The Voice of Podiatrists

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February 03, 2007 #2,801 Editor-Barry Block, DPM, JD

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We've just posted the February CME titled "Pediatric Fractures and Dislocations" by Edwin Harris, DPM.

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Frequent Stretching Benefits Plantar Fascitis: NY Podiatrist

One common source of pain is the inflammation of muscle tissues that run under the foot, from the heel to the ball. The pain is called plantar fasciitis. A new study found that stretching with a specific routine is the first line of defense.

Dr. Josef Geldwert

Dr. Josef Geldwert is a Manhattan podiatrist. "The key to stretching is to be very specific with it, to do it frequently," he said. "It has to be done two to three times a day, and each session should be about two or three minutes."

Source: Jay Adlersberg, WABC-TV [1/31/07]

Goldstein Makes Actipatch Presentation at OCPM

BioElectronics Corp. announced that Vincent Hetherington, VP and dean of academic affairs of the Ohio College of Podiatric Medicine, invited Sheryl Goldstein, DPM to be a guest speaker at the Cleveland Foot and Ankle Clinic.

Dr. Sheryl Goldstein

The presentation was well attended by the college faculty and residents. "This was our first opportunity to formally present at a podiatric college in the effective use of ActiPatch in podiatry," said Goldstein, director of Clinical Education for BioElectronics.

Source: News Rx [1/1/07]

Query: TMT Fractures

My patient is a 35 y/o US Marine who presented two years after a training accident with a fracture to tarsometatarsal TMT's 3 through 5 left foot. The fractures were displaced and intra-articular to the 4-5 met-cuboid joints and the 3rd met-lateral cuneiform joint. All conservative measures have failed. He received about 90% resolution of his symptoms with diagnostic injections (under fluoroscan) to all joints. He has significant arthrosis of these joints and pain with walking.

I’ve decided to arthrodese the met 3-lateral cuneiform joint, however I’m concerned about the the 4-5 met- cuboid. There is some literature supporting arthrodesing the met 4-5 cuboid joint, however in a large individual in a high-demand position, is this even a consideration?
There is supportive literature to perform resection arthroplasties of the met 4-5-cuboid joints with interposition of a slip of the EDB. How would this affect the mechanics of the lateral forefoot?

Alan E. Siegel, DPM, Honolulu, HI

Query: Billing a Consultation

Can I bill a consultation for a patient when primary doctor refers a patient? Do I need a letter, or can it be a verbal referral?

Also, when a new patient calls for an appointment, can I bill a consultation charge for this patient?

Mark D Young, DPM, Mt Pleasant, MI

Response: In your question, you didn't note whether the referral request the physician was specifically for a consultation - your opinion or advice. This has to be the underlying theme - the "bar" so to speak that you must meet) of the referral. Referrals from physicians, in and of themselves, do not automatically qualify the E/M encounter as a consultation. Let me explain...

If the call comes in from the primary doctor is that he/she is sending you a patient for a consultation (again, for an opinion or advice), and you may initiate treatment stemming from your evaluation, opinion/advice, then, yes, once you have evaluated the patient and sent back a written communication of your findings, advice, opinion, you can bill the encounter as a consultation.

It is highly recommended that you create a simple one page form that you can fax the referring doctor - when the appointment is made or the call for the referral takes place - to fill out requesting the consultation. The form can be titled "Consultation Request" (which has a nice ring to it), and should include the date, patient name, general problem and/or reason for the request the is being referred to you for an opinion/advice, and possibly include a space or check off box to indicate that you should initiate treatment of that problem AFTER you have concluded the consultation E/M. Obviously, include the name, address, etc. of you and the referring doctor - and include the signature of the referring doctor. Although a form requesting consultation is not a requirement, it certain does clarify, if anyone audits you, why the patient was referred to you, and why you billed a consultation E/M). The form can also note to the referring doctor to make a copy and include it in the patient's chart.

New patient appointments are not qualifications in and of themselves to bill a consultation. Patients cannot request a consultation (in terms of your billing a consultation E/M service). If a patient comes in and says, "Dr. Smith, said I should come see you" that is not a request for a consultation. If a patient calls and says, "I'm looking for a second opinion" that, too, is not a consultation (in terms of your billing a consultation E/M service). That is a new patient visit.

Just remember, if audited - the ultimate determinant - for consultation E/M billings, your defense would center around 1) a notation in the medical record that a consultation was requested, 2) the presence of the consultation H&P/medical record itself, 3) a letter or other written communication back to the referring doctor noting a consultation was performed (with opinion/advice findings included), and 4), hopefully, some type of support on the referring doctor's side in the form of a notation in the referring doctor's medical record confirming/validating a consultation was requested of you as opposed to a notation that the patient was just referred to you for treatment of his/her foot/ankle problem (or worse, no notation at all - which sort of discounts your claim that a consultation was requested or that the referring doctor was interested at all in your opinion/advice on the patient's foot/ankle problem).

Harry Goldsmith, DPM, Cerritos, CA

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

RE: Vincent Mandracchia, DPM

Kudos on Dr. Mandracchia’s accomplishment. Having podiatrists honored and recognized to this level is fantastic for our profession.

Ivar E. Roth DPM, MPH, Newport Beach, CA

RE: Boxing Shoes (Alex Kor, DPM, MS)
From: Multiple Respondents

Boxing shoes are difficult to come by. The ones I have used and prefer are Adidas and Everlast. The Adidas website will list them but you need a keyword search-Boxing. Everlast is more economical, not quite as good as the Adidas product. Check Adidas.com and Everlast.com.

Cosimo A. Ricciardi, DPM, Ft. Walton Beach FL, basewedge@yahoo.com

Boxing shoes are definitely a recognized category. I'm surprised a boxing coach would not know the specific shoes made for his sport from companies such as Nike, Adidas, Title, Everlast, Pony - even Micheal Jordan's own brand has a boxing shoe on the market. For evaluation - just suggest he goggles his request on the net and spends some time going into specifications and critiques of all the models on the market.

Mel Cheskin MBS, C.Ped., Boca Raton, FL, melcheskin@aol.com

Try http://store.titleboxing.com/boxing-shoes.html

Paul Busman, DPM, Troy, NY, BREWERPAUL@aol.com

RE: Circulator Boots (Paul Kesselman, DPM)
From: Simon Young, DPM, Michael M. Rosenblatt, DPM

I can empathize with Dr. Kesselman’s commentary on "circulator boots" but in reality in today’s billing environment "if it's not evidenced based it’s hearsay." We as podiatric practitioners should present our positive personal experiences to our vascular surgeon colleagues for comment and research analysis prior to giving possible false hope to our patients.

Simon Young, DPM, NY, NY, simonyoung@juno.com

The issue surrounding the circulator boot and other "non-traditional" medical treatments sits directly into "political medicine." To Government, "non-traditional" = fraud and abuse. This has existed in medicine in some format or another throughout history. When Lister demanded that his staff wash their hands between patients, that was
considered "abuse" of the staff or worse.

All Government has to do is say anything is "non-traditional" and any form of payment for it by Government will be considered fraud, even in cases where the technology works as described. Yet, in the same breath, Government has taxed and benefited from tobacco and allow its use, even though "using tobacco as directed" contributes to the death and disability of the user.

Any healthcare provider who makes the decision to utilize non-traditional methods must separate that use COMPLETELY from Government. They must run a clear paper trail away from it, and even if they do, they may still face charges of fraud and abuse the podiatrists' did who used the Circulator Boot. And their patients must also be made "acutely aware" that it is a non-covered service.

Any provider who enters the realm of "political medicine" is playing with fire. They must do it with open eyes and careful financial records. Even that is no guarantee. If medicine is to be considered "free," Government should introduce "Safe Harbors" for its practice. Then, let the chips fall where they may.

Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net

RE: Patient Rejects Potential Surgery (William Axton, DPM)
From: Multiple Respondents

Editor’s note: These notes can be read at:
http://www.podiatrym.com/letters2.cfm?id=12590&start=1

RE: Integrative Medicine (David Secord, DPM)
From: Bob Kornfeld, DPM, Mitchell R. Mosher, DPM

Editor’s Note: These notes can be read at: http://www.podiatrym.com/letters2.cfm?id=12589&start=1

ASSOCIATE WANTED - NORTH CAROLINA , CHARLOTTE AREA

Incredible opportunity to join a busy, well-established group practice. Looking for a self-motivated, hard-working individual seeking to become a partner. Hospital and surgery center privileges. Salary plus percentage, 401k and real estate opportunities. Send CV to universityoffice@ bellsouth.net

ASSOCIATE POSITION--PHOENIX SUBURB

Attractive opportunity for enthusiastic, proficient, and personable associate. Well-established modern practice with multiple newer spacious offices, technology and equipment. Solid referral base, close to hospitals, knowledgeable certified staff. 22% MCR. Practice and surgical center partnership potential opportunity. Prefer 24-36+ PSR. Send CV: AZpodassociate@aol.com

ASSOCIATE WANTED FOR SOUTH MIAMI AREA

Large group, busy, multi-office, partner potential. Motivated applicants only. Mail resumes and letters of intent to 999 N. Krome Avenue, Homestead , FL 33030. July start time OK, sooner preferable. E-mail lianadpm2@aol.com

PRACTICE FOR SALE -NORTHERN CALIFORNIA

Great opportunity to own a well-established turn-key podiatry practice located in modern medical office building in East Bay; Electronic billing, good payor base, no HMO contracts; biomechanics, general podiatry with great potential for surgery. Please send CV and letter of interest to: norcalpod@hotmail.com

ASSOCIATE POSITION – CENTRAL NEW JERSEY

Associate Wanted....For well established Central Jersey practice, diversified in all aspects of podiatric medicine and surgery. I am looking for a highly motivated, conscientious, individual with strong work ethhics. My practice may offer great potential for the right person. Minimum PSR 24. Please reply to Jerseypod@gmail.com

ASSOCIATE POSITION -MINNESOTA – PRIME MINNEAPOLIS SUBURB

Busy, well-established, full-scope podiatry practice, seeking highly motivated podiatrist for a full-time position with potential partnership opportunity. Looking for PSR 24+ individual. Excellent opportunity for long-term growth with unlimited income potential. E-mail CV to employment@associatedpodiatrists.com or fax to (612) 866-5875 Attn. Jennifer.

PRACTICE FOR SALE -BOSTON SUBURBS

Established practice for sale. Practice averages 18 – 22 patients per day. Currently all surgery is referred out. Opportunity to transition patient base to full service. Priced for sale. Contact dpminboston@comcast.net

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

ASSOCIATE POSITION -WASHINGTON - SEATTLE AREA

Two-location practice looking for long-term commitment leading to partnership. Medicare certified surgicenter each location. Must be highly motivated, ethical & have good patient skills. Competitive salary & benefits package available. Excellent opportunity for the right candidate. Send CV to fax 425-775-9078, e-mail to nwfootandankle@yahoo.com or call 425-775-1505.

ASSOCIATE POSITION - SOUTH CENTRAL PENNSYLVANIA-PM & S 36

Large, busy podiatry group looking for associate interested in future partnership. Practice facilities and technologies include: Surgical Center, Physical Therapy Department, six appointment locations, EMR, MRI and Digital X-ray. Full compensation and benefit package offered. Mail CV to Martin Foot and Ankle, 1203 S. Queen St. York, PA 17403 or email business administrator, johnreitzel@comcast.net

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multi-location practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.com

ASSOCIATE POSITION – MISSISSIPPI

Well established, busy, 3-doctor practice seeks PSR 12 or 24 trained podiatrist for associate position to fill vacancy of retiring member. East central location is a great area to raise a family and is a prime location for accessibility to several major cities. Competitive salary, benefits, and incentives. Partnership possible in 2 years to right individual. June - July start date. Applicant must be ethical, personable, and motivated. Please E-mail CV and letter of intent to shanegan@bellsouth.net

ASSOCIATE POSITION LEADING TO PARTNERSHIP - TAMPA BAY AREA-FLORIDA

Immediate position available in growing multi-office/multi-physician practice. Looking for a highly motivated psr24/36 trained podiatrist. Must be board qualified/board certified ABPS physician and be highly enthusiastic, motivated, with excellent patient/ social skills. Excellent benefit package including salary/bonus, health ins, paid time off, paid CME, and much more. Please e-mail CV to drdad94@aol.com or contact (727) 944-2522 for more information.

EXCELLENT ASSOCIATE OPPORTUNITY – SOUTHERN CALIFORNIA

Established 25 year well-rounded biomechanical and surgical practice seeking energetic, enthusiastic, personable and proficiently-trained PSR-24 or PSR-36 foot and ankle surgeon for associate with ultimate partnership opportunity in LA area. Excellent position for an individual interested in all aspects of podiatric medicine with emphasis on reconstructive foot and ankle surgery. Only 8% Medicare with No HMO. Email CV to dr4feet@sbcglobal.net

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