It is okay just because the dollar amount is
low? Making even $10 for billing knowingly
incorrectly is too much! Some podiatrists in MI
have been doing this for over 30 years. My dad
was treated by one such podiatrist year's ago
until I challenged this practitioner about it.
At the time, he was the Medicare liaison to Blue
Cross of MI! Talk about a fox in charge of the
chicken coop. He insulted me by telling me he
would see my dad for free as a courtesy to a
family of a colleague.
I would rather have had him stop committing
Medicare fraud. I went to a very respected
colleague Dr. Irv Kanat for help. He was kind
enough to address this individual personally on
the issue as well. However, it didn’t stop the
doctor. My dad never went to him again, but my
parent's friends verified he was still billing
the same way. For all I know, he is still
billing this way. His justification to me on the
phone was that ”I am not trimming nails for $35
or $40!”
It has spread to Oregon too as one of my local
colleagues has been doing 2 avulsions on
patients every two months when in reality she is
just doing qualified primary care. It pays
better when billed that way, but is fraudulent
any way you slice it. I wrote in to Codingline
and asked to clarify “avulsion” because it
appeared to me that either I had learned it
wrong when I was in school or the definition had
changed. I was glad to hear I was correct. I
asked Codingline to pass it on to the readership
of PM Magazine which would stop this billing
issue before more doctors get caught.
The definition of avulsion has not changed and
spicule removal without injection anesthesia is
NOT an avulsion!
It hurts us all. I know the reimbursement is not
as good but it is what it is. We can complain
from our offices or we can sit in jail and
lament on the money we once made. Your choice.
Gerald Peterson, DPM, West Linn, OR,
DRP@ifixft.com
