The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

January 09, 2010 #3,749 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2010- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

Donald Borchard, DPM
 
Dr. Donald A. Borchard was a podiatrist whose energy out-paced his staff for decades, co-workers said. As recently as May, he still worked three days a week at his Saginaw practice of 60 years. Borchard died Tuesday, one day short of his 92nd birthday. His son, Dr. Charles A. Borchard, worked alongside his father for nearly 25 years and marveled at his enthusiasm. “It was a joy to work with my dad,” Borchard said. “The man had energy that was unbelievable, both in and out of the office.”

Dr. Donald A. Borchard

Borchard graduated from the Ohio College of Chiropody, Cleveland, now the Ohio College of Podiatric Medicine. He opened his practice in downtown Saginaw in 1949 and was joined by his brother in 1951, Dr. William F. Borchard, who predeceased him in 2007. He was former president of the Michigan State Podiatry Association and was named to the State Board of Registration in Podiatry in 1970.

PM News policy is to recommend that memorial donations be made to the APMA Educational Foundation or the Ohio College of Podiatric Medicine.

Source: Deborah Brown, The Saginaw News [1/7/2010]

PA Podiatrist Discusses Cold Weather Risks to Feet

Dr. Daniel J. Yarmel, a podiatrist at the Harrisburg Foot and Ankle Center was recently interviewed. The following is an excerpt:

Dr. Daniel J. Yarmel

Q: What risks does cold weather pose to our feet?

A: Cold-related injuries to our extremities are often called “frostbite” injuries, but there exists a large distinction between a minor injury termed “frostnip” and the more severe late stages of “frostbite.” There are grading systems similar to those used for burns. Although injury usually occurs at temperatures below freezing, some injuries might occur at or near this level.

Individual risk factors, including increased age, poor nutritional status and certain medical conditions such as Raynaud’s, diabetes and peripheral vascular disease might increase one’s risk. Specific physical conditions such as poor circulation and perfusion to the feet and a history of smoking might create healing complications if a cold-related injury does occur.

Source: Pennlive.com [1/7/10]

NJPMS Sues Insurer to Block New X-Ray Policy

The New Jersey Podiatric Medical Society (NJPMS) has sued the state’s largest insurer to block a new policy that says patients must go to a certified radiologist for ankle x-rays and diagnostic ultrasounds — and can’t get them in their podiatrist’s office — if they want to be reimbursed. The policy was to have been implemented on Nov. 30, but has been delayed, according to Horizon Blue Cross Blue Shield of New Jersey.

The insurer, which covers more than 40 percent of New Jersey’s insured population, says the policy is necessary to make sure that X-rays are safely delivered and competently interpreted and that unnecessary imaging services are reduced. The policy would apply to more than 900 podiatrists in Horizon’s network, 60 percent of whom have imaging equipment in their offices. Podiatrists are physicians who specialize in care of the feet and ankles.

Dr. Jeffrey Conforti

NJPMS says the insurer will be denying reimbursement for services that are integral to the practice of podiatry and part of the scope of practice defined by the state Board of Medical Examiners. Plus, they say, the new rules will inconvenience their patients and add to patient expense. It “costs the patient time, inconvenience, more pain and triple the amount of money,” said Jeffrey Conforti, a Ridgewood podiatrist and past president of the society’s northern branch. “When they come to see me, they pay the office a co-pay, then another co-pay to the x-ray facility, and then to my office again when they come back.”

Source: Lindy Washburn, The Record [1/7/10]

Nine NYC Podiatrists Sentenced for Medicare Fraud

Nine area podiatrists have been sentenced in federal court to prison terms for Medicare fraud in various schemes dating back to the 1980s, according to court papers. The firm Citywide Clinics had offices under different names in Manhattan, Bronx, Brooklyn, and Queens. Podiatrists were convicted of submitting false claims, doing unnecessary treatments, and using the higher Manhattan billing rate for procedures performed in the firm’s outer-borough offices.

In one scam, Citywide Clinics solicited patients off the street with flyers for free treatments. The treatments were indeed free, but in order to qualify for the Medicare reimbursement the clinics received, the patients should’ve been charged a 20 percent co-pay. Read full story by clicking here.

Source: Fred Mogul, WNYC,  Lawfuel.com  [1/7/10]

Query: CTS-5500 Ultrasound Machine

I am considering a CTS-5500 ultrasound machine. I would appreciate opinions from those who use this ultrasound in their practices.

Rick Wittock, DPM, St. Louis, MO

Query: How Do I Code This?

I'm looking for some guidance on coding the following:

1) Talo-navicular joint fusion with 3 screws and 4-hole plate, right foot
2) Dorsal exostectomy, talus, right foot
3) Dorsal exostectomy, navicular, right foot
4) Surgical exploration of anterio-medial aspect, right ankle, and
5) Excision, soft tissue mass (6 cm by 1.5 cm), anterior right ankle.

Which procedure is considered primary (highest value)?

Robert Steinberg, DPM, Schaumburg, IL

Response: It appears that you performed two comprehensive procedures: fusion of a tarsal joint and excision of soft tissue mass right ankle. I would recommend the coding:

CPT 28740 - arthrodesis, midtarsal or tarsometatarsal, single joint (16.66 total RVUs [facility])
CPT 28039-59 - excision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or greater (9.19 total RVUs [facility])
CPT 28039 is new for 2010 distinguished from CPT 28043 (redefined) by size of the mass.

Bone remodeling at the fusion site and the exploration of the soft tissue excision site are included in the allowances of the comprehensive procedure codes above. The internal fixation (by whatever means) is also part of the fusion procedure allowance.

Harry Goldsmith, DPM, Cerritos, CA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Bleomycin Injections (Elliot Udell, DPM)
From: Multiple Respondents

I use Bleomycin frequently in my practice. When I order the product from my pharmacy, I order five 1cc syringes and it costs about $100. I charge the patient $20 per syringe used. I estimate how many syringes it will take and inform them of the cost before the treatment.  There is a J code for Bleomycin, but if you use it, you will lose money and clearly you can’t charge the patient and use the J code, so I don’t use it. You can then bill the chemical destruction of verrucae code for the visit. The caveat is that you must use all syringes before the product expires. It has a shelf-life of about a month and must be refrigerated. So, block a few patients together to avoid expiring product, but even with the best planning, it is possible to lose a little money on an expiring product.

Rick Wittock, DPM, St. Louis, MO, wittockr@sbcglobal.net

I have not used Bleo. However, I have used Candin or yeast injection. The bottle is over a hundred dollars for 5cc. It is a service from me to my patients, and I break even (if that). I may use it once or twice a year for extremely recalcitrant verrucae.

Pete Harvey, DPM, Wichita Falls TX, pmh@wffeet.com

I have used Bleomycin for the past 3 years or so and find it to be probably one of the most effective treatments for verrucae. I get a 15 u vial from a local pharmacy for $100. I add 10 cc of 1/2% Marcaine with epi 1:200,000, so each cc "cost" is $10. I use this therapy mostly for solitary lesions or maybe patients with two or three lesions. At most, each lesion receives about 0.3 to 0.5 cc (injected with a 1 cc tuberculin syringe), so for each wart, the Bleomycin "cost" is $3 to $5. I usually just eat this cost. I bill wart destruction code CPT 17000. Some may prescribe Bleomycin and have the patient get this, but I don't believe this is good for the patient, as they receive 3% of the drug they were prescribed!  Anyway, I keep the mixture refrigerated and my 15 units lasts quite a while. 

R. Alex Dellinger, DPM, Little Rock, AR, raddpm@yahoo.com 

RE: Covered, Then Non-Covered Orthotics (Michael Forman, DPM)
From: Brian Kiel, DPM

Our approach to orthotic fee coverage includes patient information from the beginning. Once orthotics have been determined to be necessary, I personally explain what our fee is to the patient. I think that to surprise the patient with a large fee at the checkout desk is unfair. If patients are unwilling to pay, for whatever reason, I don’t want them to be embarrassed. I feel that by my explaining the fee, I give greater importance to the orthotics and have fewer refusals.  I also explain that there is a deposit equal to 25% of the fee due at the time of casting. If a patient is unwilling or unable to pay at that time, we will not cast and tell them that when they are able to make the deposit, we will reschedule them.

Prior to casting, my assistants go over a written contract verbally. It explains that the deposit or a portion will be refunded if there is insurance reimbursement, and if there is not, the deposit will be applied to the balance. We also explain that the deposit is non-refundable for any other reason. As is want to occur, after payment is denied and someone decides that they do not want the orthotic, the deposit will at least cover our costs. We do not make exceptions for these policies, and over the years, we have had few problems.
 
Brian Kiel, DPM, Memphis, TN, Footdok4@gmail.com

RE: My New Career as an Orthotist (Name Withheld)
From: Multiple Respondents

In reading the posts on this topic, I must agree that it seems that the newly-minted podiatrists are mainly oriented towards surgery. I have interviewed a few for associates and no doubt, when the real world intervenes, except for an HMO job possibility, their expectations of being ONLY a surgeon are unrealistic. Not only are these graduates unrealistic concerning having an ALL surgery practice, but I believe that they do a great disservice to the patients they serve; conservative care is a real treatment plan for many presenting problems. To go straight to surgery for problems like heel pain, metatarsalgia, neuromas, etc. is completely unjustified. Unfortunately, these seem to be the practitioners who get into malpractice trouble later on.

Concerning some podiatrists not being able to “hack it”, from the ones I have met, they should have never graduated from podiatry school in the first place. I know this comment seems harsh, but these doctors are the victims of the schools being greedy. The schools are to blame for passing them along to get their tuition. These doctors were doomed for failure from the beginning. This is a small subset of graduates, but a real problem nonetheless. These doctors, for whatever reason, lack the skills necessary to be successful and should have been identified early on and counseled by the schools to find a different occupation.

Ivar E. Roth DPM, MPH, Newport Beach, CA, ifabs@earthlink.net

It is disturbing that this doctor chose to change careers. Hopefully, someday, he will return to the fold. However, his plight is, by no means, anything new to this or any other profession. Many years ago, I attended a Midwest Seminar in Chicago as a student. I met at least three supply salesmen who were former podiatrists. As a profession, we don’t need to beat ourselves up because of an occasional misstep by other people. Be proud of what we do.

I agree with Dr. Rosenblatt that each individual needs to jump in the pool and get wet. There are no guarantees. We can’t expect Mom or Dad, an employer, the government, or anyone else to bail us out when things don’t go right. I feel that government student loans are the way that the government creates its own serfdom. When students graduate with high government debt, the government can extract high tolls in terms of emotional and professional success.

Pete Harvey, DPM, Wichita Falls TX, pmh@wffeet.com

I have read the opinions of members on this topic and would like to perhaps give a devil’s advocate point of view. My intent is not to...

Editor's Note: Dr. Paul Bishop's extended-length note can be read by clicking here.

PRACTICE FOR SALE - TENNESSEE

Well established practice for sale. Full scope medical and surgical practice including DME. Exceptional practice with a high volume of new patients. Excellent hospital and surgical center privileges with investment opportunity. Great area for a family and the outdoorsman. 731-446-7285/E-mail nraines@charter.net

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Full benefit package included. If interested, please email your curriculum vitae to foot1st@yahoo.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

PRACTICE FOR SALE - MAINE

20+ year, full scope, turn-key practice. Retiring seller will assist in transition. Excellent expansion potential, superb place to raise a family. mainefootdoc@yahoo.com

DREAM PRACTICE OPPORTUNITY - OKLAHOMA

Use forefoot, rearfoot, wound skills in ideal small city with nearby lake. No buy-in costs. No limit on income. EMR. Act fast. OK State License deadline is 1-30-10 and test is comprehensive. Personality preferred over ego. Email julietburk@gmail.com or call 918-931-1425 for details.

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

ASSOCIATE POSITION - MASSACHUSETTS

PSR-24 trained podiatrist for busy multi location practice, high volume and high-tech. Seeking energetic individual for high volume of patients with multiple needs. Orthopedic, sports medicine, wound care, pediatric orthopedics and surgery skills required. Looking for immediate hire for the right candidate with possibilities for partnership. Contact Debbie Roberts debbierobertsm4@hotmail.com

ASSOCIATE POSITION – NORTH AND CENTRAL FLORIDA

Quality Podiatry Group of Florida provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists.  Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

PRACTICE FOR SALE - ALABAMA, GULF COAST

Established 26 year old practice for sale. Owner desires to sell and relocate. Practice operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Seller will lease office to buyer. Call Mike Crosby at 1-888-776-2430 or email at mcrosby@providerresources.com

ASSOCIATE POSITION - BROOKLYN, NY 
 
Full or part-time position available for a busy well-established podiatry practice in downtown Brooklyn. All phase of podiatry. Modern office with EMR, Ultrasound, digital x-rays with a great support staff. Must be highly motivated, ethical, with good communication and clinical skills. please email resume to tkd@gishpuppy.com

ASSOCIATE POSITION - HUDSON VALLEY, NY

Recruiting a podiatrist who enjoys doing surgery! We are a seven–doctor podiatry group and we’re great to work with. A residency program is attached to our practice. Interviews will begin shortly for this special position. Please forward CV to: healthyfeet4ever@yahoo.com

ASSOCIATE POSITION-CHICAGO AREA

Medical-surgical podiatry practice seeking full-time associate, future partnership opportunity. Start with full schedule. In Elgin, IL 45 minutes from downtown Chicago. Established 75+ years, new state of the art facility. 5 minutes from new, high-tech hospitals. Excellent relationship with other specialties, high physician referral base. PSR-24/36. Email resume to kenjacoby18@gmail.com

ASSOCIATE POSITION – CINCINNATI, OHIO

This is your once in a lifetime opportunity to join one of the most successful practices in the United States. We do not have a seniority system. If you are motivated and have completed a PSR 24-36 residency, your income is limited only by your enthusiasm and desire to achieve. Email resume to khart@cincinnatifootcare.com

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.