The Voice of Podiatrists

Serving Over 10,600 Podiatrists Daily

January 26, 2008 #3, 151 Editor-Barry Block, DPM, JD

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“Never Ignore Foot Pain” MO Podiatrist

Did you know that by the time you are 50-years old you will have walked 75-thousand miles? That’s up to 10-thousand steps per day! Board Certified podiatrist, Dr. Zenon Duda says since the feet are very small compared to the rest of the body, thus the impact of each step creates tremendous force on your dogs!

Dr. Zenon Duda

He tells KZIM/KSIM that he often hears misconceptions at his foot clinic that he wishes to dispel…For instance, Dr. Duda reminds us that feet are not supposed to hurt at the end of the day. He says many conditions can easily prevented by wearing properly fitted footwear or using the right over-the-counter foot products. He suggests never ignoring foot pain. 75-percent of all Americans have foot pain at some point in their lives.

Source: KZIM/KSIM [1/24/08]

Diabetes Cost U.S. $174B in 2007; Cases Continue To Rise

Diabetes cost the U.S. $174 billion in 2007 in both direct care and lost productivity, an increase over $132 billion in costs related to the disease in 2006, according to a report released on Wednesday by the American Diabetes Association. The Richmond Times-Dispatch reports About one million people are diagnosed with diabetes each year, the report said. The condition costs almost as much as cancer, which totaled $206.3 billion in 2006, but fewer people die from diabetes than from cancer, USA Today reports. The report also found that:

• About half of people with diabetes have health insurance through public health insurance programs;
• About half the cost of treating diabetes comes from inpatient care;
• Diabetes increases hospital stays for other conditions by almost 50%;
• Routine care to treat the condition has a relatively low cost; and
• Most of the cost comes when the disease is unmanaged.

Source: Richmond Times-Dispatch, USA Today Via American Health Line [1/24/08]

Query: Hypoallergenic Nail Polish/Remover

I have a young female patient who recently presented to office complaining that her nails break easily. She does not present with any evidence of onychomycosis, psoriasis or other obvious nail dystrophy. She used to wear high-heeled shoes, which may be responsible for micro trauma to her nails. She does have a history of contact dermatitis to multiple materials and chemicals. Does anyone know of hypoallergenic nail polish or nail polish remover as her dermatologist believes that this (polish and/or remover) may be responsible for her toenail lysis?

Larry Dorman, Miami, FL

Query: Since A9160 Was Deleted

What would be the appropriate CPT code to use when the patient presents a thick, non-painful, fungus dystrophic nail for debridement?

Bruce Freedman, DPM, Richards, VA

Response: Assuming this is a Medicare patient, if you only debrided the nail, and there was no medical necessity to evaluate the patient or discuss treatment options (they were previously discussed, and there were no new options to offer), then if you need to submit it to Medicare*, bill CPT 11720-GY (statutorily not covered), and BILL THE PATIENT. *Only submit a claim to Medicare if the patient requests you to do so.

If an H&P was medically necessary, and you did discuss treatment options (and documented this in the chart), you may be able to bill Medicare for an E/M service.

Mark Schilansky, DPM, Catskill, NY

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

RE: S/P Talar OCD Arthroscopic Debridement and Continued Pain (David T. Taylor, DPM)
From: Howard A. Stone, DPM

Generally, large OCD’s in the medial Talus need to be approached through a medial malleolar osteotomy, since adequate exposure is critical. Filling of the defect with either a cartilage plug from the knee or a synthetic plug like Osteocure is your best option. It is very important to make sure that the cartilage replacement graft is seated firmly into the sub-chondral bone. Also, it is critical that there be a smooth transition from the normal cartilage to the graft. One large plug is typically much more desirable then several small plugs.

Howard A. Stone, DPM, Glenview, IL, drstone@nspodiatry.com

RE: When an Unhappy Post-op Patient Appears in Your Office (Peter Bregman, DPM)
From: Amy Schunemeyer-Purdy, New Iberia, LA

I have had this scenario in my practice frequently. If I know the other podiatrist I call them 1) as a courtesy and 2) to find out the facts. I ask the patient what their concerns are and usually send them back the the initial DPM. If the patient wants to transfer care to myself, I use my judgment for accepting them mid-care post-operatively ONLY after speaking W/ the initial DPM and/or requesting medical records.

I feel speaking W/ the original DPM defuses any animosity.

Amy Schunemeyer-Purdy, New Iberia, LA, apodiatrist@mindspring.com

RE: MediSoft Billing Software (Syed Ahmed, DPM)
From: Robert Boudreau, DPM

My experience with Medisoft was, in one word, terrible. Many years ago, before HIPAA and electronic billing, it was a plain, simple program which was inexpensive and did a great job. Around 7 years ago, the software began having glitches in it, and one update left me w/o software for almost 3 months, and had scattered patient info everywhere. They are constantly coming out with new "updates" to the tune of $2-3,000 per update. There are much better programs out there now. I do not recommend this one.

Robert Boudreau, DPM, Tyler, TX, RBFTDOC@aol.com

RE: Reimbursement for Topaz Procedure (David E. Gurvis, DPM)
From: Multiple Respondents

In reply to the question of Dr. Gurvis regarding evaluation of Topaz, an examination of efficacy can be performed by several means without the use of a sham device. Most commonly the FDA will require an "equivalent to" test. That is, demonstrate that the results of Topaz treatment for plantar fasciitis are equivalent (or superior) to other treatment modalities which are approved (e.g - ECSWT, endoscopic plantar fascia release). Also, you must demonstrate equal or superior safety profile to other accepted techniques. Use of a sham treatment protocols are not required.

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

I have been a lecturer for Arthrocare for approximately one year now and at no time did I during my presentations, or Arthrocare indicate that the billing codes to be used are anything other than completely ethical. During the course of my lectures, (predominately on the west coast) I am routinely asked what codes should be used. When responding, the unlisted code is always brought to the attention of my audience members.

Topaz has been successfully utilized in over 45,000 cases. One of the current uses is in the treatment of plantar fascitis/fasciosis as well as tendinitis/tendinosis. When used as the sole method of treatment, the unlisted code can and should be utilized, although if Topaz is used as an adjunct procedure for conventional repairs such as Achilles tendon ruptures etc, then of course the Achilles repair should be billed, and no separate code should be utilized for the Topaz portion of the procedure.

Topaz has been shown to be effective for several reasons, but perhaps the most important one is the controlled angiogenic response which stimulates blood flow, and promotes healing. This has been proved with aged rabbit tendon studies. In addition, the anti-nocioceptor response which lasts for between 7 and 14 days, decreases post-operative pain as well.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com

Editor’s Note: An extended-length note from Dr. Mullen appears at:
http://www.podiatrym.com/letters2.cfm?id=17638&start=1

ASSOCIATE POSITION - NORTHWEST PENNSYLVANIA

Multi-specialty group is looking to add another Podiatric Surgeon or General Podiatrist to our well-established group. Office locations in northwestern Pennsylvania. Unlimited opportunities exist for the right Associate, wound care experience is a plus. Please forward your CV to adminsec@ips-mso.com

SEEKING ASSOCIATE WITH POTENTIAL TO FULL PARTNER

Busy multi-physician podiatric group with 2 locations seeking BQ/BC surgically trained doctor. Applicant should be well-trained in all aspects of surgical and conservative care. Seeking ethical, hard working and outgoing physician to join our 4-physician group. Excellent quality of life in suburban Houston, near NASA and the Gulf of Mexico. Email CV and cover letter to Dr. M. Rockett at Mrockettman@comcast.net.

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- CONNECTICUT

Established Practice looking for PSR 24/36 trained surgeon. Must have experience and be responsible for all surgical cases for the practice. EMR and digital x-ray in new 6-treatment room office. Hospital privileges available. Connecticut has a new ankle law for the Properly-trained DPM. Competitive salary, benefits, and bonus. Great area to raise a family. Fax resume to 860 243-5790

ASSOCIATE POSITION - VIRGINIA (SOUTHERN)

Immediate full-time and part-time associate position available. Unlimited income potential. Busy, diverse, 40+ yr Hampton Roads practice. Must be compassionate; energetic; and motivated; PSR24/36. Looking for long-term arrangement. Please send letter and CV to dcarrone@cox.net fax to 757-397-5889

Excellent opportunity for ethical & personable hard-working individuals to join a busy multi-office two physician practice. Looking for one podiatrist with interest in conservative care, including sports medicine and one podiatrist trained in rearfoot surgery. Rearfoot surgeon must be board eligible and working toward board certification. Competitive salaries, 401-K, health insurance, paid vacation and more. Please forward CV with references to nrussell@neondsl.com

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