The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

March 21, 2007 #2,839 Editor-Barry Block, DPM, JD

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Children’s Foot Problems Can Become More Severe With Age: CA Podiatrist

In fact, a local podiatrist says, children's foot problems can become more severe and harder to treat as they grow up.

Dr. K. David Flora, Photo Ryan Krauter/For the Times-Delta and Advance-Regis

Unfortunately, said Dr. K. David Flora, a Tulare, CA podiatrist, unless a child is born with an obvious or severe foot problem, such as clubfoot, parents often don't think much about the health of their children's feet.

Unfortunately, said Flora, heel pain, leg pain and arch pain in children often are ignored by adults who believe the pain will go away on its own. In some cases, surgery may be the best treatment, Flora added. As for preventing foot problems, he said good foot care, even for young children, can help.

Source: David Castellon, Visalia Times Delta [3/17/07]

Toni Jo Neal, DPM Discusses Her WI Practice

Dr. Toni Jo Neal, Photo for The P-C by Wm. Glasheen

Q Why did you move back from California?
A Family is a huge part of it. The other part is the Midwest. I've been all over the country. When you're young, all you want to do is to get out of Wisconsin. Once you leave, all you want to do is move back. It's the people in the Midwest. They're genuine. It was time to go home.

Q You're specializing in diabetic patients, though you're not exclusive with them. How difficult is it to establish this kind of practice?
A It is difficult. Podiatry, typically, in the orthopedic world, has been sort of a boys' club. Also, people don't understand what my education is, and that's one of my strong points. I have one of the newest residency models out there. Traditionally, podiatrists, even 20 years ago, had no residencies. You did bunions the day you got out of school. I did a three-year surgical residency that emphasized the complex diabetic foot. About 10 years ago, most podiatrists stuck to bunions, hammertoes, things like that. While I was in my residency, I did ankle fusions, Charcot reconstructions, Achilles tendons. It's a much broader span. At Loma Linda University (her residency in CA), we were part of the vascular team. Not a lot of people have done that coming out of podiatry school.

Q During your surgical residency, you volunteered with the Flying Doctors of Mercy and the Baja Crippled Children's Project in Mexico. What volunteer work are you doing here?
A I volunteer one time a month at the Fox Cities Community Clinic in Menasha. My husband and I started a nonprofit, The Foot and Ankle Project, that's just getting started. Eventually we'd like to have a mobile clinic and travel around the US and treat underserved populations. It just brings back why you go to medical school. It's not to make money — it isn't there anymore. You have to have a genuine want and need to treat people.

Source: Maureen Wallenfang, Appleton Post-Crescent [3/19/07]

NV Considers No-Penalty Law For Physician Apologies

The Nevada Legislature is considering a bill that would allow physicians to offer patients an apology or expression of regret for medical mistakes without having it used against them in court, the Las Vegas Review-Journal reports. The bill is based on similar legislation from 29 other states, and it aims to reduce the number of medical malpractice lawsuits

Source: Annette Wells, Las Vegas Review-Journal via American Health Line [3/16/07] .

AHA to Push Universal Coverage

The American Hospital Association’s national healthcare reform plan—expected to be released this summer—will call for universal coverage for all Americans, according to a draft of the plan detailed by AHA President Richard Umbdenstock. He described the plan in a video teleconference broadcast today to attendees of the American College of Healthcare Executives’ annual Congress on Healthcare Leadership in New Orleans.

To help achieve universal coverage, the AHA plan would require employers to provide health benefits to employees and require individuals without any other source of coverage to purchase their own health insurance policies, according to the draft plan.

The AHA’s plan, dubbed “Unified Health Care Plan,” has five components: Better Value; Care That is Coordinated; Focus on Wellness; Access to Information; and Health Coverage for All—Supported by All. Each component includes various options to meet the component’s objectives. For example, to promote better value, the AHA’s plan calls for all quality and price information to be available to healthcare consumers.

Source: David Burda, Modern Healthcare [3/19/07]

Query: MicroVas

Does anyone know about MicroVas for peripheral neuropathy? A rep was in my office today and left some paperwork about it. For a modality that is supposedly so wonderful (they claim 95% positive outcomes) , I’m surprised I haven’t heard about it. They also left me a list of Medicare CPT codes and reimbursements. Is this a legitimate modality and properly reimbursable by CMS?

Chuck Langman, DPM, King of Prussia PA

Query: Neuroma Injection Questions

My doctor has an Empire Medicare patient who also has an indemnity secondary policy (United Healthcare). She is complaining of a neuroma, and I have tried to find out if Empire Medicare will cover CPT 64640 (destruction by neurolytic agent, peripheral nerve)with diagnosis code of ICD-9 355.6 (neuroma), but cannot get a clear answer. We called United Healthcare, and they have said that it is covered.

Does Empire Medicare cover CPT 64640 with a diagnosis ICD-9 355.6? If not (which is what I suspect), would I bill the injection to Medicare with a "-GA" or "-GY" modifier, and would I need to have the patient sign a wavier? United Healthcare will pay with a Medicare denial.

Lisa Maynard,, New York, NY

Response: My review of the Empire Medicare (New York) site failed to show any existing local carrier determinations (LCDs), old local medical review policies (LMRPs), or bulletins regarding the billing of CPT 64640 for Morton's neuroma treatment.

I did, however, find an article in the Empire Medicare (New Jersey) site that explains why they specifically selected CPT 64640 for reviews. Their conclusion was that "a number of physicians were billing CPT code 64640 linked to a diagnosis of Morton’s neuroma. When medical record documentation was reviewed, the service provided, the agent(s) injected, and location of the injection did not support the use of this procedure code. In our review of the documentation of 455 services on 258 claims, all instances of 64640 resulted in a denial.

What does this mean to you? Injection therapy may be indicated for Morton’s neuroma, but it involves injection(s) of long-acting corticosteroids into the surrounding tissue and not an anesthetic, neurolytic, or other agent into the nerve complex. Therefore, CPT code 20550 must be reported and NOT CPT codes for injections of anesthetic agents (nerve blocks) or destruction by neurolytic agents. Procedure code 64640 is an inappropriate code for injection of Morton’s neuroma."

Keep in mind that CPT 64640 is a legitimate CPT code for destruction by neurolytic agent, but it may not be valid or proper for 4-6% alcohol solution injections of a neuroma. In the case of Medicare as the primary payer, I would recommend you add a "-GA" modifier to CPT 64640 (and have the patient sign an advance beneficiary notice) as a precaution since you cannot be sure you won't be denied payment based on your use of the code (e.g., lacking medical necessity).

Harry Goldsmith, DPM, Cerritos, CA

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RE: Thickened Nails in 12 year Old (Edward Orman, DPM
From: Bryan Markinson, DPM

A very similar case was presented this year at the annual scientific meeting of the Nail Council in early February. The consensus of an international audience of dermatologists and podiatrists was that this represented a case of pachyonychia congenita. Dr. Ormand's case photo looks very much like the textbook examples of this disease, which is a hereditary one.

It may present completely, but usually partially, and in varying degrees, with any of the following symptoms: Discolored, thickened fingernails and toenails, plantar keratoderma (blisters & thick calluses on the soles of feet), palmar keratoderma (clisters & thick calluses on the palms of hands), oral leukokeratosis (thick white growth on tongue and inside cheeks), follicular keratoses (bumps formed around hair follicules), dermal cysts, laryngeal involvement (hoarseness or thickening), hyperhydrosis (excessive plantar and/or palmar sweating), and natal/prenatal teeth (teeth present at or before birth).

Bryan C. Markinson, DPM, NY, NY, bryan.markinson@mountsinai.org

RE: Healthcare in Cuba (David Secord, DPM)
From: Gary Friend, DPM

David Secord is mistaken when he characterizes Cuba's healthcare system as a disaster. In my six trips to Cuba during the past decade, I have had the opportunity to meet with physicians and visit hospitals and clinics in Cuba. Cuban physicians are well trained and knowledgeable.

Before beginning residency, Cuban medical school graduates spend a year in the countryside where, in the words of an internist, "we become physicians." Much of the third world sends students to Cuba for medical education and residency training. South American, Mexican, Canadian, and some American patients go to Cuba for certain treatments that are unavailable in their home countries or that are much less expensive in Cuba. I have scrubbed on lower extremity orthopedic surgery in Havana. The skills and choices of procedures of Cuban surgeons are similar to our own. For example, the Chevron bunionectomy is frequently employed. Cuban surgeons lecture in Europe and around the world, but not in the US due to our embargo.

Cuban family physicians are given a roster of patients, usually everyone who lives in one city block. The physician lives on the block in the second floor of a building, and sees patients on the first. He or she is responsible for the health care of the patients, to the point that he or she will knock on the door of a woman who has missed a mammogram.

Of course there are problems. Supplies are very limited. Generic drugs are used with few exceptions. Physicians are very conscious about ordering only the x-ray views and lab studies that they absolutely require. The doctors do complain about some of their conditions and their low pay, but generally, I found them to be knowledgeable, caring, and proud of the care they provide. They do remarkably well with the resources that they have.

Gary Friend, DPM, Glenview, IL, gjfriend@aol.com

ASSOCIATE POSITION – HOUSTON, TEXAS

Lepow Podiatric Medical Associates looking for board certified podiatrist to join their six location group practice in Houston. Competitive salary and benefits. Email CV to lepowft@cs.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 AVAILABLE - OCEAN COUNTY, NEW JERSEY

Immediate position available. Desiring a hardworking, ethical, motivated and well trained individual. Minimum PSR 24. State of the art practice offering EMR, digital xrays, ultrasounds. Must be willing to do all aspects of podiatry. Competitive salary and benefits package. E-mail CV to NJFEET@aol.com

PRACTICE FOR SALE SAN DIEGO, CALIFORNIA

5 y/o LaJolla Ca (San Diego) office collecting $289.5K with mostly soft tissue office procedures, biomechanics, general care, and no HMOs. Affluent community with great schools. Major opportunity for growth. Selling due to age and health. Call 858-405-4780 before 8PM PDT. Serious only, please.

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

ASSOCIATE POSITION- MINEOLA, NY

Excellent opportunity in fast-paced well-established podiatry practice for full time associate, all phases of podiatry including surgery, biomechanics, orthotics and routine foot care. Begins July 2007. Includes competitive salary and benefits. Please send CV and letter of interest to: cfcsteve@optonline.net

WELL ESTABLISHED PODIATRY PRACTICE IN MT. AIRY, NC

Dr. John H. Hodges had a well established practice in Mt. Airy, NC that is either for sale or in need of an associate/partner to take over patient care. Dr. Hodges unexpectedly passed away, leaving approximately 3,500 patients. This is a unique opportunity to be able to begin work in a busy podiatric practice. If interested, contact Carolyn McMackin at (336)577-2886 or cmcmackin@triad.rr.com

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

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

ASSOCIATE POSITION SE MICHIGAN DETROIT SUBURBAN PRACTICE

Busy podiatry group looking for associate interested in future partnership. We have a progressive team-orientated practice. Well-established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a surgical center. New third office being developed on hospital campus. Must be BQ/BC. Minimum PSR/24. Competitive salary and benefits. E-mail CV to jeffsz@msn.com

PODIATRY OFFICE FOR RENT – TUCSON, AZ

Shared space with podiatrist signage already in place for ten years. X-ray, processor, and all furnishings in place. Put your chair in and open for business. Contact Dr. Parks at 520-544-2445 or e-mail parksovc@aol.com

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 - NORTHERN VIRGINIA

Well-established, busy, diversified, multioffice/multidoctor practice seeking associate with opportunity for partnership. Must be highly motivated and ethical with strong interpersonal and patient skills. Excellent opportunity for PSR 24 or higher trained DPM to complement a full-scope podiatric medical and surgical practice. Competitive salary and benefits package. Please send CV and references to saglag2@aol.com or fax to (703) 368-5103.

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 POSITION - VICTORIA, B.C. CANADA

On beautiful Vancouver Island, 3 office practice. Full scope practice, owner near retirement. Future buy-in Exams for B.C. given in June. Willing to sponsor for immigration. Dr.Cole@shaw.ca 1-250-516-7440

PODIATRY PRACTICE FOR SALE - PRIME LAKES AREA, MN

Great place to live and raise a family. 400+K yearly gross with continued growth and potential. Good mix of general podiatry and surgery. Hospital privileges available. Fully computerized, electronic notes with capability to go completely paperless. Recently remodeled office, 5 tx/procedure rooms, well equipped in owner occupied building (for sale or lease). lakespod@charter.net

ASSOCIATE POSITIONS - VIRGINIA

Immediate/July full time associate positions available. Unlimited income potential. Busy, diverse, 40+yr Hampton Roads practice. Must be compassionate; energetic; and motivated; PSR24/36. Looking for long term arrangement. Please send letter and CV to fixafoot@cox.net or fax to 757-397-5889; www.podiatryltd.com

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

PRACTICE FOR SALE - BUFFALO, NY

Part Time Practice with full growth potential. Mi of conservative, biomechanics and diabetic foot care. Great surgical potential. Gross 180K. Willing to stay through transition. Call 716-836-8123.

2 ASSOCIATE POSITIONS AVAILABLE IN WYOMING

We need 2 associates to work in our Wyoming offices. We are a growing multi office (podiatry only) group. We are the largest podiatry provider in the region. 100K+ potential. Percentage salary, malpractice and medical paid, CME allowance yearly. Great outdoor locations and activities. Email CV and for more information. craig@enotesoftware.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

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