The Voice of Podiatrists

Serving Over 10,600 Podiatrists Daily

January 09, 2008 #3,137 Editor-Barry Block, DPM, JD

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Many Problems Associated With Chronic High Heels Use: FL Podiatrists

Dr. Neil Strauss

“I have seen a lot of injuries from high heel shoes”, says Broward podiatrist Dr. Neil Strauss. Wearing high heels over two inches for prolonged periods can lead to chronic problems with your back, hip, knees, and of course, your feet.

Dr. Eric Weinstein

“The most common problem I see with high heels is aggravation of existing bunions and causing hammertoes deformities and corns, as well as pinched nerves, says Weston podiatrist Dr. Eric Weinstein.

Source: Christy Kruger, Local 10 News [1/6/08]

2007 Stickel Award Winner Announced

The winner of the 2007 William J. Stickel Award for Research in Podiatric Medicine is “Effective Orthotic Therapy for the Painful Cavus Foot: A Randomized Controlled Trial” by Joshua Burns, PhD; Jack Crosbie, PhD; Robert Ouvrier, MD; and Adrienne Hunt, PhD. The paper was published in the May/June 2006 issue of Journal of the American Podiatric Medical Association (JAPMA).

In 2006, the format for the competition for the William J. Stickel Award for Research in Podiatric Medicine was modified. Formerly a prospective process, with papers submitted specifically for award consideration, the award is now retrospective, with papers published in the Journal in the preceding calendar year being eligible. In the past, Gold, Silver, and Bronze Awards were normally given for the top three papers submitted; in the revised format, a single award is given for the best original research paper published in the Journal in the preceding calendar year.

Source: APMA Daily eNews [January 7, 2008]

NPI Deadlines Approaching Fast

Two more national provider identifier deadlines are fast approaching for physicians. As of March 1, doctors who bill Medicare electronically must include their NPIs on all Medicare claims in addition to any older IDs they may have been using. For most of the past year, the program has been allowing physicians to use their older, "legacy" identifiers alone while they obtained new NPIs and made sure the personal information attached to all of the numbers was matching correctly.

After May 23, physicians will be required to use only NPIs on all electronic claims submitted to Medicare and all other health care payers. That means any information discrepancies must be ironed out before then. Although the deadlines don't apply to physicians who file only paper claims, those who send their claims to a clearinghouse that files electronically on their behalf must comply.

Source: Davidd Glendinning, AMNews [1/14/08]

Query: Prescribing Systemic Drugs

Are we, as podiatrists, within our scope of practice to prescribe Procardia for Raynaud's disease and allopurinal for chronic gout. Up to now I have referred patients to their internist for evaluation if I felt that medications like those mentioned would be appropriate.

Michael J. Schneider, DPM, Vail, CO

Editor’s comment: PM News does not provide legal advice. The issue of what systemic drugs a podiatrist can prescribe is predicated on the education and training a podiatrist receives. One reliable guideline is to look at the curriculums at our colleges of podiatric medicine.

Clearly, a podiatrist is taught how to prescribe such systemic medicines as antibiotics, analgesics, antifungals, and anti-inflammatories. Pharmaceuticals such as Procardia or allopurinol generally do not fall within the sphere of drugs for which podiatrists are routinely trained. Individual state laws may vary, so it’s possible that it may be legal to prescribe such drugs in your state. If so, you would need to check with your malpractice carrier to determine if you would be covered for this practice. You should also be prepared to document where you received the education and training in the use of these drugs.

Query: Medicare Denial of CPT 15004 & CPT 15400

We received at denial from Wisconsin Physicians Service (WPS) Medicare when we billed CPT 15004 (surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar [including subcutaneous tissues], or incisional release of scar contracture) and CPT 15400 (xenograft, skin [dermal], for temporary wound closure, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children).

The denial reasons on the explanation of benefits included:

- CPT 15004 surgical preparation of open wound payable to approved specialty. Podiatry not an approved specialty.

- CPT 15400 xenograft payable, but not in office place of service (11).

I know we have billed and been paid in the past on these codes. Has something changed?

Mary Pat Leveille, Practice Manager, Escanaba, MI

Response: When a payer denies a claim based on "podiatry is not an allowed speciality" for the billing of a service or procedure, this is usually address by submitting a copy of your state practice act to the medical director and appeals department, and request that they 1) modify their software to permit podiatrists to bill the code(s) in question and 2) process the claim. Be sure to copy the letter to your state association, CAC representative, and APMA Health Policy and Practice Department.

Regarding the skin substitute policy, obviously, go to the WPS website, and review the skin substitute policy (http://www.wpsic.com/medicare/part_b/policy/gsurg037.pdf) which was revised effective January 1, 2008.

If you find no inconsistencies in the policy and how you billed, you have run up against either a carrier edit not listed in the policy, or a processing error. What did WPS reps tell you when you called for explanation?

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at:
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RE: Value of APMA Membership
From: Jeffrey Frederick, DPM

Editor’s note: This extended-length letter can ve read at; http://www.podiatrym.com/letters2.cfm?id=17353&start=1

RE: MD Program for Podiatrists (Thomas A. Graziano, DPM)
From: Dwight L Bates, DPM

I teach MD/DO family medicine residents at Parkland Memorial Hospital in Dallas. Some of them are foreign medical school graduates and even the best of them sometimes have problems getting a medical license in Texas.

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

ALTERNATIVE PATHWAY TO BOARD CERTIFICATION PETITION

I am seeking to gather the names of my fellow podiatrists who are being denied the opportunity to sit for the board certification exams and would like to join my efforts to petition our leadership for a fair alternative within the system. To join this effort, please email your name and contact information podiatrydoc@gmail.com

PARTNER WANTED FOR GROUP PRACTICE LOCATED 1 1/4 HOURS NORTH OF NYC

BE AT THE RIGHT PLACE AT THE RIGHT TIME. YOU CAN'T BEAT THIS OPPORTUNITY. Respond to: mhudes@footcaregroup.com

REPRENTATIVES WANTED - OUTCOME MEDICAL

Outcome Medical, (see our ad in Podiatry Management) is looking for reps to call on podiatrists and primary care physicians to market our pain program. Our FDA-cleared technology for pain and circulation is currently used by hospitals and doctors throughout the country. We provide training and technical support. On staff, certified billing, coding, and compliance specialist. Attractive commissions and leads furnished Website, www.outcomemedical.com. Request our representative package by email @ don@outcomemedical.com phone, 770-487-0029; Fax 770-692-0116

PRACTICES FOR CANADA - CANADA

2 DPM practices for sale in metro Vancouver and the Fraser Valley in beautiful BC. Both are well established with healthy client bases over a 30 year practice and can be sold separately. Gross revenues are $190.K and $100.K respectfully with an average net profit of 8% with great potential for increases. Priced at $199,000 & $99,000 to a graduate of any of the 8 USA colleges for approval by local licensing requirements. Contact pearsonhome@telus.net or by phone 1-604-986-0809 or fax: 604-986-0870.

ASSOCIATE POSITION - VIRGINIA

Multi-office practice, EMR, digital x-rays, sonography. Great opportunity for hard-working, personable new or established surgeon. Hospital and surgery center privileges available. ABPS eligible/certified. Full scope of foot & ankle care. Base salary, immediate percentage, and benefits. E-mail letter of introduction, CV and photo to practice administrator at: mtrevor41@yahoo.com

MANUFACTURING ORTHOTICS BUSINESS FOR SALE - CANADA

In Vancouver BC with a average client base of 40 with potential to increase to over 60 clients by calling on MD, ND & Chiropractor practices. Gross revenue averages $230.K over the past 2 years with a 5% net profit after taking a management fee of $12,000. Owner is retiring and will sell for $185,000. Contact Milt at marketime@telus.net or tel: 888-359-2202 fax: 888-303-0017.

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.com

PRACTICE FOR SALE - SOUTH CAROLINA

Upstate SC practice of 25 years. Retiring. High volume, high grossing. 60% routine foot care, 40% surgery. Several nursing homes. Plenty of opportunity for growth. Hospital and Surgery Center privileges. Financials available upon request. Serious inquiries only! Beautiful area. Contact: Carolinafootdoctor@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

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