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The Voice of Podiatrists
Serving Over 15,770 Podiatrists Daily
February 19, 2014 #4,992  Publisher-Barry Block, DPM, JD
A partner of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2014- No part of PM News can be reproduced without the
written permission of Barry Block
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| PM NEWS QUICK POLL |
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| PODIATRISTS IN THE NEWS | |
TX Podiatrist Discusses Hyperspectral imaging
Hyperspectral imaging (HSI) has helped a surgeon evaluating a potential amputation to know exactly what to remove and what not to remove, a conference session heard last week. Using the technique to monitor oxygen levels in tissues, the instant analysis showed details of a patient’s foot, marking high and low blood oxygen in red and blue, respectively. Speaking at the “MOEMS-MEMS” symposium, part of the Photonics West event recently held in San Francisco, Dr. Javier La Fontaine, an associate professor of plastic surgery at University of Texas Southwest Medical Center in Dallas, showed slides of the injured foot. He said that his first impression had been that both the fifth and fourth toes would have to be removed. But an HSI scan changed his mind, and the fourth toe was saved.
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Dr. Javier La Fontaine HSI of Gangrenous 5th Toe |
“It has saved some patients time spent in returns to the operating room,” La Fontaine said. “It lets us more comfortably address the severity of the wound infection. Having an idea of how much oxygen is at a surgical site is something we cannot see with the naked eye,” La Fontaine added. La Fontaine said the HSI images help him decide exactly how much dead tissue needs to be removed. “If you take too little, the wound can get re-infected,” he explained. “That can lead to a return to the operating room and can lead to a greater level of amputation.”
Source: Ford Burkhart, optics.org [2/10/14]
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| FORENSIC PODIATRY | |
Aussie Podiatrist Testifies in Murder Trial
An expert witness in the Daniel Morcombe murder trial is podiatrist Dr. Paul Bennett, who studies the science, motions, and movements of the human foot. He said he was asked to conduct a comparison analysis by police on three pairs of shoes in Queensland in August 2011. “Effectively the kinds of comparisons you are looking for are consistencies in the way footwear might wear out,” he said. He said he looked for wear patterns to form a picture of how an individual would move. Dr. Bennett said he examined a right Globe-brand skate shoe. “Effectively using the Bata reference grid, it would belong to a person roughly 12 to 15, possibly older,’’ he said.
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Dr. Paul Bennett |
He said he also examined a left Globe-brand skate shoe. Dr. Bennett said he was also provided with a pair of black school shoes and brown size 7 skate shoes as a reference point. He said the wear patterns and an "asymmetrical finding" were consistent across all the shoes. “There are locations with inside the footwear that correlate with the mechanism that has caused this particular set of wear patterns,’’ he said. He said the shoes matched.
Source: News.com.au [2/17/14]
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| PODIATRISTS AND THE MILITARY | |
Military Recruits Can Select Sneakers if Approved by Army Podiatrist
The Defense Department (DoD) has issued a formal notice asking American manufacturers who want to make an athletic shoe for service members to come forward and be counted. Under a 2002 exemption from the Berry Amendment, which mandates clothes for troops must be U.S.-made, the Army, Navy, and Air Force issue a cash allowance that allows recruits to select sneakers based their own comfort and injury-prevention needs. Despite pressure from Congress and American shoe makers, DoD has for several years resisted ending the exemption, framing it as an issue of choice and safety for troops.
At present, recruits in the Army, Navy, and Air Force can take the allowance, or a voucher, to a reception center or military clothing store where they can be fitted and select from footwear approved by the Army podiatrist, according to a defense official. The assortment primarily includes Asics, Brooks, and New Balance brand sneakers.
Source: Army Times [2/16/14]
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| CODINGLINE CORNER | |
Query: Foot/Ankle X-Rays for the Same Extremity
At times, there are patients with conditions that warrant the taking of both foot and ankle x-ray studies on the same extremity. My standard billing for this is CPT 73630 (foot, 3 views) and CPT 73610 (ankle, 3 views). However, the lateral ankle film is the same as the lateral foot film. There are 5 films total in the patient's chart.
My question is which is correct: billing one of the x-ray codes indicating 2 views and the other 3 views so the total amount of billed views is 5; or billing two 3-view codes? If an insurance company requests records, can I print the lateral films twice; once for foot, once for ankle?
Kelly Malinoski, DPM, Naples, FL
Response: My standard billing for this is CPT 73630 (foot, 3 views) and CPT 73610 (ankle, 3 views). However, the lateral ankle film is the same as the lateral foot film. There are 5 films total in the patient's chart. Pick one of the series and that will be your lateral.
My recommendation is to use CPT 73610 (complete ankle study) and CPT 73620 (limited foot) when you bill foot and ankle, especially knowing you have only taken 5 total views.
David J. Freedman, DPM, CPC, Silver Spring, MD
Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription
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| RESPONSES/COMMENTS (CLINICAL) - PART 1A | |
From: Steven J. Kaniadakis, DPM
This is so classic and typical of the fusion of the growth plate in a 12 year old male. Use a posterior plantar heel wedge or gel accommodation like a Viscoelastic heel insert. Place a small round piece of Velcro® at the bottom of the insert and the shoe. Since, these kids are so active, it will hold it better in place. I think you will elicit a patient history of the peroneal brevis tedonititis is from a change in terrain, activity routine, or footgear.
Also, there might be accommodation or even compensation from the posteior symptoms from the long history of what appears to be calcaneal apophysitis (Sever's disease). An Unna boot and/or a post-op Darco shoe would help. Dispense a short leg walking brace unitl the acute signs/symptoms improve (usually two to four weeks).
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| RESPONSES/COMMENTS (CLINICAL) - PART 1B | |
From: Philip J. Shapiro, DPM
Based on the radiograph, your exam, and the mother’s report, this is most likely calcaneal apophysitis (Sever’s disease). During my clinical practice years, I would occasionally see this condition, and if it was symptomatic, I recommended avoiding athletic activities until the pain was resolved. I also had the youngster wear a compression heel cup during ambulation.
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| RESPONSES/COMMENTS (CLINICAL) - PART 2A | |
From: Robert Bijak, DPM, Peter Bregamn, DPM
Assuming labs are normal (esp thyroid, glucose, C&S, plus additionally a vascular ck), re-cut out the margins and re-suture the fresh wound. Based on her weight, consider using a non- weight-bearing device .
Please make sure you take a proper culture, biopsy the tissue, and get an MRI. If the wound is clean, I recommend using multiple injections with amniotic fluid which will heal it in a couple of weeks if kept clean.
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| RESPONSES/COMMENTS (CLINICAL) - PART 2B | |
From: Ross B Feinman, DPM, Elliot Udell, DPM
My first recommendation is to cease all surgical intervention. It appears that there is a reason that the wound is still open. Get an ID consult as soon as possible. Get a culture and sensitivity, arterial Doppler and vascular consult, and an MRI per ID recommendation. It appears that there is probably a deeper reason than just localized dehiscence, and that there could be a deep abscess or infected hardware or suture and possibly a more serious vascular complication.
In cases where there is post-operative dehiscence and all other factors such as poor vascularity have been ruled out, take a fine hemostat and probe for buried sutures. You might be surprised that either remnants of non-absorbable sutures or even those that are supposed to be absorbed may be causing an idiosyncratic reaction and preventing post-operative healing. Once these are identified and removed, you will be surprised as how rapid the wound closes.
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| RESPONSES/COMMENTS (EMR) | |
From: Jay Goldstein, DPM, MS
When I researched Epic for my office in 2011, I came to the following conclusions at that time:
1. The four major hospital systems in my area had all agreed to use Epic.
2. The main hospital that I utilize was offering an incentive to contract with Epic.
3. Using Epic would have saved me some time if my interactions with the hospital were quite frequent.
4. Epic was not in the least aggressive about responding to a tiny fish in the sea like me.
5. Despite the financial incentive offered by the hospital, Epic was at that time quite expensive.
6. I did not feel that it was well-suited to a small office. It is quite robust, with many features helpful for a large clinic or hospital.
I use EPIC in my office and have been very satisfied with my decision. I have found it very user-friendly.
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| RESPONSES/COMMENTS (PM JURY VERDICT REPORTER) - PART 1A | |
From: J K. Winckelbach, DPM, Burton Katzen, DPM
I have had the privilege to know Dr. Harris for 48 years, both as a classmate and colleague. Dr. Harris is one of the most honest people I know. He is respected as one of the most knowledgeable podiatrists in his sub-specialty. If he testifies for the plaintiff, then you know he will be as fair as if he were to testify for a defendant. Unfortunately, there ARE bad outcomes, either from inadequate training, bad judgement, or perhaps a cavalier attitude, and those "patients" need to be represented fairly.
Dr. Harris, I am so glad you are all for "fairness" for plaintiffs. I also realize that in rare occasions, you may come across an unscrupulous member of our profession who deserves
to be punished. However, what you failed to mention is how much you profited by trying to "save the world" from these unscrupulous podiatrists.
Let me give you a suggestion. About twenty years ago, I re-operated on a case which had a horrible result. Since I was the only doctor who saw this patient after the original surgery, I was called on to review the case and testify. After reviewing the previous doctor's record, it was obvious...
Editor's note: Dr. Katzen's extended-length letter can be read here.
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MEETING NOTICES - PART 1
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| RESPONSES/COMMENTS (PM JURY VERDICT REORTER) - PART 1B | |
From: Barry Mullen, DPM
Many comments have been made, but no solutions have been offered! I agree with Dr. Udell about the need to compensate legitimate malpractice victims. BUT, current scales are grossly tipped, fostering the litigious climate we practice in. The resultant, incessant fear grossly affects how competent physicians practice and, in part, escalates healthcare costs. The solution starts with the adoption and implementation of meaningful malpractice tort reform. Here are ideas. Dialogue is welcome.
1) Adopt a "loser pay" system (U.S. only "civilized" country not to incorporate) = ends frivolous lawsuits! The stumbling block is...
Editor's note: Dr. Mullen's extended-length letter can be read here.
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MEETING NOTICES - PART 2
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Choose any or ALL (50 CME Contact Hours) from the 30+ CME Category-1 articles posted
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| CLASSIFIED ADS |
ASSOCIATE POSITION - UPSTATE NEW YORK
Mmulti-specialty, busy practice looking for highly motivated Podiatrist. Outstanding opportunity, excellent salary and benefits, working with three Podiatrists as well as residents, high volume of surgical cases, advance wound care, broad based referrals, and Electronic medical records. Opportunity for partnership. Please submit CV to associateinfoot@yahoo.com or fax 607-723-1567.
ASSOCIATE POSITION - TENNESSEE
Opportunity for fully credentialed podiatrist(s) needed to join or purchase a high-volume practice with enormous growth. Located on the largest medical center/hospital campus in East Tennessee. Please email CV, letter of intent, and references to PodiatryFootAnkle@gmail.com.
ASSOCIATE POSITION - CAPITAL DISTRICT (NY)
Associate position with option to purchase practice. Upstate NY, Capital District. Applicants require NYS podiatric license and Medicare # ,Board certified or qualified. Position available immediately. Salary negotiable. Send CV and inquiries to: Gopodiatry@gmail.com
ASSOCIATE POSITION – WISCONSIN
Experienced podiatric physician and surgeon seeking a motivated associate with the ability and drive to join a multi-faceted, exceptionally busy, and firmly established Midwestern practice located within driving distance of Chicago. Those who apply need be well-rounded yet humble and willing to provide all types of foot and ankle care, from diabetic and neuropathic treatments and biomechanical exams, to minor office procedures and complex surgical corrections. Please send your CV along with a cover letter describing your treatment style along with your desire to grow with a successful practice to Associatematch@yahoo.com.
ASSOCIATE POSITION – SW FLORIDA
Immediate position available in SW Florida. Podiatrist to join a small group. Must be Florida licensed, surgical privileges pending experience. Board Certification or Qualified preferred but not necessary. Some nursing home care and limited travel. Excellent pay and lifestyle. Send CV to: 1foot.ankle@GMail.com
ASSOCIATE POSITION - CALIFORNIA (SANTA CRUZ COUNTY)
The Foot Doctors of Santa Cruz County is a multi-office podiatric group looking for a self-motivated, committed podiatrist with a CA license. Offices are up-to-date with EMR, digital x-ray, and laser. Duties include all aspects of podiatry including wound care, surgical cases and nursing homes. There is great surgical growth potential. Must intend to reside locally. Send CV to: srfctysc@gmail.com
ASSOCIATE POSITION - KENTUCKY
Immediate opening for palliative/general podiatric care provider in established clinics, nursing home and assistive living settings in beautiful Southern Kentucky. Travel involved, but transportation provided along with ability to provide a wide range of clinical care including DME. Board certification not mandatory, but must be eligible for KY state license. Base salary with incredible bonus opportunity/full benefits. Join Kentucky’s largest and most respected podiatric group. Email CV and letter of interest to:jonkim12000@yahoo.com
ASSOCIATE POSITION – CHICAGO, IL
Podiatrist in Chicago. Independent, energetic Dr. needed to do house calls; schedule will be accommodated due to Dr.'s preferences; both full- and part-time will be considered. Send your inquiries to: dpms2@hotmail.com
ASSOCIATE POSITION - PUERTO RICO
Looking for a well-motivated surgically trained podiatrist for a 20 year-old hospital-based multi-office practice. WILL BE INTERVIEWING PERSONALLY AT 2014 ACFAS MEETING IN ORLANDO Candidate must be personable, ambitious, and knowledge of SPANISH language a must. Hospital surgical privileges available with heavy load of high-risk diabetic foot patients. This position leads to PARTNERSHIP, and eventually ownership. Offices located near San Juan Metro area nearbBeaches, great schools, and major shopping malls. Please send CV to medicopodiatra@aol.com.
ASSOCIATE POSITION - CENTRAL PA
Looking for an associate with strong surgical training. Personal and energetic a must. The physician will provide all aspects of podiatric practice, including sports medicine, wound care, and foot and ankle surgery. Competitive compensation package. Partnership opportunity for right person. To apply, please email, letter of intent and CV to premierfootpa@outlook.com
ASSOCIATE POSITION – OH
Join our thriving practice of 3 podiatrists in the fastest growing county in Ohio (Delaware located north of Columbus). We are looking for a motivated, personable, caring doctor with solid training who wants to work in a positive environment and enjoys our profession every day! Contactfootandanklewellnesscenter@gmail.com
HOUSE CALL OPPORTUNITY - CHICAGO, IL
Chicago-America’s Disabled, a not-for-profit medical group is looking for a podiatrist. You decide when you want to work and we will prepare your schedule. Competitive Compensation ($500-$1000 a day). Send CV todberliant@totalhealthcaregrp.com or call 773-774-7300.
ASSOCIATE POSITION – CHICAGO, IL
Podiatrist in Chicago. Independent, energetic Dr. needed to do house calls; schedule will be accommodated due to Dr.'s preferences; both full- and part-time will be considered. Send your inquiries to: dpms2@hotmail.com
ASSOCIATE POSITION - SOUTHEAST GEORGIA STATESBORO & SURROUNDING AREAS
Beautiful weather year round. Seeking experienced, Family-oriented, podiatrist looking to build a career & long-term relationship. Must be PSR-24/36 trained. Multiple locations. Full range of services with access to Surgical Center. Willing to live in a College town with rural settings. E-mail cover letter & CV to melissafoot@atlanticfeet.com.
PRACTICE FOR SALE - SOUTHERN ARIZONA
Terrific opportunity! Profitable practice with outstanding growth potential – surgery, lots of physician referrals. Within a medical/professional office complex. EMR system with 3 computer stations. Meaningful use met thru Stage II. Very reasonably priced. Will remain through transition period. Contact 520-304-2443 in evenings (PST) or reflisa@centurylink.net - serious buyers only.
PRACTICE FOR SALE - SOUTHWEST FL
Multilocation multidoctor practice in beautiful Southwest Florida. Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to: practiceforsaleswfla@gmail.com
PRACTICES FOR SALE - WASHINGTON STATE
Puyallup – South of Seattle. Great practice in perfect location. Oregon: Portland (Tigard) – In Portland suburb with high traffic/great visibility. See more at mpocorp.com or call 386 597-5766
PM News Classified Ads Reach over 15,500 DPMs and Students
Whether you have used equipment to sell or are offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 15,500 DPMs. for details, click here or write to: bblock@podiatrym.com or call (718) 897-9700 for details. For commercial or display ads contact David Kagan at (800) 284-5451
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| Disclaimers |
Acceptance and publication by this newsletter of an advertisement, news story, or letter does not imply endorsement or approval by Barry Block or Kane Communications of the company, product, content or ideas expressed in this newsletter. Podiatric Medical News does not represent the views, and is a separate entity from Podiatry Management Magazine and Podiatry Management Online. Any information pertaining to legal matters should not be considered to be legal advice, which can only be obtained via individual consultation with an attorney. Information about Medicare billing should be confirmed with your State CAC.
THIS MESSAGE IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR
ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS
PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE.
If the reader of this message is not the intended recipient or an
employee or agent responsible for delivering the message to the
intended recipient, you are hereby notified that any dissemination,
distribution, or copying of this communication is strictly
prohibited. If you have received this communication in error, please
immediately notify me and you are hereby instructed to delete all
electronic copies and destroy all printed copies.
DISCLAIMER: Internet communications cannot be guaranteed to be
either timely or free of viruses.
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