The Voice of Podiatrists

Serving Over 10,700 Podiatrists Daily

February 14, 2008 #3,167 Editor-Barry Block, DPM, JD

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Spring Runners More Susceptible to Injury: TUSPM Podiatrist

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All spring-time runners can suffer from sprains to blisters to shin splints, but it is more common in new or average runners, a U.S. expert said. Temple University podiatrist Howard Palamarchuk, who has cared for runners' feet at the finish line of some of the most difficult races in the country, including the Boston Marathon, said that first-time runners are more likely to ignore foot and ankle pain.

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Dr. Howard Palamarchuk

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Beginning or average runners take nearly twice as long to finish the same course and also tend to weigh more than experienced runners, leading to more stress on feet and ankles, Palamarchuk explained. "Because the legs, feet and ankles bear up to 1 million pounds of pressure during one hour of strenuous activity, they are most vulnerable to injury," Palamarchuk said in a statement.

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Palamarchuk advises beginner runners to listen to their bodies and adjust their routines accordingly. "If the 'weekend warrior' gets hurt, he might have to give up running altogether," Palamarchuk said. "Err on the side of caution."

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Source: UPI [2/11/08]

Query: Pre-Fab Orthotic W/ Deep Cup and Ribbing Under Arch

At the NY conference there was a company who made a prefab orthotic with a deep heel cup. There was "ribbing" under the arch to prevent "give" when someone stepped down on it. Does anyone have the contact info to this company?

Jeffrey Kass, DPM, Forest Hills, NY

Query: Bone Biopsy Code

What would be the best procedure code for billing a bone biopsy, distal phalanx left hallux?

Ray McClanahan, DPM, Longview, WA

Response: Because the bones of the foot are "superficial" compared with a biopsy of a vertebral body or the femur ("deep"), biopsies performed with a Jamshidi needle, for example, would be coded as CPT 20220 (biopsy, bone, trocar, or needle; superficial) which has a 0-day Medicare global period assigned. For most third-party payers, excluding Medicare, I have not had a problem with reimbursement. Medicare, however, is another story. My carrier usually rejects CPT 20220 as "this provider is not eligible." This requires an appeal and eventual payment. If the biopsy is obtained "open," code it as CPT 20240 (which has a 10-day Medicare global period assigned).

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found at:
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RE: Aqua Relief System (Richard A. Simmons, DPM)
From: Paul Kesselman, DPM

This falls under the old adage, "If it’s too good to be true, it probably is ..." I recently received this advertisement, courtesy of a fellow podiatrist seeking my opinion. The ARS (Aqua T pump) has been advertised by a company well known for its line of therapeutic shoes for diabetics. They claim this hot water circulating pump is eligible for reimbursed for patients suffering from diabetic neuropathy. The associated HCPCS code, E0217 provides a high reimbursement ($422-$496).

A pre-payment audit on claims for this device was recently conducted by Tricenturion. The Program Safeguard Contractor for DME MAC A and B. They rejected 84% -92% of these claims.

I have asked the DME MAC A outreach and education department to provide me with more information on this particular point-of-service probe, with respect to podiatry, and am awaiting a response. For those who wish to reference this, go to http://www.tricenturion.com/content/pcalpet.cfm
Look in the middle of the page for the area entitled "Revised Articles - Jurisdiction B DME MAC (Posted: 10/18/2007) Heat/Cold Application Widespread Probe Results HCPCS E0215 and E0217

For the most part, I would not advise most podiatrists to be billing for this device, particularly at the same time as one dispenses Therapeutic Shoes for Diabetics. This is a huge red flag, which will only cause you more grief.

I have submitted an article for April's issue of Podiatry Management entitled "Ethical Issues in DME Advertising." This will provide a more in-depth look at how to respond to the ever-increasing number of DME-related advertisements appearing in both lay and professional publications.

Paul, Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: Pruritic Rash [Chris Seuferling, DPM]
From: Kent Biehler, DPM, Hal Ornstein, DPM

The location of the rash could suggest that this person may possibly have a limb length difference causing the right foot to over pronate or have a flexable compensated right cavus foot. Either of these conditions would cause a lowering of the arch on the right foot while at the same time causing a functional hallux limitus. This would change the persons gait causing them to roll off the medial side of their foot. The excessive pressure in this area could turn out to be the route cause of the problem.

Kent Biehler, DPM, Adel, GA, kbiehler@pol.net

I use Amerigel Blue when I get insect bites (mosquitoes, ants) and it takes the itch away within minutes of application. It works well on various rashes and since it has antifungal and anti-inflammatory properties, it may benefit your patient. Amerigel Blue can be also be applied as needed, unlike the others you mentioned. If you’re looking for symptomatic relief from the itching, it' s worth a try.

Hal Ornstein, DPM, Howell, NJ,hornstein@aappm.org

RE: Outsourcing Appointment Scheduling (James L. Rose, DPM )
From: Bob Kuvent, DPM

My office had excellent results with eppointments Plus, an online scheduler. You allow certain slots to be booked directly from your web site. Patients love the convenience. It is distibuted by a DPM in TX, Kurt Koepsel. He is very easy to work with and does a great job on web sites also.

In addition you need to have a heart to heart w your office staff. Don't expect mindreaders-make your position clear.

Bob Kuvent, DPM, Chandler, AZ, ftfixr@hotmail.com

RE: Universal Healthcare (PM Jan 08 Column by Harry Goldsmith, DPM)
From: Scott Whitman, DPM

While I know she is a polarizing figure, Hillary Clinton's healthcare plan deserves a second look. Her plan proposes a government plan that must compete against the free market. The consumer can choose to participate with either the private payers or a government plan. The plan requires everyone participate by purchasing insurance. This strikes me as no more or less reasonable, oppressive, or enforceable than requiring car insurance for all automobile owners or workers compensation insurance for all business owners. A larger pool of insured citizens with increased competion should keep premiums down.

We can all agree that any government bureaucracy can be inefficient, and that corporations can be excessively greedy. Both can be corrupt and down right frustrating. In the spirit of Adam Smith, and in the interest of providing every citizen the right to adequate healthcare, let the market decide. If the government can't deliver a more efficient product than the private payers, no one will buy it and vice versa. Maybe this will strike Dr. Loninger as more "American." My only frustration is most will dismiss the idea because of the messenger. While I'm not advocating Hillary for president, the plan deserves consideration.

Thanks to Dr. Goldsmith for publishing an idea and starting a dialogue... your case for advocating a government run, single-payer, government healthcare system. As for Dr. Loninger... you terrify me.

Scott Whitman , DPM, Brewster, NY, whitmanscott@hotmail.com

PODIATRIST WANTED – MICHIGAN

Busy 2-Office practice looking for the right podiatrist to take the practice to the next surgical level. Fast track to partnership. PSR 24/36 ABPS qualified/certified. Email resume to drflatfoot@yahoo.com

EQUIPMENT FOR SALE - AUTOMATIC PROCESSOR

AFP Mini-Medical/90 automatic X-ray processor. Excellent condition. Purchased in 2003. Have monthly maintenance records. Location: Pasadena, MD. $1000. View at http://www.afpimaging.com/medmini Contact Jayne at jferris@chesapeakefac.com for details.

PRACTICE FOR SALE - PORT ST LUCIE, FLORIDA

The office is 0.2 miles away from the hospital. Good mix of Medicine, Surgery, Wound care, and general podiatric care. Wound care center privileges available. No HMO's. Please call 1-772-475-7920 or derrico@pol.net for details

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

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

ASSOCIATE WANTED -BOCA RATON-DELRAY BEACH AREA

Great opportunity-must be hard-working, reliable, Responsible and good with patients & staff-surgical Training a plus-partnership after 1yr. Florida License required fax resume to 561-865-2225.

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

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