07/26/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Source for Accu-Mold Substitute (Joan Schiller, DPM)
From: Robert Teitelbaum, DPM
Otoform-K, offered by Alimed Co., and seen in some other "sports medicine" catalogues is my alternative of choice. It is manufactured in Unna, Germany (as in Unna boot). Unna is stamped on the tub.
Robert Teitelbaum, DPM, Naples, FL, Mfvandange@aol.com
07/25/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Setting the Record Straight on Debridment of Calluses in Diabetics (Alan Sherman, DPM)
From: David Armstrong, DPM, MD, PhD
Just to let you know, we responded directly to Dr. Bernstein months ago directly in the journal Diabetes Care.
David Armstrong, DPM, MD, PhD, Tucson, AZ, Armstrong@usa.net
07/25/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Source for Accu-Mold Substitute (Joan E. Schiller, DPM)
From: Christopher Case
PediPlast® Moldable Podiatric Compound has long been a popular alternative to Accu-Mold for the creation of custom digital devices in less than 5 minutes.
To order, or get more information, contact PediFix or the major industry distributors, including Gill, Moore, and Schein, all of which have PediPlast in stock for immediate delivery.
Christopher Case, PediFix Footcare Company, Christopher.Case@pedifix.com
07/03/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: First Coast Disallows CPT 76942 for Podiatrists
From: Marc Katz, DPM
Here is the link and some of the points that have been issued by First Coast Medicare regarding CPT 76942. Those who scrupulously used this code for a small portion of your patients to guide injections will no longer be able to use the code in pretty much all cases. You can thank our colleagues who use it on every injection in the office. It seems to just be the story of podiatry! And, of course, of all specialties, podiatry is one of the only ones specifically mentioned, "Needle procedures of the foot by podiatry or other specialties. (Most of these interventions are standard office based needle procedures and not special procedures performed on a radiology suite)."
A few other points from the link: "Though MAC J9, based on the low quality of evidence in the peer reviewed literature, could deny many of these billing situations as services not meeting the reasonable and necessary threshold for coverage, there is concern with beneficiary liability. CPT® 76942 is valued in the 220 dollar range, whereas the majority of the office-based procedures outlined above suggest value in a range from 0 to 40 dollars. (This is based on reference value mapping of CPT® codes such as the value assign for CPT® code 76937 Ultrasound guidance for vascular access). In summary, it is the expectation that physicians utilizing ultrasound guidance for standard office based needle procedures will not code separately, or alternatively, bill the unlisted code CPT 76999."
Marc Katz DPM, Tampa, FL, dr_mkatz@yahoo.com
06/08/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Facility Fees (Tip Sullivan, DPM)
From: Martin V. Sloan, DPM
There is likely no rational explanation for fee discrepancy, just as there is no rationale for other areas of reimbursement. Here's another: Medicare will NOT pay for functional orthotics when medically necessary, yet they WILL pay for accommodative diabetic inserts ANNUALLY when medically necessary. So, over a ten-year period in a diabetic's life, they will pay approximately $2,000 for A5513 (@$200/year) but they WON'T pay $400 for a pair of well-made orthotics that should easily last ten years.
Martin V. Sloan, DPM, Abilene & Rockwall, TX, mvs32154@gmail.com
06/04/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Medicare Calling Patients
From: Name Withheld (MA), Name Withheld (NY)
I had a very similar conversation with one of my patients a couple of weeks ago. She informed me that Medicare called her and asked her why she sees me. I find this very troubling as well.
Name Withheld (MA)
A colleague of mine had the same issue, but it progressed from simple questioning to audits, to now an indictment. Be careful, because it seems like a fishing expedition on the part of Medicare.
Name Withheld (NY)
05/10/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Letter to Gov. Christie About ESWT Coverage
From: William A Sachs, DPM
I recently had a former patient return to see me. I had performed ESWT on her 10 years ago. She began to tell me how great the procedure had been and that she has been pain-free for all these years. She remarked that she heard "it's not covered anymore" and she's so happy she was able to have it covered at that time because it really "made a difference" in her life. It prompted me to write this letter to Governor Christie. My hope is that others will take the time to write a letter to their government officials in the hope that there may be some transparency and maybe some action taken to allow us to better serve our patients.
Dear Governor Christie, ....
Editor's note: Dr. Sachs' extended-length letter can be read here.
05/06/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Purchasing a Digital X-Ray System (Raymond Posa)
From: Michael L. Brody, DPM
Mr. Posa goes into great length to describe the differences between CR and DR, and claims that CR is not true digital radiology. Scholarly papers refer to CR - computed radiography as digital radiography. The only place I have seen claims that CR is not true digital radiography is in literature by DR manufacturers.
Please remember the POWER of digital radiology is not in the image capture, but...
Editor's note: Dr. Brody's extended-length letter can be read here.
05/02/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Podiatry's Secret Problem (Victor Marks, DPM, MPH)
From: Barry Mullen, DPM
There are a plethora of medical conditions that can and should be added to Dr. Marks' dementia list for at-risk foot care coverage. These include, but are not limited to, blindness (and a multitude of other physical and mental conditions that preclude patients from safely rendering self foot care), immuno-suppression from ANY cause, anticoagulant therapy, and DM, to name but just a few.
That said, be careful what you wish for. Cash is always a preferred compensation for medically needed, rendered podiatric services; if the...
Editor's note: Dr. Mullen's extended-length letter can be read here.
04/29/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Replacement for Fabco (Paul Taylor, DPM)
From: R.D.Teitelbaum, DPM
I have used a self-adherent gauze called Stat-Wrap, that originally was sold by several vendors, including Miami Bandages Plus. It came in several sizes--- 1" and 2" were my favorites. Recently, only Henry Schein carries it under the German manufacturer's brand name -'Haftelast'. Why this seems to be the only self-adherent dressing gauze on planet Earth is an interesting question in itself. It is essential to my practice.
R.D.Teitelbaum, DPM, Naples, FL, Mfvandange@aol.com
04/29/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Purchasing a Digital X-Ray System (Laura R Lefkowitz, DPM)
From: Pete Harvey, DPM
Most digital x-ray systems, whether DR or CR, should be adaptable to your current X-Cell machine. Your costs will probably go up because of software agreements, etc. However, that is usually offset by the convenience of digital.
Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com
04/26/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Podiatry's Secret Problem (Steven Moskowitz, DPM)
From: Karen Malley Banks, DPM
I am a “call it like ya see it” podiatrist. Every time the subject comes up about billing for nail care, I feel the need to offer a bit of caution. No matter how “clean” you feel about NOT billing Medicare for nail care, you can’t make general statements about coverage without examining the patient.
I personally know a podiatrist who got busted for UNDER-utilization. He went into a nursing home and told them...
Editor's note: Dr. Banks' extended-length letter can be read here.
04/25/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Podiatry’s Secret Problem (Steven Moskowitz, DPM)
From: Michael J. Schneider, DPM
Dr. Moskowitz’s post was the second post in a few weeks by a member of our profession intimating that there are a significant number of our colleagues who are intentionally scamming/stealing from insurance companies by overbilling and billing for procedures or services not needed.
He based his statement on the fact that Medicare was billed $120 for his mother’s visit with a podiatrist at her assisted living residence and previous nail treatment by other podiatrists. My question would be...
Editor's note: Dr. Schneider's extended-length letter can be read here.
04/23/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Competency of APMA Leadership (Tip Sullivan, DPM)
From: Steven J. Kaniadakis, DPM
I say that the problems of leadership are not the mere focus of the top side of leadership. The bottom side of leadership (no pun intended) must be examined as well. The records show that states (like the one Tip Sullivan, DPM, Jackson, MS practices in) should have kept the one-year post-graduate and "preceptorship" program pathways viable.
Even when these states still carry over this pathway, the states' licensed podiatrist leaderships are insisting that all new DPMs must have a residency, and they are also increasing the number of years of residency training required. There are many DPMs in practice with one year post-graduate training programs. Alaska appears to now have a one year "surgical" residency requirement. MT and WY, I think, still have one-year, post-graduate program requirements.
Steven J. Kaniadakis, DPM, St. Petersburg, FL, stevenkdpm@yahoo.com
04/08/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: TRAKnet Hires Its Original Computer Architect
From: Michael J Felicetta, DPM
Bravo to Nemo Tech for getting the heart and soul of podiatry software back with the profession that appreciates him, and additional kudos to Nemo Tech for establishing a singular podiatry-friendly EHR vendor. It has always been necessary for podiatric medicine to fend for ourselves in the healthcare field, and our niche has been bolstered by the events at Biomedix-TRAKnet's recent upheaval.
Michael J Felicetta, DPM, Toms River, NJ, DrMFoot@aol.com
03/08/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Pre-Authorization for Imaging (Robert Steinberg, DPM)
From: Keith L. Gurnick, DPM
Rather than trying to "get even" with an insurance company, I am requesting that patients get involved as an advocate in their own healthcare, as I too have often been asked to do. When I ask the patient to find out if a pre-certification or pre-authorization is required prior to obtaining an outside imaging study that I have requested, the patient becomes a better patient and learns exactly how their health insurance works (or doesn't work).
Usually, the patient makes the call right away, sometimes on their cell phone while they are still in the office because they want to have the test done ASAP. There is nothing wrong with having the patients do some of their own leg (foot) work. When authorizations are in fact required, my office also gets it done usually the same day, because I too want the test done ASAP so I can get the results and move forward with treatment plans for the patient.
Keith L. Gurnick, DPM, Los Angeles, CA, keithgrnk@aol.com
02/12/2013
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: Kudos to Paul Kesselman, DPM (Eddie Davis, DPM)
From: Hal Ornstein, DPM
I would like to echo the comments of Eddie Davis, DPM about Paul Kesselman, DPM. Durable medical equipment and diabetic shoes have become an integral part of achieving best outcomes and quality for our patients as well as adding to the bottom line. I get to see much behind the scenes and the many hours of dedication and passion to help our profession that Paul has given. Paul, simply stated, thank you!
Hal Ornstein, DPM, Howell, NJ, halo@footdoctorsnj.com
12/21/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
RE: Policy for Handguns in a Podiatric Office (Frank Lattarulo, DPM)
From: Philip McKinney, DPM
Policy regarding handguns in the office. You mean for staff or patients? Do you have a problem with guns in your office now? Why is this even an issue? Do you have other amendments to the Constitution that you have issues with? Perhaps, we should get rid of any newspapers or news magazines. No Christmas or Hanukkah seasonal displays?
If an individual comes into the office with a concealed weapon, it is concealed, no one else is going to see it; if they have a permit, it is legal. You're going to deny them their Constitutional rights like what's being done in the city of New York? You think that the individual coming into your office meaning to do you or your staff harm is going to be concerned at all with your “policy”?
I have a gun; many of my patients have guns. I have multiple law enforcement patients who are often seen during duty lunch breaks. Guns in the office are not an issue. In my twenty plus years of practice, I have drawn my gun in the office twice and fired it once. I am responsible for myself, my staff, and any patients in the office. I am not going to allow someone high on meth (common here) to assault me or anyone in my office. Perhaps, you should look more to establishing a policy for those who wish to do harm to those in your office because if you post a “policy” towards guns, the only people who are going to respect it are the law-abiding individuals, not the ones you should be concerned about.
Philip McKinney, DPM, Eugene, OR, opodiatry@oregonpodiatry.net
12/19/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 5
RE: Rental Real Estate Market (Michael Rosenblatt, DPM)
From: W. David Herbert DPM, JD
I have practiced both law and podiatry in California. I also owned several rental properties in California, including several thousand acres of ranch land. I believe California is one of the worst places to own rental property in! The California Civil Code contains over 100 pages of rights for tenants! States such as Wyoming are much better places to own rental property in!
W. David Herbert DPM, JD, Billings, MT, herbert.dpm.rn@gmail.com
12/18/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 3
RE: The Doppler an Integral Part of a Podiatric Practice
From: Ed Cohen, DPM
The office Doppler can be an invaluable aid to diagnosing PAD. The ABIs, PPG waves, and hallux pressures provide significantly more information about the vascular status of a patient than can be determined by just feeling the patient's pulses. Some patients will not have any ulcers and have a lot of foot pain which is not from an ingrown big toenail, neuroma, or other podiatry problem, but is from PAD.
It is important to determine the vascular status, which can be a real challenge, especially in the geriatric and diabetic population. The podiatric history can be very helpful, however, sometimes on rare occasions a patient could...
Editor's note: Dr. Cohen's extended-length letter can be read here.
12/08/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Source for Urea Liquid or Gel (Steve Block, DPM)
From: Susan Papp-Mlodzienski, DPM, George Jacobson, DPM
Kera- 42 (42% Urea cream) Clinical Therapeutic Solutions (ctsrx.com) - For in-office it dispenses for approximately $25, retail.
Susan Papp-Mlodzienski, DPM, Philadelphia, PA, papp.mlodz@comcast.net
Look up Stratus Pharm. Inc. Miami, FL. They have a 15cc 40% gel with an applicator brush. They also have urea cream in all strengths.
George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com
11/01/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Laser for Plantar Fasciitis (Susan Papp-Mlodzienski, DPM)
From: David Zuckerman, DPM
One of the lasers that I use for treating tendinopathy diseases is the Diowave 10, 15, or 30 watt laser. There are others. You can use a 10 watt laser, but the higher wattage in the laser, the faster the onset and increased tissue penetration. This is called peak power.
A 980 wavelength is very important to ensure deep tissue penetration without getting photons to the damaged tissue. There will be little to no effect. This is why power is important as well as wavelength. This is part of the therapeutic window for tissue penetration. The concise
principle...
Editor's note: Dr. Zuckerman's extended-length letter can be read here.
10/30/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1
RE: Landmark Medicare Changes for Long-Term Care
From: Michael M. Rosenblatt, DPM
There has been a landmark settlement of a class action suit against Medicare regarding long-term care and some beneficiaries who need it, including both at-home care and institutional care. It is too long to explain here, but it might have an impact on long-term care that includes podiatry. An interesting example of this involves one of the plaintiffs, who herself had diabetes, blindness, and an amputation. Prior incidents of refused coverage for podiatry services at home/institution may now be re-opened for payment.
This may be a game changer for at-home/institutional podiatry services, but the exact impact has yet to be determined, since the impact seems mainly on nursing care. For podiatrists who see these patients, you may be asked by some of your patients or their families to re-submit denied claims based upon lack of eligibility. You may also see requests for more podiatry services from people who might otherwise have been excluded. Also unknown is the extent of increased costs to Medicare resulting from these changes.
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net
10/09/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 1B
RE: Combination Billing/Collection Service (Ron Werter, DPM)
From: Robert K Hall, DPM
The best way to avoid this dilemma is to use free eligibility sites available or pay sites like checkmedicare.com/Cortex to determine up-front the patient's liability. Then either "attempt" to collect by showing the "patient responsibility" printout OR "Hold" deductibles until met. Co-pay/Co-Ins, if low ($10/20%), may be worth writing off and taking the 80% UCR. High co-pays $40-50 often are in excess of allowables and must be collected at time of service. Just some thoughts in this tightening economy.
Robert K Hall, DPM, Ft. Lauderdale, FL, robertkhalldpm@bellsouth.net
10/08/2012
RESPONSES / COMMENTS (NON-CLINICAL) - PART 2
RE: Combination Billing/Collection Service (Ron Werter, DPM)
From: Brock Rasmussen, DPM, MBA
We found ourselves in a similar situation as Dr. Werter. With rising deductibles and more patient responsibility, we found more “excuses” as to why patients couldn’t pay. We also found more and more patients not being willing or able to pay for their surgeries up front in a lump sum and then rarely paying us on time afterwards.
We found a lot of it had to do with our lack of structure on how we collect. We used to send large bills to a collection agency, but because of these issues, we decided to create our own in-house financing program. We invested a significant amount of money to be sure we did it legally and correctly, and now our billing people handle everything with coding and insurance, and our finance person handles all...
Editor's note: Dr. Rasmussen's extended-length letter appears here.
