The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

March 24, 2007 #2,842 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2007- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

The next issue of PM News will be sent to you directly from the 2007 APMA House of Delegates in Washington, DC. We’ll provide you with highlights from the opening of the Resolutions Committee on Saturday morning to the last gavel on Monday afternoon.

Cosmetic Surgery Should Also Address Foot Function: NY Podiatrist

Stuart Mogul, a podiatric surgeon at Lenox Hill Hospital in New York City, says that a growing number of women are seeking surgical solutions for such cosmetic worries as hammertoes, corns, crooked toes, and toes with erratic or unnatural lengths. "Sometimes we'll see one toe that's extremely long," he said. "For example, a second toe that is a half-inch longer than the third toe. That's a foot that if 10 people looked at it, 9.5 of them would understand the patient's concerns," he said.

Dr. Stuart Mogul

For this reason, Mogul says, many of the patients he sees are highly motivated to give their ugly feet a face-lift. "It's not uncommon that a patient tells me that she is embarrassed to show her feet," Mogul said. "I don't think that is hyperbole — I think that they don't take their shoes off."

Even surgeons who perform cosmetic foot procedures say that above everything else, the proper workings of the foot must be preserved or a doctor could do lifelong harm to a patient. "The foot has to function," Mogul said. "That's the No. 1 thing. The foot has to bear and transfer weight, and it has to last a lifetime." But Mogul says that there are many situations in which a foot can be operated upon safely, without a negative effect on the foot's function. "I would submit this: Is there an industry out there that caters to the aesthetics of feet? Of course," Mogul said. "Some people have said that this is wrong, but we have been doing it for years, and we have some very happy patients."

Source: ABC News [3/20/07]

Medical Debt Incurred by Many With Health Insurance: Study

Health insurance premiums, deductibles and co-payments, as well as confusion about policies and billing practices, have led to an increased number of individuals who have coverage but incur medical debt, according to a study released on Thursday by the Access Project, USA Today reports.

For the study, sponsored by the W.K. Kellogg Foundation and the Missouri Foundation for Health, researchers examined the experiences of 45 individuals with health insurance who had incurred medical debt. About two-thirds of participants attributed their medical debt in part to health insurance premiums, deductibles and co-pays, the study found. The study also found that about one-third of participants attributed their medical debt in part to a lack of coverage for certain health care services, such as prescription drugs, dental care or medical equipment.

Some participants attributed their medical debt to annual or lifetime benefit caps; additional charges for out-of-network care; and complex hospital and health insurer billing practices, according to the study. Carol Pryor, senior policy analyst for the Access Project, said, "Shifting more costs onto patients has significant health access and financial consequences.

Source: USA Today Via American Healthline [3/22/07]

Query: Kinesio Taping?

Does anyone use kinesio taping? A physical therapist friend told me about it. Says it's great for plantar fasciitis. I ordered the tape (it's expensive) but wondered if it works. You leave it on for 3-4 days, and I assume you can bill for taping each foot for a bilateral condition.

Marilyn Henderson, DPM, Lancaster, PA

Query: Orthotic Dispensing Code - CPT 97760

Our doctors recently attended a seminar, and were told that they could bill for the dispensing of orthotics. The code that they were told to use was CPT 97760 (orthotic management and training [including assessment and fitting when not otherwise reported, lower extremities, each 15 minutes]). The code we use when we bill for custom-made foot orthotics is L3000-LT and L3000-RT.

I would like to confirm if the dispense code, CPT 97760, is correct. If not, what do others do? Do you simply include the dispensing in with the orthotic code? What do you do if the dispense gets denied by the insurance? Can you bill the patient for the dispensing?

Angela Gottbreht, CMC, CCP, Everett, WA

Response: Either the speaker at the seminar was inaccurate, or your doctors misinterpreted the speaker's comments. CPT 97760 (orthotic management and training [including assessment and fitting when not otherwise reported], upper extremities, lower extremities and/or trunk, each 15 minutes) or CPT 97762 (checkout for orthotic/prosthetic use, established patient, each 15 minutes) codes should only to be used when another provider is billing for the devices (HCPCS codes).

From your comments, it is clear that this is not the case - your doctors are supplying their patients with the orthotics. A particular patient's insurance carrier may choose to either bundle (or not) the dispensing of the device into the HCPCS supply code for the devices themselves. This is something you would need to clarify from the specific insurance carrier. In only these circumstances, an office visit, presuming the E/M service criteria has been met, would be more appropriate than the CPT 97760 code.

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found at
http://www.codingline.com/subscribe.htm

RE: Mitek Anchor Removal (Joseph Borreggine, DPM)
From: Amol Saxena, DPM, Raman Sinha, DPM

I would recommend using image intra-op, w a trephine larger than the diameter than the anchor to core over it, or an osteotome to extract it. If there is a big void, fill w bone graft or an orthobiologic.

Amol Saxena, DPM, Palo Alto, CA heysax@aol.com

We recently used a trephine to help remove a G2 Mitek anchor when performing a modified Lee procedure. Luckily the anchor was placed in the area that we were going to trephine in the fibula anyway.

Raman Sinha, DPM, Houston, TX, dr.raman.sinha@gmail.com

I have found it fairly easy to remove them with a bone dowel. I have only had to remove two that the patients “felt” were giving them problems. I have also removed one from an infection and one from an allergic rx. These were no problem and could basically be pulled out due to periimplant bone destruction.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

I have successfully removed Mitek anchors and helped others by drilling a hole the same size as the anchor directly next to it and sliding it sideways with a hemostat. This works every time.

Michael L. Gerber, DPM, Sterling Heights, MI, mgfoot@aol.com

RE: Post-op Respiratory Depression Following Opiate Administration
From: David Weiss, DPM

I recently read about a malpractice case where a man in his 40's had back surgery and was placed in the hospital on Demerol 75mg q6. He died of respiratory depression. The experts believed he had sleep apnea, which contributed to his respiratory failure.

I thought about the number of opiates that we use in the post-op period. This case makes me now ask my patients about their sleep habits - or ask their spouses (they are the ones who hear the snoring!). I hope this alert will help other DPM's avoid a potential problem.

David Weiss, DPM, Richmond, VA, podmed2@verizon.net

RE: Lewandowsky-Lutz Dysplasia?
From: Al Kline, DPM

There is a post circulating on the internet of a proposed case of Lewandowsky-Lutz dysplasia. I found the post on the WFMU's blog. http://blog.wfmu.org/freeform/2007/03/missionary_enco.html

Lewandowsky-Lutz Dysplasia?

Lewandowsky-Lutz dysplasia is a form of epidermodysplasia verruciformis, an extremely rare skin disease characterized by the growth of scaly macules and papules, particularly on the hands. It is named after doctors Felix Lewandowsky and Wilhelm Lutz. The condition begins in childhood and has no known cure. It is believed to be caused by the HPV in combination with a genetic predisposition. It looks more like a PPK with 'horny' hyperkeratosis, which is an autosomal-dominant disease. I’m not really sure this would be considered Lewandowsky-Lutz dysplasia, which is viral. Many times I've seen similar conditions with fungal and viral infections superimposed over a genetic hyperkeratosis. It may be more in line with Unna Thost disease. The jury is still out on this Internet post .

Al Kline, DPM, Corpus Christi, TX, al@kline.net

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 - 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 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

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 - MICHIGAN-DETROIT AREA

Great opportunity-must be hard-working, reliable, responsible and good with patients & staff-surgical training a plus-partnership after 1 yr. Michigan license required fax resume to 248-478-1370

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

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.

WEEKLY SPECIAL - One week of ads (5x) for only $75

PM Classified Ads Reach over 9,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 9,000 DPM's. Write bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.