The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

January 18, 2012 #4,361 Publisher-Barry Block, DPM, JD

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OK Podiatrist Discusses the Need to Examine Children for Flatfeet

Don't forget your feet! Throw out old shoes, monitor the wear of your existing shoes, and check their fit and style. According to podiatrist Dr. Raymond Smith, little kids can be flatfooted until about the age of seven. Until then, their pediatrician needs to monitor their feet for problems. One thing we can do is examine these kids when they're young.

Dr. Raymond Smith

Make sure that kids are placed in proper shoes. "We use proper orthoses to realign the feet and not allow children to have extreme pathological flat footedness," Dr. Smith says. A clue that your child may be having trouble, says Dr. Smith, is if your child can't keep up with other children. 

Source: Angela Buckelew, KWTV(CBS) [1/13/12]

NY Podiatrist Discovers Rare Dinosaur

Palentologist Phil Currie is here today to meet a Calgary-based helicopter pilot who is going to airlift the 350-kilogram hip bone of a Daspletosaur that had to be left behind last summer because it was too heavy to carry out with the skull, ribs, and other fossilized bones that went with it. The dinosaur was discovered by Dr. Stuart Plotkin, a podiatrist from New York who spotted the foot of the creature protruding from the sand. 

Dr. Stuart Plotkin with 3 foot long metatarsal from Daspletosaur

Plotkin, a graduate of the California College of Podiatric Medicine is the author of Dig: The Search for Dinosaurs. Each summer, he enjoys his hobby of uncovering dinosaur bones.

Source: Ed Struzik, Edmonton Journal [1/13/12]

OH Podiatrist Elected as President of School Board

Beachwood High School graduates Dr. Brian Weiss and Mitch Luxenburg were elected president and vice president, respectively, of the Beachwood school board at its first meeting of the year, Jan. 9. Weiss, a 1976 BHS graduate, has served on the board since 2004. He also served a one-year term as board president in 2009.

Dr. Brian Weiss

“I am excited to serve in this capacity and look forward to the opportunity,” Weiss said. Weiss, a podiatrist and a longtime Beachwood schools volunteer, welcomed newly elected board members Joshua Mintz and Steven Rosen and encouraged them to maintain the passion they showed in running their campaigns.

Source: Ed Wittenburg, Sun News [1/16/12]

Study Finds Remote Dermatology Consults Help Treatment, Outcomes

Live interactive telemedicine consults with dermatologists appeared to result in improved treatment and positive outcomes, according to a report in the American Medical Association's Archives of Dermatology journal. In a study funded by HHS' Agency for Healthcare Research and Quality, researchers examined the records of 1,490 patients who had a live teledermatology visit with a physician at the University of California at Davis between 2003 and 2005, and compared diagnoses and treatment plans between the referring physician and the dermatologist.

These visits resulted in changes in diagnosis for 69.9% of the patients and changes in disease management for 97.7%. Clinical improvement was seen in 68.7% of the 313 patients who were identified to have two or more virtual visits. The most common changes from the referring physician's original diagnosis were changing the diagnosis from skin infection to “primary inflammatory process,” such as psoriasis or eczema appearing as a fungal infection; changing from malignant lesion to benign; and from changing a benign lesion diagnosis to malignancy.

Source: Andis Robeznieks, Modern Healthcare [1/16/12]

Query: Following up on Attestation
 
Does anyone know of a way to check the status of your attestation for meaningful use incentives after you have already completed the attestation process?
 
Lori Weisenfeld, DPM, NY, NY

Query: Repairing a Non-Union

A patient of mine has been suffering from a fracture non-union. This resulted from an avulsion fracture at the base of the 5th metatarsal and involved the insertion of the peroneus brevis tendon. The surgery involved excision of the proximal non-union fragment with advancing and reattaching of the brevis tendon using an anchor. Regarding the coding: Would it be appropriate to bill for a repair of a non-union (CPT 28322) and transferring/advancing of the brevis tendon to the remaining 5th metatarsal (CPT 27690), and would the coding be different?

Bradley Copple, DPM, Omaha, NE

Response: I would not consider your description as a repair of a non-union, but rather an ostectomy of the 5th metatarsal bone. Therefore, I recommend using CPT 28122 - ostectomy, partial, tarsal/metatarsal.

With regard to the peroneus brevis repair, with tendon advancement, there is no code for tendon transfer within the foot itself, so you would either include it in the ostectomy code with a "-22" modifier indicating more work than usual, or consider using: CPT 28899 - unlisted foot/toe procedure. Include a copy of your operative report or narrative of what was done, and request a peer review from the payer.

Howard Zlotoff DPM, Camp Hill, PA

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RE: Medicare Records Analysis Audit (Name Withheld)
From: John Harris DPM
 
I had the same thing happen a few months ago. I showed it to my local Medicare liaison and he did not know anything about it. The representative was polite and provided us a few weeks in advance with a list of patients whose records they want to see. I do not have a medical records staff and would not feel comfortable with a "staff member" preparing this either. I had my office manager pull the charts and print records from EMR. (I did not allow them (insurance rep) into my EMR). I personally reviewed each chart for completeness. All charts, notes, and documents were organized to ease the process. They stopped by the office and scanned the documents with their equipment and left without headache.

I have not heard back or received feedback from them and am not really worried. Just remember - you can be audited anytime. Make sure you document and code accurately and thoroughly the day of the visit and sign your notes at that time as well. EMR helps with this. If you do this, you will be safe and sleep at night. WHATEVER YOU DO, DO NOT ALTER YOUR NOTES.
 
John Harris, DPM, Jacksonville, FL, harrisdpm@gmail.com

RE: ADA and Deaf Patients (Jon Purdy, DPM)
From: Robert Wunderlich, DPM
 
As others have shared previously on PM News, a hearing-impaired patient will often agree to communicate with the use of a simple notepad and pen. I have one such patient, and we simply pass the notepad back and forth to each other; this has worked well for us. Obviously, it takes a little bit longer than a typical visit with a non-hearing-impaired patient, but it saves the trouble and expense of hiring a sign-language interpreter. Another idea would be to ask if a family member can be present to interpret (perhaps offer them a small stipend for their time and travel expense). Finally, if the patient belongs to an HMO, you can contact their PCP's office to request a sign-language interpreter; I have had success doing this as well.
 
Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com

RE: Transition from In-House to Billing Agency (Cedrick Cooper, DPM)
From: Michael Forman, DPM

Before deciding to go to an outside billing service, you have to do some calculating. You should know what part of your yearly expenses go toward billing, i.e., employee salary and benefits, space, stationary, stamps, clearinghouse costs, etc. The national average for physicians is 7%. How  much is the billing service going to charge you? What are the other factors? Be aware of the dangers of one employee handling the money. Is the employee sending out statements on a regular basis? Is she familiar with coding, etc.?

Disclaimer: I currently serve as a consultant to ABC Billing Co.

Michael Forman, DPM, Cleveland, OH, im4man@aol.com

RE: Wood Laminate Flooring in the Office (Arthur Lukoff, DPM)
From: Brian Kashan, DPM

After reading the posts of the use of wood flooring in treatment rooms, my only comment is that ANY flooring with seams, e.g., tile, laminate, wood, etc. does get bacteria in the seams. These are called fomites, and is not as easily dealt with as prior posts suggest. In treatment rooms, there is always spilling of materials. Fluids will seep within crevices as well as under them. Wiping, sweeping, and the use of disinfectants will not always get to the entire spill, and moisture will eventually cause bacterial growth.
 
Brian Kashan, DPM, Baltimore, MD, drbkas@att.net

RE: Cinderella Procedure Allows for Early Ambulation: CA Podiatrist
From: Peter Bregman, DPM

I want to thank Dr. Sadrieh for bringing attention to the public regarding bunion surgery, and that it is not a horrible experience in the right hands. I do think, however, that calling it the Cinderella procedure is a bit misleading as the procedure is simply a capital chevron-type procedure that most foot surgeons utilize. Perhaps, it would have been better to market a Cinderella foot.

Calling a chevron with a headless screw Cinderella is certainly provocative and good marketing, especially in Beverly Hills. I also think it would be a bit of a stretch to tell patients they will be back in high heels in a month after surgery. You may get into some trouble with that one. However, I think the exposure is overall good for the profession.
 
Peter Bregman, DPM, Las Vegas, NV, drbregman@gmail.com

RE: Podiatry Management Celebrates 30th  Anniversary
From: Richard H. Mann, DPM

Congratulations to Barry, David and the rest of the Podiatry Management team on 30 years of superlative work. Your publication has become an unequaled and invaluable source on all things affecting the profession. Thank you for all of you have done for podiatry.

Richard H. Mann, DPM, CEO and Founder, Realm Labs, LLC,  richard.mann@realmlabs.net

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