The Voice of Podiatrists

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March 24, 2012 #4,418 Publisher-Barry Block, DPM, JD

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Sometimes Ankle Injury is More Than a Sprain: ND Podiatrist

"Some ankle sprains are more than an ankle sprain; some are fractures," said Dr. Tyson Williams a podiatrist from Trinity Health. Many times, ankle sprains go misdiagnosed or even worse, untreated because people try to solve them on their own. As a result, they are subject to many long-term issues. "They can have chronic pain and instability, which in turn can lead to arthritis," said Doctor Williams.

Dr. Tyson Williams

They can also cause runners to lose trust in their ankles and ultimately lose their strength. However, Doctor Williams said that it`s important to look and listen for signs of partially healed ankles. "They feel something that’s mechanically not correct like clicking or catching or locking; then there’s something more then a typical ankle sprain," said Dr. Williams. The best advice: if you can`t put weight on your foot, go get treatment.

Source: Rich Wisniewski, KFYR-TV [3/21/12]

CA Podiatrist Appointed to Healthcare District Board

The Board of Directors of Eden Township Healthcare District recently appointed Dr. Ronald A. Hull, a podiatrist practicing in Hayward and Castro Valley, to fill the vacancy created by the resignation of Dr. Vin Sawhney on Feb. 16 of this year. After being unanimously appointed, Dr. Hull took the oath of office immediately following the meeting and is now an active member of the board. 

Dr. Ronald A. Hull

“The board was impressed with so many qualified people applying for the job – all the candidates were excellent.," said Director Lester Friedman. "It was Dr. Hull’s persistent interest in the District over the long term and his grasp of current issues that carried the day.” Dr. Hull has been in the community as a practicing podiatrist for more than 20 years, first in Castro Valley (1988 – 2006). He is now on the active staff of St. Rose Hospital, Eden Medical Center (including San Leandro Hospital) and the San Leandro Surgery Center.

Source: Analisa Harangozo, Castro Valley Patch [3/22/12]

MI Podiatrist Leads "Walk With a Doc" Event

The March Walk with a Doc program at Heritage Park last week took place under sunny skies and brought out some 35 people, one of the largest turnouts so far. The free program is open to the community and is for all ages and fitness levels.

Dr. Susan King

Healthcare professionals are available for discussions, blood pressure monitoring and more. This time, Dr. Susan King, podiatrist, talked about selecting the right walking shoes, and injury prevention and care.

Source: Susan Steinmueller, Observer and Eccentric [3/22/12]

House Votes to Repeal IPAB

The House of Representatives voted to repeal a provision in the healthcare law that would create the Independent Payment Advisory Board, a 15-member panel with responsibility for controlling Medicare cost growth. The House voted 223-181 in support of the Medicare Decisions Accountability Act of 2012, a bill that would repeal the Patient Protection and Affordable Care Act provision.

A report issued last week by the Congressional Budget Office found that repealing IPAB would increase spending by $3.1 billion from 2013 to 2022. Critics of IPAB include the American Medical Association, which said in February that it supported the Medicare Decisions Accountability Act and the elimination of the IPAB provision.

Source: Jaimy Lee, Modern Physician [3/22/12]

Deliver a ‘No’ Without Devastating

As difficult as it can be to tell someone “No,” you can turn that moment into a positive experience. For example, when an employee is asking for a raise. With this approach, the other person will thank you later:

• Soften your “No.” Put yourself in the other person’s shoes, understanding that they want a “Yes.” Say “I wish that I could tell you that (what the person wants to hear), but I can’t.” Say it that simply, without apologizing.
• Redirect. Steer the conversation in a positive direction. Lead the person with a phrase like “Let’s do this …” or “Here’s what we can do instead …” You will maintain your credibility as an honest person and be seen as someone who is a problem solver rather than a naysayer.

Source: Adapted from “What to Say When You Can’t Say ‘Yes,’” Beth Haiken, PR News via Communication Briefings.

Platelet Rich Plasma Units?

I am interested in knowing which PRP systems others are using. I would like to know costs, amount of blood needed, and any other helpful details.

Marc Katz, DPM, Tampa, FL

Query: J Code Denials form Medicare

We have been submitting "J" injectable supply codes to Medicare, following the new requirements (e.g., lot numbers, etc.). We are, however, getting denials stating "too many units" for J3302 (triamcinolone diacetate) and J1094 (dexamethasone acetate). We are getting paid correctly by all other payers with the exception of Medicare. For example, we billed: CPT 99213-25, CPT 20550-LT-59, and 
J1094-A6 x 3 units.

Any ideas? I have yet to find a policy that actually states what is acceptable in terms of billing units for "J" codes.

Jennifer, Office of Paul LaFata, DPM

Response: Recently, Medicare began requiring NDC codes for any and all injected supplies. The NDC number is printed on the label of the supply bottle. That number specifically states what the therapeutic element is, its concentration, volume of the container (single vs multi-dose), whether it is generic vs. branded, and any other issue that the payer might want or need to know.

If you don't provide the NDC number, Medicare can not and will not process the claim. I suspect all other payers will follow suit in good order.

Rick Horsman, DPM, Olympia, WA

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RE: Delta Phalanx (David Weiss, DPM)
From: Roody Samimi, DPM

If it's flexible, I would try taping/splinting first. If it fails conservative treatment, instead of a fusion, I would release soft tissue contractures and pin for at least 3 weeks.
 
Roody Samimi, DPM, Flushing, NY, roody.samimi@gmail.com

RE: CROW Walker vs. Patellar Tendon Brace (Jeffrey Kass, DPM)
From: Josh White, DPM, CPed

Patellar tendon bearing AFOs can be made as part of a metal double upright type brace attached to a shoe or integrated as part of a CROW walker.  Whether or not a CROW walker integrates a PTB component, it effectively distributes forefoot plantar pressure by integration of a rocker-bottom sole to prevent prevent mid-tarsal joint dorsiflexion.  

A PTB component, whether part of a CROW walker or part of a metal double upright will most effectively reduce pressure beneath the rear foot and is not significantly effective at reducing forefoot plantar pressures. It's most commonly used for non-healing heel ulcers and for osseous problems. A reminder that when casting for PTB AFOs, it is essential to cast the patient up over the knee using the STS Bermuda sock and not the 17" tubular version most commonly used for gauntlet-type devices.

Josh White, DPM, CPed, Safestep, joshwhite@safestep.net

RE: ICD-10 Preparation (Joseph S. Borreggine, DPM)
From: Edmond F. Mertzenich, DPM, MBA

The main question I had about this particular posting was where the figures of around $80,000-$270,000 are coming from. As has been posted, ICD-10 has been around for a while with the codes available for free from CMS. I would like to know how these figures were generated. I have a hard time understanding this because if the codes are free, and they have been already developed, there is no cost for designing them. 

As for computer programming (of which I’m not very knowledgeable) to me it is mostly a matter of just putting the codes into a program, changing a few boxes to enter the codes, and making sure the information is transmitted correctly. CMS has mandated version 5010 usage by June 2012. Version 5010 allows for ICD-10 transmission.  If these costs are true, then what is driving them?

Edmond F. Mertzenich, DPM, MBA, Rockford, IL, doctoreddpm@frontier.com

RE: DOX Podiatry EMR
From: Brian Doerr, DPM

I have been on DOX podiatry EMR for the past seven years and have been very pleased with the system. It is user-friendly and  easy to set up. They have very good support and training. 

Brian Doerr, DPM, Fort Myers, FL, DocDoerr@aol.com

RE: Taking X-Rays on Patients with Ingrown Nails (Ivar Roth, DPM)
From: Elliot Udell, DPM
 
Dr. Roth raises a valid objection to podiatrists taking x-rays in the evaluation and treatment of an uncomplicated ingrown toenail. In our practice, x-rays are only taken when a patient presents with symptoms which may be caused by osseous pathology. Let me play devil's advocate for the purpose of adding to this discussion.
 
I have my teeth cleaned professionally. Once a year, the dentist will take a series of x-rays. This past year, he discovered the beginning of an abcess. After two opinions by endodontists, I underwent a root canal in order to save the tooth, even though it was asymptomatic at the time the initial views were taken. The question is whether we as podiatrists should be conducting comprehensive foot evaluations on all of our patients and should this also include a basic set of foot x-rays?
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

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