The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

March 03, 2012 #4,400 Publisher-Barry Block, DPM, JD

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WI Podiatrist Breaks "Cycle" to Relieve Diabetic Patient's Pain

Chris Wuchter, 51, of Bristol, has been diabetic since his 20s. When he noticed the foot problem, he went to the Kenosha Community Health Center. The center referred Wuchter to Dr. Cindy Cernak, podiatrist at the Wisconsin Neuropathy Center and Southeast Wisconsin Ambulatory Surgical Center. However, Wuchter did not have insurance and was unable to obtain it, being told he could not get insurance without a job. He was not able to get a job because his foot was so painful he couldn’t put on shoes.

Dr. Cindy Cernak

“He was in a cycle,” Cernak said. “He can’t get insurance because he can’t get work. But he can’t get work because he’s hurt.” But Cernak was determined to find a solution to his pain. Cernak first told Wuchter to quit smoking. Wuchter complied and also worked on his diet, losing more than 20 pounds. Months of work, donations from companies, and doctors giving their time and expertise allowed Wuchter to eventually have the protruding bone removed last month.

Source: Matthew Olson, Kenosha News [2/26/12]

Advanced Treatments Help Hard-to-Heal Diabetic Foot Ulcers—and Improve Lives

“For many Americans who have diabetes, impaired healing of foot wounds can be a tremendous problem, making these advanced treatments extremely important,” says Peter Blume, DPM, FACFAS, assistant clinical professor of surgery at Yale School of Medicine. Dr. Blume is discussing this topic at the Annual Scientific Conference of the American College of Foot and Ankle Surgeons. 

Dr. Peter Blume

One groundbreaking approach that promotes healing is the use of bio-engineered skin substitutes. Surgeons place these advanced biologics, which are made either from living or non-living tissue, over the wound to accelerate growth of healthy skin. Another advanced wound-healing technology is negative pressure wound therapy (NPWT). This consists of a wound dressing, an air-tight film placed over the wound, and a drainage tube connected to a suction device that draws out excess fluid. The suction enables healthy new tissue to grow. NPWT makes it far more likely that a graft will survive. “Today, we rarely do a skin graft without using NPWT before and after the grafting procedure,” says Dr. Blume.

UK Podiatrist is Proponent of Barefoot Running

A leading foot doctor based in Helston is spreading the barefoot message with evangelical vigor. Steve Bloor, one of the country's most respected podiatrists, is leading the charge to promote the benefits of running barefoot or with a minimal shoe. Mr. Bloor, who spends most of his life without wearing any sort of footwear, said: "As a podiatrist with 25 years' experience, my professional inclination was to consider barefoot running to be dangerous – but it's the most natural thing to do." 

Stephen Bloor

Feet had about 200,000 nerve endings and every part of the body was affected by the feet, he said. "I previously believed that 80 per cent of people were born with problems with their feet," he said, but after reading about the Tarahumara Indians, Ethiopian and Kenyan runners, who run without shoes or with minimal footwear, he now believes that feet function best without the hindrance of shoes.

Source: This is Cornwall [3/1/12]

Query: Coding for Bone Marrow Aspiration

What code would I use for bone marrow aspiration (foot/ankle)?

Edward Nieuwenhuis, Jr., DPM, Wyckoff, NJ

Response: A bone marrow aspiration is a bone marrow aspiration, regardless of the anatomic site from which the marrow is obtained. The code is CPT 38220 (bone marrow; aspiration only). Please note that multiple aspirations from the same needle insertion site are coded as one unit of service (CPT Assistant, January 2004).

Given that most bone marrow aspirations are done on bones that are not within the scope of practice for a podiatrist (such as the iliac crest or the sternum), you might run into a claims edit problem where the edit limits the use of this code to just certain provider types. As a result, if you anticipate that you will be doing a bone marrow aspirate as part of a scheduled foot/ankle procedure, it may be in your best interest to pre-certify the aspiration service along with the other procedure(s) you anticipate performing in the planned operative session. At a minimum, if the payer is absolutely adamant that they will only cover a bone marrow aspiration when performed by a physician of another specialty, you'll know this in advance and can plan accordingly.

Joan Gilhooly, CPC, CHCC

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Plantar Keloid (Alan MacGill, DPM)
From: Bret Ribotsky, DPM

If the patient refuses to let you do what you think is best (biopsy), send her a certified letter and dismiss her from your practice. Send her to the University of Miami and Barry University. Always do what is best for patients, and when they refuse (which they will forget when they sue), document this, send them on to a university medical center, and move on. Each of us sometimes alters what we know is best in order to comply with a patient's wishes. In this case, don't be the last physician when the leg gets amputated.

Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

RE: Painful, Discolored Toe (Chuck Ross, DPM)
From: Suhail Masadeh, DPM,

I recently evaluated a 28 year old Caucasian female with similar presentation of painful erythematous macules of the distal digits (see photo). I obtained a rheumatology panel which showed a positive ANA. Concurrently, two 2 mm punch biopsies of the most representative lesion were sent to Bako pathology and confirmed the diagnosis of pernio(chilblain), a form of low-grade lymphocytic vasculitis. 

Pernio (chilblain)

Here is an article that will provide more explanation. (emedicine.medscape.com/article/1087946-overview). In my opinion, you need to work the patient up for inflammatory arthritis as well as a biopsy of the lesion prior to instituting therapy. The patient may require work up via PCP or/and rheumatology to evaluate for associated systemic diseases such as lupus.

Suhail Masadeh, DPM, Muncie, IN, smasadehdpm@yahoo.com

RE: Plating Choices (Mario Dickens, DPM)
From: S. Jeffrey Siegel, DPM, Ivar E. Roth DPM, MPH

Although there exists many internal fixation options, if this were my patient, I would percutaneously place a mini ex-fix, provide a bit of compression, and dispense an Exogen bone stimulator, CAM walker, and crutches. 
 
S. Jeffrey Siegel, DPM, Philadelphia, PA, Heeldoc@verizon.net

This fracture will heal. Do not treat the x-ray. A bone stimulator and some continued immobilization with a surgical shoe will probably do the job with NO surgery required. I have seen too many of these healable events have surgery, and end up having significant post-op problems and malpractice lawsuits.
 
Ivar E. Roth DPM, MPH, Newport Beach, CA

RE: DR X-Ray Equipment (Neil H Hecht, DPM)
From: Cheryl Martinetti, PMAC

In our office, we were using a high-end CR digital x-ray unit. We are a very busy 4-doctor practice, and we found that our CR x-ray unit was a choke point in our practice. So, for us, it made perfect sense to replace a fully functional CR unit with a DR unit. The efficiency enhancements that we have realized have more than paid for the unit. We went with a unit from FOZnetworks (foznetworks.com). Their product and support are first class. Unlike all of the other DR vendors out there, this is the only one that offers free lifetime support and software updates. Other companies are charging monthly fees for support. FOZnetworks has saved us thousands.
 
Cheryl Martinetti, PMAC, Howell, NJ, cherylmartinetti@yahoo.com

RE: The Technological Imperative: A Warning (Allen Jacobs, DPM)
From: Tip Sullivan, DPM

I write this with the greatest respect for one of our most notable podiatric physicians, Dr. Jacobs. His points regarding technology and utilizing off-label applications of surgical devices made me think of other things along the same line. Perhaps a slightly greyer area, standard of care. I have listened to Dr. Jacobs speak, I believe for Metanx, and I can recall actually believing I should start doing skin biopsies on diabetics and sending them for peripheral nerve density studies following his inspiring lecture.

To me, this was as exciting as going to a national meeting and hearing about some new off-label use of an implant. While this made my Metanx rep very happy, it is not what I would call standard of care in my neck of the woods in podiatry or any other medical specialty. I would venture to say that if I had a diabetic patient who developed complications from such a surgical procedure, I would have to call Dr. Jacobs in my defense. I am sure we would win.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net

RE: Pre-Payment Audits for Therapeutic Shoes (Cyril M Gostich, DPM)
From: Paul Kesselman, DPM

Unfortunately, the advice given by the previous posting is exactly the opposite type of advice one should be following. If one were to follow this logic, then one should discontinue any of the other procedures frequently performed by podiatrists which are high up on the Medicare auditing totem pole. This would include all at-risk foot care procedures (1172X, 11719, 1105X) and all wound care services, which are all on the top of most Medicare carriers' audit lists. Once you take money from the government, be prepared for them to be an unwelcome partner in your daily business life. To suggest that one becomes a criminal based on any of the pre- or post-payment audits going around is inflammatory and downright wrong.

Criminal activity would be based on not providing services or providing services which do not meet the requirements of a particular policy. One example would be for therapeutic shoe inserts which you know do not meet Medicare's guidelines. Certainly, one needs to understand the nuances of all LCDs and document as carefully as possible. However, one should not suggest that carriers are looking to portray ethical and honest practitioners as criminals.

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

RE: The Cost to Podiatry for ICD-10 in 2013 (Bruce Krell, DPM)
From: Harry Goldsmith, DPM

Most experts estimate the cost for implementation of ICD-10-CM within a 3-doctor practice to be somewhere between $40,000 and $80,000. What will drive the cost?

1) Software upgrades – practice management software – not only to include ICD-10, but also retain ICD-9
2) Software upgrades – EMR software – not only to include ICD-10, but also retain ICD-9
3) EMR podiatric-specific documentation upgrades/development (templates, macros, dropdown choices, etc.) to account for higher levels of specificity,...

Editor's note: Dr. Goldsmith's extended-length letter can be read here.

RE: A Musical (Podiatry) Sign of the Times

A revolving podiatry sign on Sunset Boulevard in Los Angeles, California was the inspiration for Sarah Paul Ocampo’s performance title: Happy Foot, Sad Foot. A five-year Los Angeles resident, Ocampo traversed the city on foot and by public transportation and still doesn’t drive today.

Happy Foot, Sad Foot Sign

Written and performed by Ocampo, Happy Foot, Sad Foot fuses theater, music, and film with observational snippets of commuters and stops gleaned from Los Angeles bus routes, to explore where the magical and mundane meet on Sunset Boulevard.

Source: Santa Barbara Independent [3/1/12]

PRACTICE FOR SALE - CALIFORNIA

V.A. podiatrist closing one day a week private practice in Long Beach, CA. Great location in medical building. Reasonable rent. Basic equipment. Good opportunities for growth. Contact Art Hatfield at
Afootjob@juno.com

SOUTHEAST GEORGIA- SAVANNAH & SURROUNDING AREAS

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking podiatrist looking to build a career & long-term relationship. Either established practicing physician or new residency graduate. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION - MANHATTAN

Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. Along with CV, please provide medical plans that you are currently participating in. Please forward your information to roni@myfcny.com

ASSOCIATE POSITION - LOS ANGELES
   
Multi-specialty group seeking part time podiatrist. Opportunity to transition into full time position. Required:  3 years or surgical residency, including Charcot reconstruction, fellowship or interest in biomechanics, and ability to train surgical residents. Send CV to podiatricri@yahoo.com 

ASSOCIATE POSITION – PORTLAND, OREGON  

$120K approx. starting salary plus malpractice and benefits! Long-term possibility with a unique buy-in plan. Busy, well-established private practice has an immediate opening with an established patient base for a dynamic, motivated, surgically-trained podiatrist. Practice is mainly general podiatric medicine and forefoot surgery with very little nail care. Some rearfoot and very occasional ankle and trauma. Prefer PSR 24-36. Call (503) 652-1121 and ask for Dr. John Mozena or email jlmozena@aol.com.

FULL-TIME  PODIATRIST NEEDED - ORANGE COUNTY, NY  

Looking for a highly motivated surgical trained podiatrist in the Orange County NY (West Point) area. Hospital, wound center and surgical center affiliated. It is a busy practice that covers hospital inpatients, Wound Center, and takes ER calls. The applicant has to be trained in all foot surgery and be able to handle advanced Diabetic wound care. The practice is a 1 hour car ride from NYC and is close to hiking,fishing, skiing, and state parks. Please Email a CV and contact info to clsp4@yahoo.com

ASSOCIATE POSITION – SUBURB OF DALLAS, TEXAS

Available in suburb of Dallas 2-office practice. Excellent base salary/ bonus structure, malpractice, full benefit package with 4-5-year track to partnership. Looking for someone that wants to grow with our practice. Must have strong communication skills, excellent bedside manner and be PSR 24-36 trained. Email CV and letter of interest to myfoothurts2@yahoo.com

ASSOCIATE POSITION – ALBANY, NEW YORK

Solo practitioner looking to wind down after 29 years. Immediate position available in a well- established diversified practice. Must be ethical, hardworking and committed to quality patient care. Must have good communication and surgical skills. Patient base established with additional growth present. Excellent salary & benefits. Please send cover letter and resume to McBride719@aol.com

ASSOCIATE POSITION - KANSAS CITY, MISSOURI

I'm not just looking for an associate. I am looking for a doctor who wants to build a highly successful career with a doctor who is as committed to their success as he is to his own. Go towww.YourFutureInPodiatry.com to find out about this opportunity.

ASSOCIATE POSITION – BROOKLYN NY

Busy multi-specialty Medical office in Brooklyn, NY is seeking an experienced podiatrist. We are offering great compensation, flexible schedule and great office environment. Our Requirements: Must have Experience Must have Medicaid & Medicare provider. Please respond by email to:ddpropertymgmt@gmail.com

ASSOCIATE POSITION - NORTHEAST GA

Well-established 18 year practice in Northeast Georgia seeking full-time associate leading to partnership. General podiatric care with moderate amount of surgery to be done in local hospital or surgery center. Competitive salary and benefits. Please respond by email to: Fivetoes1946@aol.com

ASSOCIATE POSITIONS - MULTIPLE STATES

Podiatrist Needed in Missouri, Nebraska, Iowa, Minnesota, North Dakota, South Dakota, Ohio, Texas, Colorado, Oregon, Washington, Arizona, Massachusetts, Rhode Island, Wisconsin, Indiana, Oklahoma, Connecticut and Vermont. Expanding multi-state medical practice seeking podiatrists to service long-term care community residing in nursing homes and assisted living facilities. We offer an established patient base, scheduling, equipment allowance and cover travel expenses. Provide generous compensation, bonus opportunities, disability, health insurance benefits, malpractice coverage and flexible scheduling. Looking for a Podiatrist with excellent skills, able to provide expert and compassionate care to patients. Email CV to: careers@aggeus.org or call 773-770-0140 x300/x305.www.aggeus.org

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to: myfeetfeet@aol.com

ASSOCIATE POSITION - CENTRAL NEW JERSEY

Associate Wanted for Central NJ offices. Looking for highly motivated self starter to build/expand practice locations. Great part-time opportunity for the right candidate. Email your CV with references toejema@aol.com

ASSOCIATE POSITIONS - TEXAS

TEXAS licensed podiatrists needed in San Antonio and Austin. Great paying positions for full or part-time. Well-established, unique mobile podiatry practice servicing senior living facilities. Business office location with excellent support staff for your assistance and scheduling. Check us out before looking elsewhere. Find us at www.footmobile.com. Reply with cover letter and CV to doctor.cohen@yahoo.com with a cc: to lisa.schulze@yahoo.com or call us at 210-495-6477.

EQUIPMENT FOR SALE - COOL BREEZE COOT TOUCH VARIA

Cool Breeze Coot Touch Varia. Very low use. You won't find a laser at this price. $39,500. Has about 19 hours of use of it. E-mail for photos, and ask any questions. Will go fast. David Zuckerman DPM 856-229-2939 footcare@comcast.net

EQUIPMENT FOR SALE

Summit Doppler, Hall Micro 100 set with 5 heads including burrs, drills, and rasps (pristine condition). Original Hall/Zimmer set (still works), two major podiatry surgical packs; will sell them complete or piecemeal. Titanium Synthes Mini frag set; Osteotome sets, etc. Inventory of all equipment for sale available on request. Best offer. Call 586-675-4311 or 440-285-2827  or email me at gwdocks@aol.com

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

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