06/08/2013    

RESPONSES / COMMENTS - (CODINGLINE CORNER)

RE: Staff Performing Routine Foot Care

From: Margie Plon, DPM

Palliative care will always be a vital part of the services we provide to the public as not all patients need or, more importantly, are candidates for surgical intervention. Although our profession has expanded in scope of  practice and post-doctoral training over the years, there are still many of our colleagues who practice palliative care, in part or totally. To diminish their value by allowing a non-DPM to perform this service diminishes the value of our whole profession. 

I urge those who have no interest in providing this service to refer it to one of your colleagues who considers palliative care their area of expertise. I pose this question - Following your aortic valve replacement, would you feel it appropriate to have your ongoing cardiac care followed by a non-medical staff member of your cardiac surgeon or would that best be handled by a cardiologist?

 

Margie Plon, DPM, Elkins Park, PA, margieplon@comcast.net

Other messages in this thread:

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08/15/2013    

RESPONSES / COMMENTS - (CODINGLINE CORNER)

RE: Surgery on Hearing-Impaired Patient (Jeffrey Worman, DPM)

From: Larry Kobak, DPM, JD

In regard to the inquiry of performing informed consent on patients who are hearing impaired, it is my experience that unless they are also unsighted, diagrams and paper work fine. Have them sign any diagrams used in your informed consent and give them a notepad so they can write down any questions. Write out your answers to their questions. Have your patient sign these documents. Remember, informed consent is a process, not a signed piece of paper.

 

Larry Kobak, DPM, JD, Westbury, NY, lfkobak@gmail.com

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06/13/2013    

RESPONSES / COMMENTS - (CODINGLINE CORNER) - PART 2

RE: Staff Performing Routine Foot Care (Margie Plon, DPM)

From: Cedric Cooper, DPM

I treat countless patients who have been infected by the practices of some nails shops in my area. Yes, palliative care is important to your practice, and allows a professional to practice the skill of diagnosing and treating a foot problem when that foot problem first arises. Never, I repeat, never are the  sterilization practices of a nail salon better than that of a trained ethical podiatrist. To say so is a loose expression, at best.

I say that palliative foot care is best provided by a trained, dedicated, and ethical podiatrist. I just pray that those who do utilize the services of an unsupervised physician extender do so ethically. Aesthetic foot care has its place in the community. Aesthetic foot care is not a safer economic product  because it is currently more profitable. Look - this whole trend of lower reimbursement for surgery, palliative care, etc. is a cycle, and people know that podiatrists are the best providers of foot care.

Cedric Cooper, DPM, Humboldt, TN, y2kcedric@hotmail.com

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06/13/2013    

RESPONSES / COMMENTS - (CODINGLINE CORNER) - PART 1

RE: How Can American DPMs Get Involved Teaching Podiatry Skills Throughout the World? (Bret Ribotsky, DPM)

From: Leonard A. Levy, DPM, MPH

Bret Ribotsky queries, “How can American DPMs get involved teaching podiatry skills throughout the world?" One international, highly credible way to accomplish this is by becoming a Fulbright Scholar. I was appointed by the Fulbright Commission (a component of the U.S. Department of State) as a Fulbright Scholar in 2009 and assigned to Comenius University Faculty of Medicine in Bratislava, Slovakia. Among the activities that I participated in was the provision of information about podiatric medicine. Like almost all areas in the European community, there may be lesser trained individuals but no equivalent to the podiatric physician.

Among the categories for Fulbright Scholars is a global health listing. Among the areas of eligibility is podiatric medicine. I strongly encourage DPMs, especially those within podiatric medical schools (i.e., students, residents, faculty), to consider applying for one of the highly competitive Fulbright posts. So far as I know, no other podiatric physician has been awarded a Fulbright appointment. I strongly encourage others to apply.

Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu

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06/12/2013    

RESPONSES / COMMENTS - (CODINGLINE CORNER)

RE: Staff Performing Routine Foot Care

From: Michael M. Rosenblatt, DPM

There is a direct complication when it comes to staff performing ANY service that insurers require that physicians do themselves. RFC is one of those, but there are others as well, like removing sutures, putting on and removing casts and braces, and even minor surgery. When Government insurance is involved, these rules become the force of Government itself. None of us has the resources to defend ourselves against vengeful Government, seeking to destroy us as an individual for their charge of "fraud."

 

Certainly RFC will remain a necessary and valued service as our society ages. Many podiatrists still continue to offer this treatment, which is basically a non-covered service that patients still expect Government to pay for. We have an uphill job explaining to patients (and their families) that fraudulently billing Government for non-covered services, no matter who does them, is illegal.

 

The entire issue of staff performing non-covered services requires expertise of our best advisors on the legality of billing. This means using and properly executing "Advance Beneficiary Notices" with complete, correct knowledge of their use.  There is the mistaken belief that just because you don't accept Medicare for a service "excuses" you from following Medicare law, say if the patient submits the bill instead of you. My bottom line is that we should be offering training and seminars on the PROPER ways to manage non-covered services of all kinds. It's either that, or you run the risk of getting yet again into serious trouble. It's a mine-field out there.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

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06/05/2013    

RESPONSES / COMMENTS - (CODINGLINE CORNER)

RE: Staff Performing Routine Foot Care

From: Mark E Weaver, DPM

 

This discussion brings up the case of physician assistants in podiatry practices. Some may say our assistants did not spend years in training. However, did any of us acquire these qualifications, or do we need these qualifications to trim toenails?

 

PAs in our orthopedic practice take on real medical responsibilities (i.e., closing surgeries, debriding wounds, first post-op visits on surgery, writing prescriptions, etc.; all of which compare to the foot care of the most high risk podiatry patient). It is the MD/DO's responsibility to monitor them.

 

Maybe our profession needs to wake up and smell the future. I know that my orthopedic foot specialist colleagues do. As the MD/DOs, we would need to manage our staff.

Mark E Weaver, DPM, Ft. Myers, FL, tcopn@att.net

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06/04/2013    

RESPONSES / COMMENTS - (CODINGLINE CORNER) - PART !B

RE: Staff Performing Routine Foot Care (Robert Spaulding, DPM)

From: Richard A. Simmons, DPM

The original question was: “If a Medicare patient meets the criteria for covered nail debridement (e.g., CPT 11720 or CPT 11721), may I have a trained staff member perform the service while I bill for it?” Until dentists routinely bill Medicare for their services, it is never wise to compare podiatrists with dentists. Medicare is a program administered by the United States government. It operates on the idea that we, as physicians, are honest, trustworthy, and that we know the law. Not one statement in the Medicare law is up for interpretation.

The law is what the law is. If you are not sure about the law, contact a lawyer who specializes in healthcare. Too frequently, we are reading about a good podiatrist who was ruined or is now in federal prison. For non-Medicare routine foot care, have a healthcare attorney check your state laws and practice acts to see what you can and cannot allow an assistant to perform.

Richard A. Simmons, DPM  Rockledge, FL  RASDPM32955@gmail.com

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06/04/2013    

RESPONSES / COMMENTS - (CODINGLINE CORNER) - PART !A

RE: Staff Performing Routine Foot Care (Name Withheld)

From: Scott Hughes, DPM

Previous posters on this topic have cited the Medicare Benefit Policy Manual stating that only the physician must render the service for the service to be covered. While I don't have assistants provide services in my office, I also don't think this is simply a black and white issue.

It has been my understanding that the legal doctrines of respondeat superior (which states that an employer is responsible for the actions of employees performed within the course of their employment) and qui facit per alium facit per se (which is a Latin legal term meaning, 'He who acts through another does the act himself') allow us to have our assistants provide services as long as their experience and training are adequate to meet the standard of care for that service. 

Now I am not a lawyer (and of course we all know what happens when we assume!), so I would be very grateful if our legal experts would be kind enough to share their thoughts on this topic.

Scott Hughes, DPM, Monroe, MI, dr.hughes@comcast.net

Editor's note: PM News does not provide legal advice. The doctrine of respondeat superior pertains only to matters of tort liability. It does not grant employees rights or privileges that are governed by state or federal law.  Likewise, qui facit per alium facit per se applies to agency law, not the practice of medicine.

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06/01/2013    

RESPONSES / COMMENTS - (CODINGLINE CORNER)

RE: Staff Performing Routine Foot Care (Name Withheld)

From: Jeffrey Kass, DPM

I find it terribly disappointing to read a question as the one asked by "name withheld" asking if a "trained staff member" can perform the doctor's duties while the doctor gets paid for it. Did your trained staff member go to podiatry school for four years and pay 100 grand to get a podiatry license? If not, then why should they get to practice podiatry?

I don't want to hear how easy nail debridements are - heck, a skin biopsy above the ankle is probably easier, and I am not allowed to do one of those, so keep your trained staff members away from the feet. If you are that busy, hire an associate.

Jeffrey Kass, DPM, Forest Hills, NY jeffckass@aol.com

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05/31/2013    

RESPONSES / COMMENTS - (CODINGLINE CORNER)

RE: Staff Performing Routine Foot Care

From: Michael G. Warshaw, DPM, CPC

I would like to thank Dr. Weatherford for responding to this post by "Name Withheld" regarding staff members performing routine foot care services such as the debridement of mycotic toenails and the CPT codes 11721 or 11720 being billed by the physician.

 

While lay people such as "medical assistants," "certified podiatric assistants," and "medical nail technicians" are being "trained," "accredited," and "certified," to perform these procedural services, one needs to look no further than the Medicare Benefit Policy Manual (100-02), Chapter 15, Section 30 - Physician Services, to clearly read who is supposed to be performing these services - the physician. To take this issue one step further, the CPT codes 11721 and 11720 are classified as surgical procedures  or surgery. When a patient receives an EOB from their Medicare Carrier following the performance of either 11721 or 11720, at the bottom of the EOB is the date of service, the CPT code (11721 or 11720), the description of the procedure, and in big, black letters the word SURGERY. How can this be justified if there is an investigation or an audit, especially if it is at the request of the patient, and the service was not performed by the podiatrist, but rather by an unlicensed, lay person?

I have been lecturing around the country regarding billing, coding, and documentation specific for podiatry for the last twelve years. This issue is brought up at almost every seminar that I participate in. I have produced hard copy evidence upon request to substantiate the fact that these services need to be performed by the physician, yet it continues to be an issue in the profession. I would also like to thank "Name Withheld" for bringing this issue to the forefront.

Michael G. Warshaw, DPM, CPC,  Ravenna, OH, mgwarshaw@aol.com