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RE: CMS to Now Cover Obesity Counseling

From: Michael M. Rosenblatt, DPM

In a stunning change from previous policy, CMS has now started to cover counseling for diabetic patients who need "obesity" therapy. The natural question that erupts from this is whether or not DPMs will be allowed to participate. As of this time, it seems an open question. In an article on this subject , coverage is extended to "Supervised nurse practitioners, clinical nurse specialists or physician assistants also will provide the service."


Other providers will have to have a physician (as defined by CMS) available in a nearby room or venue. APMA should open immediate discussions with CMS to clarify this issue. At stake is whether or not DPMs have the training to provide this counseling, and if not, where and how they can learn it. This is a vital issue for DPMs because they eventually see most diabetic patients in a very serious capacity. In most states, DPMs are allowed to diagnose and treat pedal manifestations of general body disorders.


Michael M. Rosenblatt, DPM, San Jose, CA,

Other messages in this thread:



RE: Podiatric Billing Conferences (Shelly Figg)

From: Cosimo Ricciardi, DPM, Cindy Pezza, PMAC

AAPPM does an excellent job at their billing and coding conferences.

Cosimo Ricciardi, DPM, Fort Walton Beach, FL

In response to the inquiry regarding podiatry-specific billing and coding conferences, it is valuable to know that the AAPPM (American Academy of Podiatric Practice Management) holds both stand alone billing and coding meetings as well as two-day billing and coding tracks that run alongside other practical topics such as marketing, implementing protocols, adding associates and partners, and proper training of ancillary staff. The next meeting will be held in Ft. Lauderdale (November 7-10), followed by Santa Monica (December 6-7).  For more information, you can visit 

Disclosure: I have lectured at AAPPM Meetings

Cindy Pezza, PMAC,



RE: Inexpensive Cast Cutter (Judd Davis, DPM)

From: Burton J. Katzen, DPM

"It's disturbing to me that once a piece of equipment is labeled "medical", the price can be marked up ten-fold or more."

I had to laugh when I read Dr. Davis' comment about something labeled as "medical" being marked up. It reminded me of something that happened to me a few years ago. I have had three Great Danes and two Dobermans who have had their ears done. There is a round tubular material called drainage tile that we use to hold the ears in an upward position. As I remember, it sold for about $6.00 for a 50 foot roll in any hardware store.

 A few years ago, I had a rep come to my office and asked if I used toe crests. I told them I usually made them out of cotton rolls and elastoplast and just give them to patients. He said he had a new "special" medical grade material that wouldn't lose its elasticity and was nicely packaged in two three inch rolls for $11.00. You guessed it. Drainage tile. Great idea. I never thought of it. I've been buying it from Home Depot for my patients ever since.

Burton J. Katzen, DPM, Temple Hills,



RE: Inexpensive Cast Cutter (Judd Davis, DPM)

From: Howard R. Fox, DPM

When I started my practice 33 years ago, instead of spending $100 on a stainless steel kick bucket and rollers from a medical supply company, I saw a pile of hundreds of them stacked up alongside a barn while driving in Pennsylvania. I found the farmer, asked him what he wanted for one of them. Five bucks! Stainless steel. I then went to the local Electrolux store, and for another $5, got a round roller base which the bucket fits perfectly on. I still own this.

One word of caution: Working in risk management for the last 17 years has taught me if something were to go wrong with your Sears oscillating multi-tool and your patient gets injured, don’t count on Sears to share any damages with you, as their saw was never designed, marketed, or meant for medical use (although we all know it’s the exact same saw). A good percentage of just about anything we purchase, doctor and non-doctor alike, goes for product liability and insurance.

Howard R. Fox, DPM, Staten Island, NY,



RE: Proper Biopsy for Melanoma

From: Mark Schilansky, DPM

On January 24, 2013 Dr. Harry Goldsmith presented the annual “Simply Coding Seminar” at the NYSPMA Clinical Conference. There were excellent lectures on new codes, proper coding, charting, and audits. New this year, Dr. Goldsmith invited well-respected podiatrists to present clinical scenarios for a panel of Codingline experts to review.

Dr. Bryan Markinson presented a number of dermatology cases, including a case of a patient with a melanoma on the plantar aspect of the foot. The presentation started with a shave biopsy of a suspicious lesion that the pathologist reported as non-invasive in situ melanoma. Additional excisions were performed, culminating with a...

Editor's note: Dr. Schilansky's extended-length letter can be read here.



RE: Equality For Podiatry

From: Raymond J. Uscinski, DPM

Is the APMA misguided or moving too slowly to advance the podiatric profession? This is the question that I have wrestled with for over 40 years.

The American Association of Medical Colleges projects a physician shortage of 62,000 physicians in the U.S. by 2015 due to the increased medical needs of an aging population and a growing number of people who will be insured under the Affordable Care Act of 2010. I am confident that our podiatric medical schools can be adjusted to partially fill this shortage. We know that podiatric medical schools are superior in education and training to...

Editor's note: Dr. Uscinski's extended-length letter appears here.



RE: ABPS Recertification Course (Joseph Grillo, DPM)

From: Alexander Estrada, DPM

Being recently certified by ABPS (just last year), I can relate to Dr. Grillo's desire to have a comprehensive ABPS board review course and related materials. I highly recommend the board review course offered by Present Podiatry. This board review includes the current version of Boards by the Numbers which can be installed onto any computer. The content is presented clearly and concisely by a “who’s who” in podiatry, several of whom have been board interviewers themselves. Another added fringe benefit is that you can get CME credits for every lecture viewed, so you kill two birds with one stone!

Alexander Estrada, DPM, West New York, NJ



RE: Medical School Admission (Brian Kiel, DPM)

From: Daniel Grapel, DPM

Unfortunately, Dr.Brian Kriel does not want to face the truth. According to data from the American Medical Colleges, for the years 2008-2010, these ARE the facts: The average GPA for 2010 of all students was 3.53 and the average MCAT was 28.3. At the lower rate of admission MCAT 24-26 and GPA 3.2-3.39, only 12.3% of whites were admitted, 7.9% of Asians were admitted, and 66.4% of Blacks were admitted. So black applicants are more than 8 times as likely to be admitted as Asians, and more than 5 times their white counterparts.

A black applicant with average grades and below average MCAT score is more likely to be admitted to medical school -78.1%- than an Asian student with higher grades and average MCAT 73.7%. All these numbers are the truth. If you doubt that, please Google "medical school  acceptance rate." This country has been practicing reverse discrimination for over 30 years for the sins of the past. I can give you hundreds of examples.

Daniel Grapel, DPM, Bayside, NY,



RE: Regranex Alternative? (Elliot Udell, DPM)

From: Elliot Udell, DPM


Today, I spoke with a representative from  Healthpoint, the company that recently bought Regranex. According to the person I spoke with, they moved their manufacturing to a new location and they need to satisfy certain FDA requirements before manufacturing more product. Hence, they are willing to dropship the remaining stock of Regranex to any pharmacy, but anything they have in stock will expire at the end of January. They do not have a firm date as to when the FDA will allow them to restart making the product. They hope this will be within a few months.


Elliot Udell, DPM, Hicksville, NY,



RE: Podiatrists and Flu Shots (Elliot Udell, DPM)

From: Paul Kesselman, DPM

The last time the New York governor declared a flu emergency, we heard the same suggestions from podiatrists statewide. Due to scope of practice issues and other nonsensical reasons, podiatrists were not given the okay.

Unfortunately, even if we were given the okay, there is a more practical and business side of the questions surrounding flu vaccinations. According to an internist whom I am closely connected to, a solo practitioner cannot order only a few doses of flu vaccine for the few patients...

Editor's note: Dr. Kesselman's extended-length letter can be read here.



RE: Definition of Diabetic (Charles Morelli, DPM)

From: Steven D Epstein, DPM

I look at it another way. A few years ago, I was diagnosed as "pre-diabetic". That meant my hemoglobin a1c had reached 6.5. So I watched my weight and diet, and by diet alone, got it down to 5.6. But over the next several years, it crept back up, and at one visit, my a1c hit 7.0. So, then I was officially diabetic, despite the fact that I again would go on diet alone to get it to drop below 6.0. Most recently, it was 6.6. I'm "watching" myself again, but from my glucometer, I can tell that if anything, the next a1c will be higher, not lower.

Remember that thing about increased insulin resistance? And about glyconeogenesis...

Editor's note: Dr. Epstein's extended-length letter can be read here.



RE: Combination Billing/Collection Service (Dennis Shavelson, DPM)

From: Michael M. Rosenblatt, DPM

I cannot overstate my agreement with Dr. Dennis Shavelson, who takes a very hard line with deductibles and co-pays. One factor not mentioned in his letter is the seriousness which Medicare takes payments of deductibles and co-pays. It is considered Medicare fraud if doctors (of any kind) excuse deductibles and co-pays. This is the same kind of Medicare fraud that can result in your loss of license and imprisonment.

I liken this to a general sense that some of us believe our services are unworthy. Another part of this equation is that podiatrists feel that “success” means you are busy. Dr. Shavelson and I would ask this rhetorical question: “What advantage is there to...

Editor's note: Dr. Rosenblatt's extended-length letter can be read here.



RE: A Bullied Teen Patient (Billie Bondar, DPM)

From: Ira Baum, DPM

Thank you very much Billie Bondar, DPM for pointing out this sad and preventable condition. Bullying is a form of abuse and just like other forms of abuse, leaves a lifetime scar and affects the psychological development of the victim. 

Ira Baum, DPM, Miami, FL,



RE: New Documentary on Healthcare (Bret Ribotsky, DPM)

From: Robert Kornfeld, DPM

Thank you, Dr. Ribotsky for presenting this "eye-opener" to our profession. This is precisely why I practice the way I do. I am engaged in a true health promoting paradigm that addresses not only the symptoms of my patients, but the causes as well. For those of you who still believe that all you need is a prescription pad and a scalpel, you are heading for a rude awakening. The time is now to embrace the wisdom and efficacy of integrative medicine. Those of you who hold steadfast to your closed-mindedness will soon find yourself wondering why your patients are leaving your practice.


Robert Kornfeld, DPM, Manhasset, NY,



RE: PM News Classified Ads

From: J. Ressler, DPM

Within the last several weeks, I have used the PM News classified website twice. Once to find equipment I needed, and the other time to sell equipment. Both times were very successful. The equipment I purchased saved me thousands of dollars. I was also able to sell a chair. The amazing part to this is I had posted ads on other "free" podiatry classified websites and never received any calls.

Podiatrists should not be discouraged about selling power chairs due to the logistics of shipping. I am using a moving company named Plycon. They ship throughout the U.S. and are very dependable with very reasonable rates. As we all know, PM News is a powerful source of information within our podiatric community. You should think about using this resource for your equipment needs.

J. Ressler, DPM, Lauderhill, FL,



RE: Checking Medicare Eligibility (Laura R. Lefkowitz, DPM)

From: Richard Rettig, DPM, Dan Klein, DPM

We stopped using when we discovered that NaviMedix -(part of the Navinet juggernaut) has the same  information in an easy-to-use format for a flat $7.00 per month unlimited usages. It gives you the deductible amount used, the dates of eligibility, and any other insurance that may be primary to Medicare. Navinet also gives us eligibility and benefits information for many of our private insurances and Blue Shields for free, as well as authorizations.

Richard Rettig, DPM, Philadelphia, PA,

Nowadays, more seniors are signing up for advantage plans. Often they don't know to tell you, or they carry old cards, or they require referrals from their primary gatekeeper. Then there are the co-pays that you learn are due at the time of visit from their EOB after you file their claim. I'm afraid things will get worse with Medicare if forced reductions in fees to doctors take effect and fewer doctors accepting Medicare. I tell my patients when making appointments to check their benefits before arriving for their appointment, and that they are responsible for all co-pays and deductibles at time of visit.

Dan Klein, DPM, Fort Smith, AR,



RE: Cantharidin Plus (Beetle Juice) (James Stough, DPM)

From: Stephen Musser, DPM

There are some Canadian pharmacies that carry Cantharidin Plus. Google Cantharone, and you will get options that are available.

Stephen Musser, DPM, Cleveland, OH,



Checking Medicare Eligibility (Laura R. Lefkowitz, DPM)

From: Mak Yousefpour, DPM 


Try It will give instant access to their eligibility and deductibles, along with any managed care organization they belong to. There is a set-up process, and you pay for how many patients you want to check. Currently, I pay $100 per month for 400 patients.


Mak Yousefpour, DPM. Los Angeles, CA,



Checking Medicare Eligibility (Laura R. Lefkowitz, DPM)

From:  Richard A. Simmons DPM

Dr. Lefkowitz wants to know of a site on-line to check for Medicare eligibility. To my knowledge, CMS does not allow direct access to this site; however, there are companies, such as that will provide you access to the CMS site for a fee. The CMS site that one can access through provides a wealth of information, and you can print this information (hard copy or with a pdf writer) for chart access.

I grew tired of receiving those Overpayment Requests from CMS that contained the wording, “you knew or should have known and are therefore liable…” Most of the information is updated at CMS at the first of the month, so make sure that your report is within the same month you render services.

Richard A. Simmons, DPM  Rockledge, FL,



RE: Hospital-Employment — Is it Causing Healthcare Costs to Skyrocket?

From: Joseph Borreggine, DPM

This article says it all. No matter that Obamacare will suck American healthcare dry - this has been a hidden secret now coming to fruition - an employed physician is a completely different animal than an independent physician. The employed physician sees all patients no matter what insurance they have. Some of their patients may have no insurance and they are still seen because they are not getting paid by the patient, but rather by the hospital.

The employed physician is paid in RVUs or relative value units, and for every procedure or visit performed or provided, a value unit is assigned. Each specialty has a minimum annual RVU quota they must meet to make the hospital profitable. This RVU quota generates an annual minimum salary for...

Editor's note: Dr. Borreggine's extended-length letter appears here.



RE: Get Rid of the Randomized Trial; Here's a Better Way

From: Marc Katz, DPM

This video suggests a great alternative to the almighty randomized placebo-controlled studies. Are these studies a thing of the past? 

Marc Katz, DPM, Tampa, FL,



RE: Checking Medicare Pending Claims (Margaret Portela, DPM)

From: Barrett E Sachs, DPM

Here in Florida, I've been using 877-847-4992 without a problem...follow the will need your NPI #, biiling #, and last 5 digits of your tax id #.

Barrett E Sachs, DPM, Plantation, FL,



RE: Prospects for US Trained Podiatrist in the UK

From: Andrew Franklin

As an English citizen, I knew that when I began a new career path in podiatry here in the United States, it would mean a real commitment to this country - a commitment I am more than happy to embrace. However, now as a third-year student at KSUCPM and as my future as a podiatrist appears more attainable, I have become very interested in my additional prospects within the profession back in the UK. I would love to speak to anyone who has trained in the States and has then gone on to practice or indeed has any occupational role and/or professional links within the UK.

Andrew Franklin, Cleveland, OH, 



RE: Compensation in a Wound Care Center (Ed Dosremedios, DPM)

From: Phil Organ, DPM

At a hospital wound center, one can be a salaried employee or an independent contractor. The independent contractor bills for services just like in private practice and indicates the hospital center as the place of service. If the podiatrist is salaried, the hospital bills and collects all fees. As for HBO - the physician can bill for monitoring the dive, but the diagnosis for the dive would have to be in scope.

Phil Organ, DPM, Naples, FL,



RE: Terminating an Office Manager (Dale Rosenblum, DPM)

From: Edmond F. Mertzenich, DPM

I believe Dr. Rosenblum is very correct on the problem of having a burnt out/unhappy employee. Use proper procedures in the termination process. I can tell you from experience that this type of employee can cause considerable damage to a practice, and it may be hard to recover from the poison that type of person can spread.

Edmond F. Mertzenich, DPM, Rockford, IL,



RE: Compensation in a Wound Care Center (Ed Dosremedios, DPM)

From: Daniel D. Michaels, DPM, MS

If you get money back from the hyperbaric center for sending patients, then this would be a Stark violation if you didn't own the hyperbaric chamber (i.e., the chamber is part of your own practice). Usually at a wound care center in a hospital, you bill for the services you render with the place of service at the hospital so you will receive a reduced amount, as the insurance company has to pay you and a separate fee for the facility.

You can prescribe hyperbarics if you need to, but you would not be compensated for this. You can prescribe wound care supplies, but...

Editor's note: Dr. Michaels' extended-length letter can be read here.

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