The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

January 04, 2012 #4,349 Publisher-Barry Block, DPM, JD

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APMWA Announces 26th Annual Student Writing Competition

The American Podiatric Medical Writers Association has announced its 26th Annual Student Writing Competition.

• All papers MUST be non-technical in nature. Appropriate subjects include practice management, ethics, law, education, or any topic that would be suitable for a lay publication.
   
• There is no word limitation. Papers will be graded for content, style, grammar, neatness, and overall impact.
   
• First prize will be one thousand dollars ($1,000.00), sponsored by an APMA Educational Foundation endowment from Dr. and Mrs. Steven Berlin, and recognition in the APMA NEWS and the APMWA Newsletter. Honorable Mention Certificates may also be awarded.
   
• This competition is open to ANY enrolled podiatric student.
   
• Entries must be received by 4/15/12 via e-mail at bblock@podiatrym.com
   
• Entries become the property of APMWA, which may arrange publication of the entry.

Aetrex Exec Coaches U.S. to Basketball Gold Medal in Pan-Am Maccabi Games

Maccabi USA used a strong defense in the opening quarter and went on to defeat Canada 87-70 to win the gold medal in the Pan Am Maccabi Games in Sao Paulo, Brazil. “We are extremely proud of this group of guys,” said head coach Stu Wittner. “They have worked very hard over the last several months and deserve every bit of this recognition—our entire staff of coaches and managers all share in this wonderful accomplishment.” 

Stu Wittner (front center) with undefeated Gold-Medal Winning Basketball Team

"The medal ceremony was one of the most magnificent moments of my life. It was an honor to stand on the platform with our team as the National Anthem was being played. I had tears in my eyes standing next to my friend Barry Neuberger who invited me on this journey 12 months ago. When not coaching, Wittner serves as Director of Podiatry for Aetrex Worldwide.

Query: Source for Canthardin Plus

Does anyone know of an American company where I can purchase Canthardin Plus? 

Brent Rubin, DPM, Bradenton, FL

Query: Hallux Varus Repair with TightRope

How would I code correction of hallux varus with TightRope?

Peter Riznyk, DPM, Orchard Park, NY

Response: There is no specific code for hallux varus repair. You would bill the comprehensive procedure(s) performed to successfully repair the deformity (e.g., a metatarsal osteotomy or soft tissue repair or capsulotomy).

TightRope is not a procedure, but a product. No code exists for its contribution to the repair. Its use would be included in the primary procedure. If you feel that using it added significant work to the comprehensive coding, you can either add a "-22" modifier to that code or bill the TightRope use as an unlisted code, CPT 28899. I am not personally aware of any payer reimbursing additionally for the use of TightRope.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Osteonecrosis of the Posterior Process of the Talus (Jim Fisher, DPM)
From: Roody Samimi, DPM

Zimmer has a product called De Novo. It's cartilaginous cells derived from fresh young cadaveric specimens, and once mixed with any fibrin glue, has been successfully implanted in knees, elbows, ankles, and even 1st metatarsal heads. Ideally, you would want to know how large a deficit you need to fill as this material costs about $4,000 per dispensed ~1-2 cm. radial piece.

So, if the MRI is not giving you a good enough picture, you may need a diagnostic arthroscopy to see exactly what you're dealing with. The De Novo is a newer technology, but your alternative would be OATS, such as implanting from the knee, or you could always debride, drill, and diastase.

Roody Samimi, DPM, Flushing, NY, roody.samimi@gmail.com

RE: Orthotic Therapy For Hallux Rigidus (Arthur Lukoff, DPM)
From: Kevin A. Kirby, DPM

Dr. Lukoff found it "very curious" that Jeff Root did not mention the name of Dr. Howard Dananberg when the subject of functional hallux limitus was discussed. To set the record straight, the first medical publication to ever mention the term "functional hallux limitus" was written in 1972 by Patrick Laird, DPM, who taught in the Department of Podiatric Biomechanics at the California College of Podiatric Medicine (Laird PO: Functional hallux limitus. The Illinois Podiatrist. 9:4, 1972).  During our Biomechanics courses at CCPM in 1980-1982, John Weed, DPM, and Ronald Valmassy, DPM, also taught us about the subject of functional hallux limitus. During the mid-1980's, I attended lectures by Dr. Mert Root where he mentioned the condition of functional hallux limitus and how it was caused by excessive rearfoot pronation during gait. As CCPM podiatry students in 1981-1983, we were taught to use reverse Morton's extensions on custom foot orthoses to treat various conditions, including functional hallux limitus.
 
Dr. Dananberg published his first paper on functional hallux limitus 14 years after Dr. Laird first published his article on functional hallux limitus (Dananberg HJ: Functional hallux limitus and its relationship to gait efficiency. JAPMA, 76:648-652, 1986). However, credit should be given to Dr. Dananberg for popularizing and adding valuable clinical information regarding the gait effects of functional hallux limitus to the literature, even though he was not the first to coin the term "functional hallux limitus."

Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

RE: Insurance Company Controls
From: Robert Kornfeld, DPM

Today, I received an e-mail from the NY State Podiatric Medical Association regarding the new Blue Cross/Blue Shield policy change for 2012 regarding orthotics. To quote - "Starting in March of 2012, claims for orthotics submitted under your Empire insurance policy will be denied. The only exception is if a claim for orthotics is associated with a disease affecting the lower limbs, such as severe diabetes, which requires the care of a podiatrist or a physician. In those cases, medically necessary foot orthotics will be covered."  So it seems in one swipe of the pen, BC/BS has decided that orthotics are never medically necessary, except in this particular situation. So much for the extensive research on lower extremity biomechanics!! So much for the positive outcomes associated with foot orthotics.
 
BC/BS, like many insurance companies, is out of control. They are motivated by nothing other than profit. They are NOT in the healthcare business. They do not care about outcome as much as they care about "cheap" medicine. So they raise premiums, pay doctors less, cut out essential coverage, and laugh all the way to the bank. 
 
I cannot understand why anyone would want to continue participating (cooperating) with these companies. They are not your colleagues. They are not in business to support your medical-decision making. They are in business for themselves to continue to rake in windfall profits while practitioners continue to struggle to pay their bills. Are you mad as hell yet?
 
Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

RE: Bone Mineral Density Testing (Joe Agostinelli, DPM)
From: Elliot Udell DPM
 
Bone density scans generally evaluate the bone density of the hip and spine. Hence, it would seem reasonable that an orthopedic surgeon who owns the machine and takes the test would be reimbursed for taking it, while a podiatrist would not, because the anatomic areas studied are clearly out of scope for podiatry in every state.
 
When evaluating a radiograph of the foot where osteopenia is noted, not only is it prudent to send a patient to a radiologist for a bone density scan, but it is imperative that we send the patient to a blood lab to evaluate serum vitamin D 25 levels. In our office, a month does not go by where do not pick up a case of a patient presenting pedal bone loss who was unaware that he or she had dangerously low levels of vitamin D.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Medicaid Change for Orthotics in NY (Alan Silverstein, DPM)
From: Paul Kruper, DPM

In New York, orthotic Medicaid coverage for podiatry-supplied devices is eliminated. One of my patients who needs hammertoe surgery had coverage denied because her insurance does not cover "weak feet, flat feet, fallen arches, corns, calluses or deformed toes." In a sentence of a dozen words, coverage for a large part of my practice is gone. If we had allopathic licenses, the loss of coverage for these services would generate a yawn. Do you think an MD cares there is no coverage for orthotics? To those who state podiatry would degenerate if we became allopathic doctors, I say the loss of insurance coverage has already accomplished the loss of our ability to practice podiatry.
 
Paul Kruper, DPM, Kingsburg, CA, prkruper@yahoo.com

SPACE AVAILABLE - NYC & LI

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." to Drgordon@gulfcoastfootcare.com

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital-based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

ASSOCIATE POSITION - LONG ISLAND, NY

Full time associate position available with well rounded multi-office group on Long Island. Ideal position for July 2012 graduating third year resident who wants to practice and live on Long Island. Candidates must be board qualified or board certified, and well trained in all phases of podiatry including surgery, biomechanics, wound care and palliative care. Compensation includes salary,malpractice insurance, paid vacations and surgical incentives, with a future partnership opportunity available for the right candidate. Interested doctors are encouraged to submit their CV's in response to:  mets724@gmail.com.

ASSOCIATE POSITION - CHICAGO, IL

Established, progressive, busy Chicago practice seeking PSR 24/36 individual with good people skills to join 2 man group. Senior associate retiring. Excellent opportunity leading to partnership for energetic, motivated, ethical professional. Submit CV to JAF@APLfeet.com

ASSOCIATE POSITION - NC PIEDMONT

Excellent opportunity for highly motivated, ethical, and personable PSR 24/36. This well established, 3-physician practice has excellent rapport with physician community,multiple office locations, and hospital privileges. Intent is an associate leading to partnership for the right individual. Competitive salary & benefits. Email CV to dpmassociatenc@gmail.com.

ASSOCIATE POSITION - HAWAII (OAHU)

Full-time position available. Join this fantastic practice in paradise. Diagnostic ultrasound, Digital X-Ray, EHR, Surgical Privileges, Competitive Salary plus benefits package. Send CV to:  yoleven316@yahoo.com.

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. $160,000 base salary with bonus incentives and benefits. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE NEEDED - NORTHERN CINCINNATI, OHIO (FAIRFIELD)

Lead to partnership &/or buy practice. Well-established, reputable & successful (700K collection annual) 25+ year practice. Newer 2k sq.ft office condo & w/5 tx rooms, Aver.80 new patients monthly, full hospital privileges, DME, Padnet, digital x-rays. Inquires to email: gsherwood1@cinci.rr.com

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." to   Drgordon@gulfcoastfootcare.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA 

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital-based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

ASSOCIATE POSITION - ALBANY/CAPITAL DISTRICT AREA

Immediate position available with generous salary, fringe benefits and percentage. All phases of Podiatry. For more information please contact Dawn at (518) 828-6516 or fax your resume to(518) 828-9510.

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