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12/28/2013
RESPONSES/COMMENTS (MEDICAL-LEGAL )
From: Myron Bergman, DPM
I've been a DPM and a volunteer EMT for forty years. The first and most important tool in an emergency is your telephone. Call 911. Don't try to treat a heart attack or anaphylaxis on your own.
Other messages in this thread:
09/24/2020
RESPONSES/COMMENTS (MEDICAL-LEGAL ) - PART 1B
From: Todd Lamster, DPM
I am curious as to whether this patient had a COVID-19 test 24 hours prior to your surgery. If he did, then it is quite worrisome that it wasn't caught. Additionally, at some point your patient was without a mask, possibly undergoing anesthesia that would create aerosolized particles, therefore exposing everyone in your OR, and possibly in the greater facility. You need to reach out to them ASAP, and find out what their protocol is. Call your local department of health, as they may be a great resource and can guide your response.
Why did he and his wife get tested 2 days after your procedure? Are they suddenly symptomatic? Could it be that he has a fever and mild atelectasis following the anesthesia, and he is actually an asymptomatic carrier? If he really is ill from COVID-19, then you and your staff were probably already exposed as well if he/they were in your office within the two weeks prior. You and your staff should also get tested.
Ultimately, you still have a responsibility to your patient, and cannot abandon him post-op. I would see him in your office, without any other staff if possible, fully gowned and gloved with a true N95 respirator, after hours. Then, thoroughly sanitize every surface in your office.
Todd Lamster, DPM, Scottsdale, AZ
10/20/2018
RESPONSES/COMMENTS (MEDICAL-LEGAL ) - PART 1A
RE: Requests to Trim Fingernails
From: Dan Klein, DPM
The discussion of whether a podiatrist is qualified and licensed to trim fingernails touches on the subject “holistic medical care”, physicians vs. podiatrists and the disparity in training and licensure. Until podiatrists obtain dual licensing or are considered having the same training as MDs and DOs, there will always be a separation and recognition of abilities and licensure. Are MDs or DOs questioned about trimming fingernails or toenails? It’s absurd to think that a podiatrist is not trained to trim a fingernail but everyone refers to licensure and scope of practice.
Podiatry schools, to have a viable future and put to rest qualifications and limited licensure, must include similar or the same curricula and residency training as MDs and DOs. Podiatry students must take the same or similar exams for licensure as MDs and DOs.
When will the podiatry profession recognize this need? It’s not by chance that many podiatrists obtained an MD or DO license! It’s all about recognition by our peers and the public and those in power and the insurance industry. Congress must come to the realization that podiatrists are to be recognized as physicians, not “allied healthcare” providers.
Dan Klein, DPM, Ft. Smith, AR
03/17/2018
RESPONSES/COMMENTS (MEDICAL-LEGAL )
From: Lesley Wolff DPM, MS, QME
This temporarily disabled podiatrist neglected to post in which state he practices. Workers Compensation laws vary from state to state. In the state of California, an injured worker has the right to request a qualified medical evaluation from one of a panel of three specialists in the relevant specialty. Once he is declared "permanent and stationary" by a QME, he may be allowed to return to his regular occupation with modification, which could include the use of double-action forceps. Future medical care may also be included.
Lesley Wolff DPM, MS, QME
04/26/2017
RESPONSES/COMMENTS (MEDICAL-LEGAL ) - PART 1B
From: Janet McCormick, MS
Nail technicians and cosmetologists are licensed in every state to perform cosmetic care that includes reducing calluses (NO blades), trimming toenails, reducing thickened nails, moisturizing the skin on the feet, and massaging the feet. Sound familiar? That does not mean that they can be hired by a podiatrist to do RFC and then the service can be submitted as a claim to Medicare or insurance companies. The care is considered cosmetic and cash only, not medical, and cannot be submitted (Patients who qualify legitimately for claim submission must have their RFC performed by the physician).
Many podiatrists are hiring nail technicians who are specialy trained to work in podiatry offices to perform this care safely, and all is done within the laws of their states. This relieves the practice of a high level of RFC (called "nail trimming service" or "pedicure" when the pedicurist performs it) and allows the podiatrist to perform higher levels and more treatment care. It also brings cash into the practice and new clients. Check around; many of you are doing it successfully and profitably. If you wish to learn more about this, go to nailcare-academy.com and check out the program titled, "Cosmetic Podiatry".
Janet McCormick, MS, Frostproof, FL
10/10/2015
RESPONSES/COMMENTS (MEDICAL-LEGAL )
RE: CPT 99214 and Billing Calculators (John M. Hurchik, DPM)
From: Lawrence M. Rubin, DPM
While no one wants to be "flagged" for an audit, if your overall medical record-keeping is thorough, and your billed codes are supported by your documentation, you may be losing honestly earned practice revenue by not billing CPT code 99214 when it is the appropriate code. When counseling and/or coordination of care is the primary activity during a patient visit, the level of care can be selected based on the time spent with the patient. Under circumstances specified in the CPT, when face-to-face counseling and/or coordination of care dominates (more than 50%) the physician/patient encounter, the time listed for each level of E/M code can be used for the basis of coding.
For example, the average physician time listed for CPT code 99214 is 25 minutes. So, if a visit solely for explaining the results of an x-ray examination and some lab testing along with discussing surgery and other treatment alternatives for a condition were to take, say, 15 minutes -- 99214 is the applicable code. The documentation should include the time spent and a description of the counseling that took place.
Lawrence M. Rubin, DPM, Las Vegas, NV
04/20/2015
RESPONSES/COMMENTS (MEDICAL-LEGAL ) - PART 1
From: Name Withheld
I am a solo practitioner and I just mailed in my affidavit to Opt Out of Medicare this week. In preparation, I stopped taking Medicare patients in January 2013 and wanted to see how my practice performed for one year. I gave my patients 4-6 months’ notice prior to January 2013 and was able to give them a list of other area podiatrists to transfer to. As I was not opting out, I was unable to retain any of my Medicare patients since I could not collect any cash for services covered as a contracted provider.
My results were interesting. In 2014, I saw 37% fewer patients than in 2013 (3,881 in 2014 v. 6,112 in 2013), yet only made 13% less in...
Editor's note: Name Withheld's extended-length letter can be read here.
04/02/2015
RESPONSES/COMMENTS (MEDICAL-LEGAL )
From: Jeff Kittay, DPM
Medicare is not the only insurer to recoup money years after the fact. After 20 years of participation with a local insurer here in MA (a subsidiary of Medicaid), I received multiple recoupment notices for office visits from 3-4 years previously. When I protested, as I had already paid taxes on that income, I was advised to file an amended return. I was also advised that "your agreement with us states that we can review records back for years and make recoupment decisions later."
Of course, the original claims with that insurer had to be filed within 60 days, but the insurer could take a leisurely 3-4 years to review them! I, of course, resigned from that insurer, the only one I have ever quit in 36 years of practice. Look carefully at the contracts you sign with any insurer, as they may contain clauses that permit them to take back money virtually at will, and with broad time limits.
Jeff Kittay, DPM, Boston, MA
07/11/2011
RESPONSES/COMMENTS (MEDICAL-LEGAL )
RE: Credit Card Processing for Physicians (Ronald Werter, DPM)
From: Pam Hoffman, DPM
There is a difference in credit card processing for doctors. Retriever, who I use for credit cards in my office, is very big with dentists. Your dentist probably uses them. My dentist gave me their number. I was being charged by another credit card company (North American) $20/ month for being HIPAA non-compliant. Retriever costs less and is compliant for us doctors who take credit cards. It is different if you are not a store.
Disclosure: I have no invested interest with this company.
Pam Hoffman, DPM, Katonah, NY, katonahpodiatry@yahoo.com
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