The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

February 28, 2007 #2,821 Editor-Barry Block, DPM, JD

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House Calls are Service to Patients: IA Podiatrist

Billie Johnson can't be on her feet for more than five minutes. She suffers from peripheral neuropathy, or nerve damage, in her legs and feet, a condition associated with her diabetes. Dr. Lynda Haver, a podiatrist, has been visiting her at home for at least two years, said Johnson, 81. "It's a godsend, really," said Johnson of Haver's visits every 10 weeks.

Dr. Lynda Haver

Haver began making house calls about five years ago. These patients make up about half of her practice. She also has an office in Des Moines. Haver makes house calls "pretty much every day," she said, with many of her patients in their 90s. Visiting people at home gives her a firsthand look at their environment and how much assistance they're receiving, she said.

"I feel like I can do a lot more for them by being able to see them at home," said Haver, 45, who practices in the Des Moines area. "I can see more of the supplies and shoes they have at home, more than them telling me." Seeing these homebound patients is more time-consuming not only because of the travel time, Haver said, but also because they are higher risk individuals who require more attention. She said she logs 70 to 125 miles daily on her car. But it's a service her patients require. "I do not work a 9-to-5 job," she said. "I've been working as needed for the patients and myself. I feel good for what I'm doing, I guess."

Source: Dawn Sagario, Des Moines Register [2/25/07]

NYSPMA Podiatrist Organizes Event For Diabetes Alert Day

Dr. Bruce Pinker, a podiatrist with offices in Rockland County and Westchester, NY, is hoping attendees will be saying “I Do” when they bid during the Bachelor Auction he’s organizing on March 29th at New York City’s Mantra lounge in honor of Diabetes Alert Day, the American Diabetes Association’s annual fund-raising event.

Dr. Bruce Pinker

“As a podiatric surgeon, I treat hundreds of patients each year suffering from diabetes. I am honored to be involved with the New York City and Westchester County offices of the American Diabetes Association, the nation's leading voluntary health organization providing services for all people with diabetes, in support of their annual fund-raising event, Diabetes Alert Day,” Dr. Pinker remarked.

Dr. Sam’s Teams Up With Dr. Comfort

Dr. Sam’s and Dr. Comfort has announced that Dr. Sam’s will become a member of the Dr. Comfort team. Dr. Sam’s will now be able to offer their customers the complete line of Dr. Comfort’s shoes and inserts.

In a recent mailing to his customers, Marty Chalfin of Dr. Sam’s told his customers that he believes that “Dr. Comfort is the premier line of shoes and inserts specifically designed for Diabetic Patients.” Mr. Chalfin also indicated that he believes that Dr. Comfort not only produces the best shoe in the industry but also has the best customer service.

Rick Kanter of Dr. Comfort expressed his delight in obtaining access to such a high quality set of customers by stating that “Marty has done a great job with his very loyal customers over the years. We at Dr. Comfort will continue to provide the same level of quality care when they order Dr. Comfort products.”

Medicaid Enrollment Increases After Enactment of Welfare Reform

The number of U.S. residents who receive cash payments from welfare has decreased since the enactment of a reform law in 1996, but enrollment in other public programs for low-income residents, such as Medicaid, has increased over the same period, according to a recent analysis by the Associated Press, the AP/Contra Costa Times reports. In 2003, enrollment in Medicaid and other public programs for low-income residents totaled 44 million, compared with about 39 million in 1996, according to the U.S. Census Bureau. By 2005, enrollment in Medicaid alone totaled 45 million, "pushed up in part by rising health costs and fewer employers offering benefits" the AP/Times reports.

Source: AP/ Contra Costa Times via American Health Line [2/27/07]

Query: Lesser Digit Night Pain

I have an 81 y.o. male patient that c/o of severe pain 4th digit R, only during the night. The pain is so intense, it wakes him. He is healthy, no meds, normal pedal pulses, and his x-rays are unremarkable, He has tried magnets, quinine, and calcium, without improvement. There is no pain on palpation or range of motion, and he is negative for Mulder's sign. I have tried multiple ultrasound treatments, low- level laser, electromagnetic/laser treatments, one injection of Xylocaine/Celestone, all to no avail. Any suggestions?

Hartley Miltchin, Toronto, DPM

Query: Single Level vs Multiple Level Exam

CPT 93922 is defined as "non-invasive physiologic studies of upper or lower extremity arteries, single level, bilateral (e.g., ankle/brachial indices, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement)." CPT 93923 is defined as "non-invasive physiologic studies of upper or lower extremity arteries, multiple levels or with provocative functional maneuvers, complete bilateral study (e.g., segmental blood pressure measurements, segmental Doppler waveform analysis, segmental volume plethysmography, segmental transcutaneous oxygen tension measurements, measurements with postural provocative tests, measurements with reactive hyperemia)."

Specifically, what constitutes a "single level" study (including an example) versus a study of "multiple levels" (including an example)? Second, does each test listed in the parenthetical examples satisfy, on its own merit, the code/study billing, or do all the listed tests within the parenthesis need to be performed to qualify the study billing? Are there any authoritative citations or references which spell that out?

Barry Wertheimer, DPM , Torrance, CA

Response: Here's my take...

(1). Single vs. Multi Level Exam. These arterial studies are always bilateral. When I perform SPP/PVR test on both feet, it is a single-levels study (CPT 93922); if I do SPP/PVR test on both feet and ankles, calf, thigh and so on, it would be a multi-level study (CPT 93923). This is how I interpret our local carrier determination (LCD) requirements.

A friend of mine from other wound care center uses TCOMs, and he bills this way: one lead, CPT 93922, two or more leads CPT 93923. I do not agree with him, and I am not sure if I can defend him in good faith if he were audited.

(2). "What's up with the lack of 'and, or' between tests?" I know it is vague, and Dr. Goldsmith also points this out in his lectures frequently. Are you supposed to do all the test, or just a few? I cannot give you an exact quote, but my understanding is that, you have to document "pressure readings" combined with "waveform analysis/recordings" with a hardcopy document to show that you actually performed the test, along with your interpretation of the test results. You should review your carrier's policy on this to see if there is a clarification.

I would perform SPP (skin perfusion pressure --> pressure readings) and PVR (pulse volume recordings --> wave form recordings) on bilateral feet/legs, then print out the results from the Sensilase System. If you send your patients to your hospital's non-invasive vascular lab, they would probably do segmental pressures of bilateral legs (feet/ankle/calf/thigh) with waveform recordings, perhaps with or without an ABI, then bill for CPT 93923.

Kazu Suzuki, DPM, CWS, Los Angeles CA

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RE: PM’s February 2007 Cover
From: Arthur Gudeon, DPM

I think you may have misinterpreted the cover of the Feb, 2007 issue of Podiatry Management magazine.. Remember, the name is Podiatry MANAGEMENT. It's meant to, and always does, help us with not only scientific, but the very important and pertinent updates on the financial end of practice. My take, and that of the other podiatrists I spoke to at our hospital and local meetings, is that we must try to hold onto as much of the money we make for our services as possible, as the managed care companies try to grab it from us. The cover cleverly depicted that well, and we found it not embarrassing or unprofessional at all, but rather it gave us the feeling of proactiveness.

Arthur Gudeon, DPM, Rego Park, NY, afootdoc@ix.netcom.com

Editor’s comment: Dr. Bonenberger states “ I can only hope that no patients glanced over the check-in counter and saw it.” We would like to remind all readers that PM is a trade publication and not meant to be placed in receptions rooms or ant areas where there are patients.

ASSOCIATE PODIATRIC SURGEON POSITION - TEXAS

We are looking for an exceptionally trained podiatric surgeon to work in the Houston, Texas area. Candidates seeking this opportunity need to be dynamic, people friendly, and have current licensure in Texas. Future licensure in Arizona will be required. Exceptional opportunity, with attractive benefits, and excellent starting salary. The successful candidate will find a rare opportunity to integrate into a specialized lower extremity practice with emphasis on peripheral nerve surgery, endoscopic and arthroscopic surgery, and other special surgery of the foot and ankle. Please submit a cover letter with current curriculum vitae via email to: Slb99@pdq.net Stephen L. Barrett, D.P.M., MBA

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 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

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 ethics. My practice may offer great potential for the right person. Minimum PSR 24. Please reply to Jerseypod@gmail.com

LEASE SPACE MANHATTAN/ LONG ISLAND

Are you sending your MRs out? Now you can lease space and run your own MRIs, bill global, and have them read by a board certified radiologist. Two locations to lease, Manhattan East 60th street (near all public transportation) and Plainview, Long Island. Call for details, lease arrangements and reimbursements Email podo2345@aol.com or Call 516 476-1815

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 – WASHINGTON, DC

Associateship leading to full purchase or immediate sale. 25 Year old practice located in a hosp. w/ full surg privileges. Large number of diabetic patients and referrals. Fully equipped with x-ray, topical hyperbaric oxy units, 4 tx rooms and more. $400K on only 3 days a week. Will finance with generous terms and stay to introduce. Owner leaving area. Contact R. Benjamin, DPM jhallux@yahoo.com or 202-841-5545

ASSOCIATE WANTED - BOCA RATON-DELRAY BEACH AREA

Full time for growing practice-surgical training a plus-hard working a real plus-opportunity of a lifetime-partnership after 1yr. Need Florida license. Fax resume to 561-865-2225

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 – PORTLAND, OREGON

Immediate opening in beautiful Portland, OR. Busy, well-established private practice is seeking a dynamic, motivated, surgically-trained podiatrist. High volume of primary care referrals. Work with a well-trained support staff in one of the most efficient offices in the area. Surgically-oriented practice. Competitive compensation package including malpractice and benefits. Call (503) 652-1121. Ask for Dr. John Mozena or email jlmozena@aol.com

SEEKING RESIDENT FOR PSR-24 POSITION: BALTIMORE, MD

Mercy Medical Center -Position for a highly motivated individual with completed non-surgical residency or one desiring additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2007. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

ASSOCIATE POSITION – NY & CONNECTICUT

Opportunity to be a part of a prestigious and well-established large Orthopaedic and Rehabilitation practice, with locations in Stamford, CT and West Harrison, NY. Looking for a Podiatrist to join an already busy practice with opportunity to build. We have state-of-the-art offices with MRI, digital x-ray, paperless charts, physical and occupational therapy. Applicants should be Board Certified or Board Eligible. Competitive salary and benefits. For further information on the practice, log onto WWW.NYCONNORTHO.COM Interested candidates should forward their C.V. to: Cliff Katz, Executive Director ckatz@nyconnortho.com

SOUTH CENTRAL PENNSYLVANIA-PM&S 36 ASSOCIATE WANTED

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.

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

ASSOCIATE POSITION - EAST/CENTRAL TEXAS

Practice in East Central Texas has an opportunity for an associate to join as an associate leading to partnership. Hospital supported practice which has two doctors seeking a third for new office. Practice is leading provider in market and offers an outstanding compensation and benefit package. This position is targeted to be an equity partner within two to three years. easttxdpm@comcast.net

ASSOCIATE POSITION - SANTA FE, NM

Established, 30 year practice with multiple office locations looking for a PSR 24/36 trained, hardworking, personable, ethical, highly motivated individual for associate position with immediate partnership available. E-mail CV and reference letters to sfpodiatry@aol.com

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