The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

January 08, 2011 #4,058 Publisher-Barry Block, DPM, JD

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NY Podiatrist Organizes Sock Drive

Recognizing the need for wintertime warmth, Rochester Clinic is hosting a first-ever sock drive for the Women's Shelter in Rochester. Podiatrist and chief manager Dr. Jengyu Lai notes that many winter clothing drives focus on collecting jackets, hats, scarves, boots and mittens. While those items are indeed essential to winter survival, socks are just as crucial.

Dr. Jengyu Lai

"Keeping the feet warm is very important," Lai says. "When your feet are warm, you feel warmer." Socks that are made of 100-percent cotton should be avoided. "Pure cotton socks retain sweat and moisture," Lai says. "When your socks are wet, it makes your feet cold." Good socks are important during summer as well, he says, because damp socks will increase friction and cause blisters, and may lead to athlete's foot.

Source: Marissa Block, Post-Bulletin [1/4/11]

NJ Podiatrist Meets with NJ Governor

Dr. Gentless (far right) and Dr. Robert Gasalberti (NYCPM Class of 1991) with wife greet NJ Governor Chris Christie at a recent Holiday reception at the Governor’s Mansion.

CMS to Offer Tips on ICD-10 Prep

The CMS will offer "Preparing for ICD-10 Implementation in 2011," a free teleconference from 1-3 p.m. ET on Jan. 12. Register online at eventsvc.com through 1 p.m. Jan. 11. The ICD-10 system increases the number of diagnostic codes to 68,000 from 13,000 and takes effect Oct. 1, 2013.

With a target audience that includes medical coders, physician office staff, health-records staff, vendors, educators, system maintenance advisers and all Medicare fee-for-service providers, the teleconference will offer advice on education and training strategies, determining vendor readiness and developing an ICD-10 budget. Information on differences between ICD-9 and ICD-10 and tools for converting codes also will be provided.

Source: Andis Robeznieks, Health IT Strategist [1/6/11]

Query: Chronic Verrucae

I have been treating a healthy 50 y/o male for verruca plantaris since Nov. 2008. He presented after treatment by the dermatologist with topical salicylic acid and then cryotherapy. The lesions had been present for 3-4 years, but had increased in size prior to treatment. Physical exam revealed irregularly shaped, raised lesions consistent with verruca along the plantar-lateral aspect of the right foot measuring 11 cm in length x 2.5 cm. width with several satellite lesions.

Chronic Verrucae

I initiated treatment with 5FU under occlusion, as well as oral Vitamin A 10,000 unit bid, zinc 15 mg. daily, and cimetidine 400 mg. tid.  I eventually stopped all oral meds. The satellite lesions resolved, and the large lesion gradually decreased in size to 7 cm. x 2.0 cm after almost 2 years of treating monthly with 5FU. However, just recently, he has developed multiple new satellite lesions on his right foot and lesions on his hand. I performed a punch biopsy which was confirmatory for verruca. Any ideas for treatment of such a large lesion. I am considering oral antiviral therapy, but am awaiting response from the patient's primary care physician. 

Michael J. Ryan, DPM, Charlotte, NC

Query: Free Internet-Based Billing Software

Has anyone used any of the free Internet-based billing software programs available? If so, what has been your experience with it?

Payman Rabiei, DPM, Brooklyn, NY

Query: Arthrex Mini-TightRope 
 
I recently used an Arthrex Mini-TightRope suture during a surgery. I would like to know how we can bill for this, and what code(s) to use.

Ann Farrer, DPM, Winchester, KY

Response: Fixation options and insertion, with few exceptions (e.g., medically necessary external fixation not included in the code description) are included in the primary surgical procedure.

There is no code for stabilization, fixation using Arthrex Mini-TightRope. You would only bill the CPT code of the procedure you performed.

David J. Freedman, DPM, CPC, Silver Spring, MD

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

RE: Zumba and Heel Pain (Neil Levin, DPM)
From: Julie Chatigny, PMS III

I recently saw a patient with plantar fasciitis who had recently become a Zumba instructor. I think we're going to see a lot more of this as Zumba is becoming another alternative to aerobic exercise: it's the recent CRAZE! According to a Zumba website, there are more than 10 million people of all shapes, sizes, and ages taking weekly Zumba classes in over 90,000 locations across more than 110 countries.

Latin dancing uses many steps with dorsiflexion of the toes, swiveling on the metatarsal heads with pronation of the foot, unnatural footwork, treadmilling, and running. So, people will get excited about a different mode of exercise, may pry themselves off of the couch, not be properly conditioned, and will over-do it.

Julie Chatigny, PMS III, Midwestern University, juliechatigny@gmail.com

RE: Recalcitrant Heel Pain (Tip Sullivan, DPM)
From: Multiple Respondents

Non-weight bearing is appropriate at this stage, no matter what the final diagnosis proves to be. 

Dwight L. Bates, DPM,  Athens, TX, dlbates04@yahoo.com

Medial to lateral palpable heel pain in a patient w/a failed clinical response to plantar fasciitis therapy. Positive MRI findings that corroborate a stress fracture of the calcaneus in both views provided. What else does one need to confirm the diagnosis? Tc Scan is completely superfluous now. The diagnosis is established. Contact the radiologist and respectfully request a re-read to CYA and his butt as well, then immediately begin treatment accordingly before the non-displaced fracture displaces.
 
Barry Mullen, DPM, Hackettstown, NJ, yazy630@aol.com

Having spent nearly two years in the Army as a podiatrist at a basic training facility, I saw hundreds of heel injuries and dozens of calcaneal stress fractures. The classic symptom of a stress fracture of a calcaneus is pain on lateral compression. That is a give-away symptom. There is often, but not always, pain on striking the bottom of the heel with the back of your wrist, while holding the foot at 90 degrees to the leg. On very close inspection, there is often minimal swelling at the medial and/or lateral sides of the heel. The onset is usually instantaneous as opposed to plantar fasciitis which is generally more gradual. Often, the patient can pin-point the time and place of the onset of pain.

Typically, the x-rays show nothing for the first two weeks, whereupon a calcified band begins to develop across the body of the bone. By the time the band is fully formed, the symptoms have subsided. With either of those findings present and a negative x-ray in the first 2 weeks, this should be treated as a stress fracture until proven otherwise.

The negative x-ray ruled out tumor and life-threatening conditions, so more expensive CT scans and MRI's are unnecessarily expensive procedures performed prematurely. Further, how a radiologist can accurately diagnose plantar fasciitis from any radiological study is a mystery to me. Conservative treatment failures should progress to non-weight-bearing casting which should resolve the problem.

Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net

RE: In-office Fluoroscopy (Dan Waldman, DPM)
From: Multiple Respondents

Why not use fluoroscopy? Because the insurance companies reimburse you for an x-ray, not fluoro -due to your specialty (at least in my state). I’ve regretted my machine from the first insurance denial…

Juliet Burk, DPM, Muskogee, OK, juliet-burk@cherokee.org

I have been using fluoro for most of my 22 years in practice. The ease of use, instant imaging, dynamic imaging, and "wow" factor with patients are great. The newer mini types are perfect for foot and ankle imaging and the quality of picture is much better. It is also great for any true needle-guided, intra-articular procedures, and if you do any minimally invasive types of exostectomies, etc. The downside is the quality of image is not as good as a standard x-ray, so with inconclusive pain patients, we still get x-rays or MRI, etc. Also, many private insurance companies are no longer reimbursing for fluoro. Medicare has strict requirements also.

Greg Mowen, DPM,  Ventnor NJ Gregmowen@comcast.net

I do not use fluoroscopy in an office setting. A major advantage of fluoroscopy (and with ultrasound units) is that the joint ranges of motion can be observed for impingement syndromes, whereas, x-rays provide the practitioner only a "static" image. The advantages cited (less radiation to patient and no need for chemicals) do not supercede one major disadvantage I see as compared with conventional/digital x-ray office units.

Standardization of weight-bearing radiographs is what we all base our surgical planning on for our patients. This is not attainable with fluoroscopy and...

Editor's Note: Dr. Scartozzi's extended-length letter can be read here.

RE: Practice Fusion (Charles Morelli, DPM)
From: Marc Katz, DPM, Martin R. Taubman, DPM, MBA

I have been trialing Practice Fusion and have had demos of many other EMR systems. Practice fusion is easy, intuitive, and simple to customize. It supports Dragon. I can't say that about many others.  This is certainly a program for strong consideration. I have been using an EMR for six years, so I do understand them well. 

Dr. Morelli is correct that PF has modular certification. Please don't be mislead by this statement. They are in the final stages of getting complete EHR certification with their newest version. So they will be in the same category as the pricey EMR systems that are mentioned. Get the facts, not the fear!

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

EHRs - forget Practice Fusion unless you want a simplistic product that puts an advertisement for themselves on each of your consults sent to other physicians. I still promote Office Ally (officeally.com). We have been using it for four years for our billings and for over a year for the EHR. It is certified and the whole deal costs about $80 per month, period, including E-RX, labs, etc. It is web-based, but has not failed once since we used it. They make their profit because they act as a clearinghouse for your billing and are paid by the insurance companies. They offer personal back-ups at your own site if you wish, or will even send you diskettes with your back-ups  for about $45 as often as you like.  Most trust the company’s multiple off-site back-ups and only make diskette back-ups a few times a year.

I have all-in-one computers (wireless network) in each treatment room and complete all but new patient charts before I leave the room.  Sure, there was some up-front work putting in codes and my templates, but this is no different than any EHR.

I have no financial interest in this company, I simply promote it because the over 6,000 other docs and myself can only benefit from more users. This is one more example of those of us using a technology and gaining the benefits, while many others are arguing about what to do!

Martin R. Taubman, DPM, MBA, San Diego, CA, mtaubman@san.rr.com

RE: Digital X-Rays ( Pete Harvey, DPM)
From: Timothy James Henne, DPM

Even Captain Jean-Luc Picard of the Starship Enterprise still preferred hard-bound books. While you may very well be on target about the scarcity of hardcopy film X-rays in the future (a decade is rather optimistic), I feel you are way, way off-track on books. And I will bet you my library on that.

David E. Gurvis, DPM, Avon IN  deg1@comcast.net

We have been using DR 20/20 imaging for over three years. It has been great. It is cheaper in the long run. We average 15-20 set of films a day, 4 days a week. After adding up the cost of film, chemicals, cleaning, etc., it is cheaper annually. There is an up-front expense of 20-30 thousand dollars. With financing, this costs about 600 dollars a month. We were spending about the same when using the processor. When our processor broke down, we went digital. When our other processor (at another location) goes down, we will most certainly go digital there as well. 

Things like copying, forwarding  and storage films are wonderful. I never get a bad film. Since the staff sees the film right away, they almost never have to retake a film. Using free software and the Internet, I can see my films at home, at the other office, in the hospital, and while I am out of town, if needed. The support has been great. The two minor issues I had were resolved in 10 minutes. 

Timothy James Henne, DPM, Clermont, FL, tjhennedpm@hotmail.com

RE: Interesting Use of Osteomed Screws

Osteomed Screw Earrings

I had recently excised two osteomed screws from one of my patient's feet. She wanted to keep them, so she made them into earrings.

Source: David T Weiss, DPM, Richmond, VA

ASSOCIATE POSITION - TAMPA BAY AREA

Excellent opportunity to join a well established multi-office group practice in the Tampa Bay area starting July 1, 2011. We are seeking a hard working, ethical and outgoing physician with Florida license.  Salary commensurate with training plus benefits. Please email or fax CV. podiatryfl@yahoo.com 813-254-8262.

TEXAS- WONDERFUL OPPORTUNITY! 

Successful multi-office, multi-professional practice seeks well-trained new and established Podiatric Physicians with expertise in one of these areas: 1. Sports Medicine/Biomechanics/Gait Analysis, 2. Podopediatrics, 3. Diabetic Specialist, 4. Ankle & Rearfoot Surgery/Ankle Arthroscopy. A must to be really good in this niche, be outgoing, motivated, and personable with a dedicated hard working ethical desire to become successful. Send resume and letter of intent to sierrajip@gmail.com

ASSOCIATE POSITIONS – TEXAS

Looking for podiatrists to join group to work in nursing facilities in Texas (Ft. Worth, Dallas, and Houston) Please respond to: doconcall02@aol.com

ASSOCIATE POSITION - FLORIDA

Three physicians providing comprehensive podiatry services to Jacksonville, FL. Senior partner retiring after 37 years is seeking associate with 3-year residency trained in reconstructive foot and ankle surgery. Salaried position leading to buy-in. Send letter of interest and CV to padler@adlerpodiaty.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Douglas Richie, DPM is seeking a well-trained, motivated podiatric physician to join his two office practice located in North Orange County, California. Applicants must have completed a 3-year residency program and must have exceptional skills in reconstructive foot and ankle surgery, sports medicine and podiatric biomechanics. This is a salaried position with a goal of long-term buy-in for equity ownership. Send letter of interest and CV to drichiejr@aol.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume to ohiodoctors@aol.com
 
ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate opening. Well-established podiatric group in Southwest Florida. Multi-office practice with EMR, Digital x-ray, Ultrasound and more. Seeking full-time associate that is PM and S-36 trained, personable, independent and highly motivated. Must be BC/BS in rearfoot and ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary, excellent lifestyle. Email CV to: JLH459@aol.com

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

ASSOCIATE  POSITION - SOUTHEAST FLORIDA

Southeast Florida practice seeks PMS-36 graduate for associate position. Candidate should posses strong work ethic, motivation and excellent interpersonal skills. He/She should be comfortable in multiple clinical settings and all aspects of foot and ankle surgery. Competitive salary, benefits, incentive structure. Reply to petaldaisy@gmail.com

ASSOCIATE POSITION - CT - (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info, www.GreatFootCare.com. Send resume to Dr.Kassaris@yahoo.com. Applications due by Jan 31st.

ASSOCIATE POSITION - BOSTON

CPME Board certified podiatrist wanted to join Orthopedic & Arthritis Center at Brigham & Women’s Hospital, Boston, MA. The position is per diem, 2 days/ week. Interested candidates should send their CV to: Brenda Surowiec, Orthopedic & Arthritis Center, 75 Francis Street, Boston, MA 02115. Or email to bsurowiec@partners.org

ASSOCIATE POSITION - NEW YORK CITY
 
One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to: A-Storjohann@footexperts.com

PODIATRY PRACTICE FOR SALE - DENVER, COLORADO 

Turn-key operation with very low overhead in a multi-disciplinary office. Young patient population. Physician’s office building affiliated with a prestigious hospital. Very low buy-in/buyout. Expected transition of about two years. Perfect for family. Contact podpracsale@hotmail.com

PRACTICE FOR SALE- SOUTHERN CALIFORNIA

An extremely well-run, paperless  office on sale.  Owner moving out of state due to family reasons. State-of-art EMR system, trained staff. Office across from main hospital. From 2005-2009, average gross was ~500 K with potential of grossing a lot higher. For more details contact: podiatry-practice4sale@hotmail.com

PRACTICE FOR SALE- MARYLAND, DC SUBURBS 

Be an owner not a worker. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

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