top model which makes for ease of installation, but you do have to be especially careful to make sure it remains perfectly level since the replenishers are gravity feed.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com

RE: Vics VapoRub (Michael Lawrence, DPM)
From: Scott Giaimo, DPM, Brian Kashan, DPM

I too have had several MD's in my area recommend this treatment for mycotic nails. I have seen a few that actually had good results. However, as soon as they stop, the fungus returns and they have just wasted a year of treatment time. I have not read any studies on this but my guess would be that perhaps the menthylatum or if there is Eucalyptus oil in it that this has a fungistatic effect. Since it does not kill the fungus it will return very quickly after cessation of the treatment.

Scott Giaimo, DPM, Portsmouth, OH, footman28@yahoo.com

I have been recommending, for several years now, that patients use Vicks on their toenails. I do this on patients whom come in every 2 or 3 months for debridements, and not on patients who come in for cure. I use the Vicks to facilitate debridement. Used regularly, it gets absorbed into the nail, making it softer and much less brittle. I am able to debride significantly more nail than without it. It also makes debridement less painful, as trying to squeeze your nail clipper around a 2-inch thick nail can be uncomfortable to the patient.

As far as "curing" nail fungus, that is ridiculous. While it may lighten the color of the nail due to bleaching agents in it, I never profess that the patient use it as an anti-fungal treatment. Some podiatrists feel that recommending old time remedies for medical conditions is lessening the value of our education and training. However, I have seen the results of using Vicks, and it accomplishes what I want. The longer I am in practice, the more I believe that if something works and benefits my patients, I have no problem using it.

Like everything else, in its proper place, and its purpose explained, Vicks can be helpful.

Brian Kashan, DPM, Baltimore, MD, drbkas@worldnet.att.net

RE: Insurance Identity Fraud (Neil H. Hecht, DPM)
From: Peter Smith, DPM

I am not sure why I need to take extra steps to prevent insurance identity fraud. If someone comes to me and tells me their name, address, and SSN, and produces an insurance card, then why should I become the fraud police. If they are lying, then they are committing a crime, not me. If the Insurance companies feel it is a big enough problem, then let them issue ID cards with photos on them. Why should we take extra steps to save them money. Let them spend the extra time and expense to police their own industry. Insurance companies are certainly not taking any extra measures to help protect my bottom line, and I'll be damned if I will do even one more thing to help them. And please don't tell me that if the perpetrator is caught that I will have to refund the money. I will gladly deal with that problem when it happens!

I am also not interested in lectures about the "moral high ground," or that because we are doctors we are supposed to try to trip up the bad guys. I have heard more stories of doctor's unscrupulous billing practices than I will ever hear about patients using the wrong insurance card! I'll just keep seeing my patients, billing honestly, and keep trying to make my living, and leave the insurance fraud to the police.

Peter Smith, DPM, Stony Brook, NY, drpetersmith@optonline.net

MEDICAL EQUIPMENT WANTED

MinXray P-200 Exposure Hand Switch with Timer Control (circa 1977). jim.fractal@gmail.com

SEEKING ASSOCIATE POSITION - NEW YORK

Hardworking, ethical and well trained PSR-24 trained podiatrist seeking a part-time associate position in Westchester county or surrounding areas. Please contact (206) 919-2832 or bbrick2@yahoo.com.

ASSOCIATE POSITION-INDEPENDENT CONTRACTOR – FLORIDA

High Income position for ethical hard working podiatrist, great for semi-retired or to supplement office practice, part time. Must have Florida license and active Medicare/Medicaid numbers. FAX CV or Resume to 727-785-4697

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com
WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established podiatry practice in Mt. Airy, North Carolina that is either for sale or in need of an associate/partner to come on board to take over patient care. Dr. Hodges unexpectedly passed away in January 2006, leaving approximately 3,500 patients without a podiatrist to care for them. This is a unique opportunity to be able to begin work in an extremely busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

PRACTICE FOR SALE – TEXAS

Practice for sale in fast growing suburb of Dallas, TX. Fully furnished office in medical building on busy street. General Podiatry, including routine care, orthotics, surgery, etc. Currently part-time office, can be full-time. Hospital privileges available. Excellent Opportunity. Must sell fast. Please respond to: cdinbigd@aol.com P.O. Box 796757, Dallas, TX 75379 or fax contact info to: (972)267-1815.

ASSOCIATE POSITON - FLORIDA

Well established, growing, multi-physician practice in central Florida seeks hard working, ethical individual with good interpersonal skills to replace retiring physician. Experienced support staff, generous salary, malpractice coverage and health insurance. Excellent start on a promising future, this position will provide for the possibility of partnership in the near future. Send CV to: jrdpm@bellsouth.com.

ASSOCIATE POSITION – UPSTATE NY

Podiatrist wanted for busy practice in growing community in mid-eastern New York State, near Saratoga Springs and Albany. Grow into and eventually own practice. New office building with 4 tx rooms, state-of-the-art surgery center available, privileges at three area hospitals and nursing homes. No limit to what you will earn percentage base. Call 518-692-9134 for more info.

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