The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

March 09, 2011 #4,103 Publisher-Barry Block, DPM, JD

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MI Podiatrist Uses Laser for Onychomycotic Nails

Dr. Charles Solon, a Grand Rapids podiatrist, points a laser at a toenail and turns it on. The laser makes clicking noises and small sparks fly out as he moves the beam across the nail. “That little sparking is just the laser reacting with the nail,” Solon says. The laser treatment is the latest weapon against fungal infections of the nails. Although not life-threatening, the infections affect 10 percent of the population. They are difficult to treat, and treatment is not covered by insurance.

Dr. Charles Solon

Karen, a slender, 50-something woman — who does not want her real name used — says she doesn’t feel much during the treatment. It isn’t painful,” she says.“It’s just a little warm, and that’s all.” There is no visible change, although Solon says the laser is destroying the fungus. The results will begin to show in a few months as the nail grows out. The full effect will be seen when the nail has completely regrown, which takes six to 12 months.

Source: Sue Thoms, MLive.com [3/7/11]

Try Fungal Treatment For Dry Feet

‘If you have dry, scaly skin on your feet that doesn't respond to good emollient creams, the cause may be fungal. In most of the cases of athlete's foot I see, the skin is dry and flaky all over, so try a treatment for athlete's foot," says podiatrist Lorraine Jones. 

Lorraine Jones

"Find moisturizing creams that contain urea. It helps break down hard skin and is brilliant for dry areas."

Source: Anne Montague, Good Housekeeping [3/4/11]

APMA President-Elect Receives Award of Excellence from AAAPPM

APMA President-elect Mike King, DPM addressed the attendees and provided an update on APMA activities and the up-coming House of Delegates in Washington D.C.

(L-R) Dr. Michael King accepts AAPPM Award of Excellence from Dr. Jeffrey Frederick.

AAPPM President Jeffrey Frederick, DPM unveiled the expanded AAPPM Fellows Program at the AAPPM Awards Dinner and presented Fellow Certification and Pins to 30 new inductees to the AAPPM Fellows Program. Frederick stated, “An AAPPM Fellow is an individual who has distinguished himself/herself as an expert in the field of practice management, and they are awarded this honor and distinction by the Academy for their achievements.”

Judge Halts CA Medicaid Rate Freeze

A federal judge has granted a temporary injunction to California hospitals, prohibiting the state from implementing a planned inpatient Medicaid rate freeze. Last October, the California Legislature froze the rate at which hospitals are reimbursed for inpatient Medicaid services (called Medi-Cal in the state) to rates paid either in January or July of 2010, whichever was less. The freeze applied to both contracted and non-contracted hospitals.

The California Hospital Association sued the state Department of Health Care Services, arguing that the rate freeze violates federal law because the state did not receive prior federal approval to implement it, among other arguments. The freeze was estimated to save the state $84.5 million. In his 61-page decision, U.S. District Judge Frank Damrell in Sacramento halted the rate freeze until the lawsuit is decided on its merits, or the two parties can reach an agreement.

Source: Rebecca Vesely, Modern Healthcare [3/6/11]

Be a Low-Tech Presentation Master - Part 1

While everyone else is jumping on the high-tech bandwagon and overusing presentation options like PowerPoint, you can make a great impression in a low-tech way. All you need is a flip chart, some markers and tape—and these tips:

• Test your tripod. Make sure that the area on which you will rest the flip chart is sturdy. When you are writing in a hurry, you may press down harder than normal, and you want the tripod to hold steady.
• Plan to use more than one color. You will need to plan and practice in advance, but you can add impact with color. For example, you might write ideas in blue, with red bullets to set them apart. Action items might appear in a contrasting color like dark purple. Just be consistent with color when you use it, or your chart will end up looking like a preschool art project..

Source:  Adapted from The First-Time Trainer: A Step-By-Step Quick Guide for Managers, Supervisors, and New Training Professionals via Communication Briefings

Query: Bunion & Tenotomy Coding Question

Can I bill for extensor hallucis brevis tenotomy as a separate procedure when also billing for Austin-Akin-type bunionectomy, or would the tenotomy be considered part of the bunion work? If the tenotomy can be billed separate, is the correct code CPT 28234?

Laurie Bodo, Lake Orion, MI

Response: Tenotomy of the brevis tendon at the site of the bunionectomy procedure would be included in the CPT 28299 (bunionectomy with double osteotomy) allowance, and not payable separately.

The tenotomy is performed to address soft tissue deforming forces associated with the bunion and/or hallux abductus present.

Tony Poggio, DPM, Alameda, CA

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

RE: Subtalar Joint Fusion Revision (Frank Cobarrubia, DPM)
From: Simon Young, DPM, Jesse Burks, DPM

Consider a Dwyer osteotomy.
 
Simon Young, DPM, NY, NY, simonyoung@juno.com

Subtalar Joint Fusion

If the subtalar fusion is complete, but simply in varus, it is much easier to perform a calcaneal osteotomy and shift the posterior segment laterally. Revisional subtalar fusions are very challenging intra-operatively, take much longer to heal, and are much more prone to non-unions than primary fusions...in my experience. If there is evidence of mal-position and incomplete union, then definitely revise/re-position the arthrodesis site.

Jesse Burks, DPM, Little Rock, AR, ftnankle@aol.com

RE: Hyperkeratosis in an 87 year old (Elliot Udell DPM)
From: Lloyd Nesbitt, DPM

This patient has probably suffered with this problem for over 50 years, and now wants a cure? Although “prior treatment has included accommodative orthotics,” I’d suggest taking a second look at those orthotics and either adjusting them to increase the accommodation or start again with new orthotics that accommodate and cushion the lesion.  By the looks of the foot, a lot of biomechanical control would not be well-tolerated; so instead, a lot of cushioning and accommodation should be a big help. It goes without saying that regular debridement and attention to any tiny nucleated areas within the hyperkeratosis would be in order on a regular basis along with footwear evaluation.

Lloyd Nesbitt, DPM, Toronto, Canada, foothealth@lloydnesbitt.com

RE: Query: Midmark, MTI Podiatry Chairs (David Gurvis, DPM
From: Jennifer B. Ryder, DPM

I bought a Midmark 647 in 2008. Patients seem to like this chair very much. Many compliment me on it and say “I need one of these at home.” It serves its purpose well. It is a very large chair compared to some of the older models, so if space is an issue, you’ll need to factor that into your decision. Initially, mine had a mechanical problem which was fixed quickly, efficiently, and under the warranty.

I did not get the remote footplate ,although in retrospect, I would have splurged on this option because of the layout of my treatment room. It would be nice if the foot rest adjusted up and down on future models. Overall, I am pleased with the Midmark 647.

Jennifer B. Ryder, DPM, Rapid City, SD

RE: Fraud and Abuse (Simon Young, DPM)
From: Jeffrey Kass, DPM

Dr. Young makes an excellent point. I would like to add, in the past few years, premiums have been skyrocketing, yet physician fees are shrinking. I think it is time for the paradigm to shift.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: OR Podiatrist Embraces Zero-Drop Shoes
From: Robert Scott Steinberg, DPM
 
Dr. Ray McClanahan says he sees no reason not to use a "level" shoe. Ah, let's see... How about Achilles tendonitis, for starters. Of course, for the tip-top athletes like Dr. McClanahan who are probably too smart of get Achilles tendonitis, this won't be a problem. But since running shoe companies like New Balance are tripping over themselves to put unstable shoes and other "stupid" footware on the market at a record pace, we'll all be more than prepared for all the walking/running wounded.
 
Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

ASSOCIATE OPPORTUNITY - FREDERICKSBURG, VA

Progressive, busy practice seeks personable, ethical, confident associate interested in future partnership. Lucrative opportunity for self-starter with strong work ethic. State-of-the-art office in rapidly growing community with two new hospitals and new surgery center. Practice has excellent reputation with well established referral base. Cover letter/CV to: fredfeet@verizon.net

ASSOCIATE POSITION - SOUTH/CENTRAL PENNSYLVANIA

PSR-24/36 trained individual for busy practice in family-friendly college town. Seeking personable, ethical, motivated individual to join our well established practice providing all aspects of podiatric care. Competitive salary and benefits package. Reply with letter and CV to Jagerone@aol.com

ASSOCIATE POSITION AVAILABLE - NY

Busy Midtown Manhattan state-of-the-art practice with 2 locations seeking part time/full time associate. Must be in-network Empire BC/BS. Looking for a personable doctor with immediate availability. Residents Need not apply. DrB@myfcny.com

ASSOCIATE POSITION - WEST CENTRAL FLORIDA

A great opportunity to join a very busy, well-established, diversified practice in Clearwater, FL. Seeking an associate who has the drive and desire to work hard, has strong work ethics, and is very personable. BC/BE and minimum PSR24 +. We offer competitive salary and benefits. Send resume to Jaye@fdn.com

TWO ASSOCIATE POSITIONS - WEST CENTRAL FLORIDA

One in general podiatry, second with surgical residency. Good diagnostician, compassionate, hard-working individuals needed for high-tech group practice. flpodiatrist@tampabay.rr.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume to ohiodoctors@aol.com

ASSOCIATE POSITION/PARTNERSHIP - CHICAGO

Chicago Podiatric Surgeons, one of Chicago’s leading podiatric practices, is searching for a FT podiatric surgeon. Applicant must be a personable and confident surgeon with ability to manage surgical patients independently and be at least board qualified. High compensation. Will be working in new 7000 sf state of the art office in AN upscale Chicago neighborhood. Ownership/partnership opportunities. Send letter of intent and CV to drcarr@chicagopodiaty.com

ASSOCIATE POSITION - MARYLAND

IMMEDIATE Associate needed to join a multi-office podiatry practice in the Baltimore MD Region. Desired candidate should be surgically trained with Board Eligible/Certification. You must be hard-working, ethical, compassionate and confident in your abilities to deal with pathology, patients, staff and fellow physicians. Patient base is already established. Excellent income and growth potential for the right associate. Please forward a cover letter, resume, and surgical log (if a current resident) and availability to FootDocMaryland@Gmail.com

ASSOCIATE POSITIONS - NW INDIANA, CHICAGO AREA

2 Full-Time positions open - One for Northwest Indiana and one for the Chicagoland area. Must have 2-year surgical residency. Must be motivated and a self-starter. State License required. If interested email: f-massuda@footexperts.com

SURGICAL EQUIPMENT FOR SALE

Hand and power pieces available. Sagittal saw, wire driver- fits Ergo electric systems Complete Synthes internal screw fixation sets 2-0,2.7 and larger with screws self-drilling/tapping Complete packs of stats, retractors, rasps, rongeurs, etc. Email questions and requests to Podassociate@aol.com

EQUIPMENT FOR SALE

Hausted 825 GMCOO Unicare III stretcher. Approximately 7 yrs old, but rarely used. Great condition. Excellent condition, no rips or tears. $250 PDM J120B Podiatry chair-Used. Navy blue upholstery with some wear. Has Lift, Tilt and Back functions. Foot pedal. Screen and doctor’s stool included. $1,750. Photos on request. 410-768-5800 jferris@chesapeakefootandankle.com

FELLOWSHIP OPPORTUNITY
 
Applications are being accepted for the Central Kentucky Diabetes Management Fellowship. Dr. Jonathan Moore, former UTHSC Diabetes Fellow, OCPM adjunct faculty, AAPPM board member and national lecturer and author on diabetes and practice management related topics is director and founder. Don't miss out on the most unique, dynamic fellowship in Podiatric medicine. Learn latest advances in Diabetes management/surgery along with knowledge to run and grow a successful practice. Generous stipend, full benefits and free housing in resort setting. Email CV and letter of interest to: jmoore@aappm.org  Visit our website

PRACTICE FOR SALE - MARYLAND, DC SUBURBS

Great opportunity. Well established and equipped practice for sale. Office includes state licensed Ambulatory Surgical Center. Present owner is retiring but will stay on as needed for smooth transition. Average gross over past 3 years is $575 K. dpmpracticeforsale@yahoo.com

PRACTICE FOR SALE - BOSTON SUBURB

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. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

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