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February 07, 2008 #3,161 Editor-Barry Block, DPM, JD

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CLEAR’S Armstrong is Keynote Speaker at French Symposium

The largest meeting place in the French-speaking world was the location for the 12th Annual French International Symposium on Wound Healing. The Palais De Congress in Paris, France was the venue for physicians worldwide to hear the latest information regarding wound healing and reconstruction.

Dr. David G. Armstrong

Dr. David G. Armstrong, Professor of Surgery at the William M. Scholl College’s Center for Lower Extremity Ambulatory Research (CLEAR)at Rosalind Franklin University of Medicine and Science, was one of four keynote international speakers in a conference that covered topics ranging from the latest research in treating war wounds and terrorism to infectious diseases and even maggot therapy. “It is heartening to see such excitement about the medical and surgical advances being made here in Western Europe." said Armstrong.

FL Podiatrist’s Study Demonstrates Effectiveness of Sertaconazole Nitrate 2%

For the second consecutive year, Dr. Bret Ribotsky, a podiatric physician from Boca Raton, FL has had his research presented at the Annual Meeting of the American Academy of Dermatology (AAD). The research was an evaluation of treatment of patients with tinea pedis who also have onychomycosis.

Dr. Bret Ribotsky

"Treating patients with co-existing conditions often makes using ideal clinical research pathways difficult." says Ribotsky. "This study, demonstrates that patients with tinea pedis can be effectively managed with sertaconazole nitrate 2% (Ertaczo )in spite of having onychomycosis." The long-term reservoir effect of sertaconazole nitrate 2% showed continued absence of recurrence of the tinea infection at two weeks after active treatment stopped, even in patients with onychomycosis.

http://www.aad.org/forms/ElectronicPosterAbstract/Uploads/PDF/e0a2f99a-6cd4-4ef8-babb-4ed3a8f8e555/1712.pdf

Medi-Cal Podiatry Proposal Draws Rare Bipartisan Agreement

About 160,000 children could be removed from the Medi-Cal program by one of Gov. Arnold Schwarzenegger's proposed budget cuts, a health official told a Senate committee today.

As the committee was told about a proposal to save $3.4 million by eliminating podiatry services from specialized foot doctors, Sen. Joe Simitian, D-Palo Alto, interrupted with a comment. "Now and then we have to stop in the process and say, 'What have we come to?' ... Is this really what we aspire to as a state?" said Simitian.

The podiatry proposal brought a rare moment of bipartisan agreement. Sen. Alex Padilla, D-Los Angeles, said podiatrists can detect symptoms of a growing problem, diabetes, drawing an amen from Sen. Bob Margett, R-Arcadia.

Source: Ed Mendel, San Diego Union-Tribune [2/4/08] via David Armstrong, DPM

Query: Piezogenic Papules of the Heel

My patient is a 38 year old healthy male. He has prominent and painful piezogenic papules of the heel. He previously had surgery to excise the fatty herniations along with cautery of the site of herniation. It helped, but he is still having pain.

Piezogenic Papules of the Heel

Has anyone done anything to "cure" this? I am thinking of using a dermal substitute such as Pegasus or GraftJacket to act as a repair to the septal herniations.

Peter J. Bregman, DPM, Tewksbury , MA

Query: Tetanus Coding

What is the best coding for a tetanus injection that is given when a patient comes in with a dirty wound? Our injectable contains both the tetanus and the diphtheria toxoids.

I am having trouble getting paid for this separate from the wound care. It is not considered part of the wound care is it?

Susan Hansen, Las Vegas, NV

Response: You don't state whether the other code you are trying to get paid for is an office visit or a wound closure, but it appears to be an office visit. If so, add modifier "-25" to the office visit since evaluating, cleaning and dressing the wound are separate and distinct from administering the vaccine.

You also don't mention the patient's age, but it is likely someone over age 7. If correct, also bill CPT 90718 (tetanus and diphtheria toxoids [Td] absorbed when administered to individuals 7 years or older, for intramuscular use) and CPT 90471 (immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]).

Some insurers will have a problem paying for the diphtheria vaccine being included with the tetanus. In those cases, if you cannot convince them to cover, then you will need to bill CPT 90703 (tetanus toxoid adsorbed, for intramuscular use) in place of the CPT 90718.

You will use the same ICD-9 code for all 3 CPT codes.

Richard Papperman, MBA, CHBME, Cape May Court House, NJ

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

RE: Videotaping of Surgery (Nat Chotechuang, DPM)
From: Daniel Chaskin, DPM

I believe that videotaping of surgery or at least pre and post photographs may possibly be a good idea for two reasons. 1) You obtain documentation of your current competence that could be used before hospital credentialing committees 2) It is persuasive before a jury during any possible future malpractice trial if you are ever sued.

Regarding the tape recording of a consent, if the patient consents to a tape recorder being used, then in a court of law you can claim that part of your written consent includes oral statements from you, including some oral statements that were tape recorded. On such a recording you could always include a discussion of possible risks, benefits and alternatives of a given procedure.

Daniel Chaskin, DPM, Ridgewood, NY, podiatrist1@optonline.net

RE: Jay Schnitzer, DPM
From: Richard Gosnay, DPM

I was thrilled to read that TUSPM has awarded Dr. Schnitzer the Certificate of Honor for 2008. It was my honor and privilege to trainunder Dr. Schnitzer during my residency. We residents were blessed to have a such a gifted teacher. Dr. Schnitzer constantly taught in a positive, nurturing manner. He had plenty of time to quiz us during cases because he was so generous with us. He would make us assist him the first time we would scrub one of his procedures. Afterwards, he would patiently let us operate because training new podiatrists is so important to him. He would assist us while constantly peppering us
with questions. His confidence in his own surgical skills gave me a great sense of security. It was obvious that I could make no mistake that Dr. Schnitzer could not correct.

It is not surprising at all that St. Mary's Hospital named Dr. Schnitzer its Physician of the year for 2004. Dr. Schnitzer is universally loved and respected there. Most of us are treated cordially by hospital staff. And when we leave the room, some less
flattering opinions of us come out. The staff at St. Mary's is cordial in Dr. Schnitzer's presence, and they gush about how much they admire him when he steps out of the room! His professionalism and kindness were a profound inspiration to me. I wish all new podiatrists could spend one day rounding with Dr. Schnitzer.

I think I speak for most, if not all, graduates of the residency at Frankford Hospital when I say that Dr. Schnitzer is a beloved treasure for podiatric education. Congratulations to TUSPM for recognizing his contributions!

Richard Gosnay, DPM, Danbury, CT

PRACTICE FOR SALE - WEST CENTRAL FLORIDA

Twenty year old mobile podiatry practice. Retiring. Alf’s, nursing homes, and Independent living facilities. Excellent location and growth Opportunity. Willing to stay on and introduce new doctor to patients and administrators. Great opportunity for a new graduate. Please contact me at footdoctor87@yahoo.com

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

PODIATRIC CONSULTANT AVAILABLE

Board-certified podiatrist with over 25 years experience available on a consultant or educational basis for health-related agency or corporation. To receive a copy of my resume, e-mail havbil@gmail.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

MEDICAL SPACE FOR RENT OR SALE - NEW YORK CITY

305 Second Avenue (17-18th Sts), 3 Treatment rooms, Private office, Lab, Separate Receptionist/Business area, waiting room, bathroom w/ stall shower Deluxe/Landmark/Prime Building and Location, 24/7 security. Multi-specialty condominiums originally designed specifically for podiatry has also been upgraded for dentistry. For further details contact Laura Dobrusin, Ny2azld@aol.com or jdobr@arizonamed.com 480-951-2480 602-980-8457.

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 – VIRGINIA

Must have Virginia license. Requires 24 to 36 month Residency. Permanent position with potential buy in. Includes all phases of Practice excluding nursing homes. Competitive Salary and Benefit package. Please send Resume including salary requirements and availability date to needpodjob@yahoo.com

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