The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

April 04, 2009 #3,511 Publisher-Barry Block, DPM, JD

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CA Podiatrist Discusses Calluses and Bromhidrosis

Extra pressure or friction on the foot creates these unattractive patches of thick, hardened skin, says podiatrist Mark Brenis, DPM, who practices in Capitola, California. "As long as this pressure continues, then calluses will grow back—even if you scrape or trim them." He suggests re-evaluating footwear and gradually softening tough spots with regular exfoliating treatments.

If your feet smell a little, um, stale after hibernating all winter, then it's time for minty essential oils and a lot of fresh air. "The bacteria and fungus in sweat actually break down dead skin cells on your feet and cause odor," says Brenis. To limit growth of these bad-smelling intruders, let shoes dry out completely before slipping into them again, and avoid wearing the same pair of shoes every day, he suggests.

Source: Adina Licht, Delicious Living [4/2/09]

MO Podiatrist Pleads Guilty to Medicare Fraud

A St. Louis podiatrist pleaded guilty to obstructing a federal audit when providing the Medicare program with a false backdated treatment record, U.S. Attorney Catherine Hanaway said Thursday. Bic Chau Stafford, who practices at the Family Foot and Ankle Care Center in Maryland Heights, as well as assorted assisted living facilities in St. Louis City and St. Louis County, pleaded guilty to one felony count of obstruction of a federal audit and now faces a maximum penalty of five years in prison and fines up to $250,000, when she is sentenced June 17.

Stafford, 59, billed Medicare for numerous complex foot surgery procedures allegedly provided to 39 local Medicare beneficiaries when she was really providing these patients with only routine foot care, such as toe nail clipping, prosecutors said.

When she was audited by the Medicare program in 2007, Medicare denied her claims for reimbursement regarding these 39 beneficiaries and requested that she repay $6,840 for non-covered services that had been previously paid to her. Stafford challenged this and as part of her efforts to avoid paying the overpayment, Stafford created new treatment records for those 39 patients in 2007, back-dating them to 2004, using fraudulent treatment information and claiming that she had provided these patients with podiatric surgical procedures, prosecutors said.

Source: St. Louis Business Journal [4/2/09]

MO Podiatrist Charged in Sex for Drugs Case

A St. Louis podiatrist is accused of trying to exchange prescription drugs for sex.

St. Francois County Prosecutor Wendy Wexler Horn on Wednesday charged 49-year-old Dave Dai Quang Pham with distribution of a controlled substance, possession of a controlled substance with intent to distribute, and a misdemeanor, patronizing prostitution.

Pham was arrested last month at a motel in Bonne Terre.

Source: Assoicated Press [4/2/09]

Query: E-Prescribing

I was wondering if colleagues that are already e-prescribing could comment on their experiences? Are you using stand-alone systems or is it integrated with your practice management software? What are your vendors charging? Is there a one-time fee or is there  ongoing monthly or annual costs?

Howard Gale, DPM, Rincon, GA
 

Query: Foot Orthotic & Toe Filler Addition

The orthotic lab I used included a charge to me for a "foam amputee fill-in" as well as the usual custom orthotic charge for devices that I ordered. Can I bill the patient's insurance plan for both the custom foot orthotic and the toe filler (foam fill-in addition)? If so, which HCPCS code is appropriate?

Neil Levin, DPM, Sycamore, IL

Response: I'm not quite sure what the "foam amputee fill-in" on this device looks like. Perhaps your local orthotic lab billed it to you because it does not have a toe filler (L5000) device on its menu. This device may or may not conform with the L5000 definition. You may want to compare it to devices which definitely meet the specifications of an L5000.

In ANY scenario, it would be inappropriate to bill a custom foot orthotic and an L5000 for the same device for the same foot to any third-party payer.

Assuming this was the left foot and it met the L5000 specification, your bill would appear as:
L5000-LT
L30xx-RT (choose the appropriate device code)

I would also take photos of the device, and be sure the order to the lab specified "toe filler." Your chart notes should also support the medical necessity of such a device.

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found at:
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RE:  Pain Post-op Arthrex Tight Rope (Ivar E. Roth, DPM, MPH)
From: Stephen Pirotta, DPM

I have used the mini tightrope at least 10 times over the past several months. I love the principle and it seems to live up to its intended design. However, all but one patient has had severe pain after surgery, more than I have ever seen with bunion surgery over the years. I still think the long-term results will justify its use. I use the mini with two small drill holes (1.1) instead of the single drill hole, which makes a larger hole in the thin 2nd met neck. I have had one stress fracture of the 2nd met due to the large bore hole of the mini tightrope.

By using the two smaller drill holes which I have now used for the past 5 bunions or so, I think the risk of fracture of the 2nd met will be minimal. I also would be interested in others, experience with this awesome procedure. I think it is the greatest invention regarding bunion correction since the advent of the Austin. I use it with almost every Austin I do now to help correction and prevent future recurrence.

Stephen Pirotta, DPM, Bentonville, AR, footdoctors@cox.net
 

RE: Hyperuricemia Management (Eugene Batelli, DPM)
From: Bryan C. Markinson, DPM

The discussion on hyperuricemia management is very frustrating. Some think or wonder if it is a scope issue. Some think that a DPM prescribing allopurinol is proof that we are physicians. Dr. Batelli boldly declares  that if we do not choose to manage hyperuricemia, we are not acting like physicians. I wonder if he takes his hypertensive gouty patients off of diuretics? Now that impresses me as being physician-like!! Dr. Barclay manages the hyperuricemia for 6 months, having a set notion of what the level of blood uric acid should be. Dr. Kass correctly points out that there are overproducers and under-excreters and wonder if allopurinol is good for both. Dr. Kashan states he could see both sides, and in the affirmative, poses the question of whether or not treating gout with allopurinol is not the same as managing blood glucose in a diabetic? But for limited in-hospital situations, is he doing that? Is anyone?

Gouty attacks are not that common. Most people have one in their lifetime. Up to 50 percent and maybe more of people on allopurinol do not need to be on it based on 24-hour urine collection test results. The 24 hour urine collection test for urates is rarely done (which is a mistake), even by internists because allopurinol has virtually no side-effects. Hyperuricemia is often not evident at the time of an acute attack. Gorging on red meat and shellfish and other high purine intake is commonly regarded as the prime cause of hyperuricemia, but hyperuricemia may be a manifestation of internal cancer, severe psoriasis, and any number of diseases resulting in DNA breakdown.

Wanna be physician-like? Manage the attack locally like you were trained. Get the patient to the internist for work-up of hyperuricemia. The leukemia patient you would otherwise be tinkering around with for six months may appreciate it.

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

RE: Chronic Calluses and Skin Fissures (James M. Petko, DPM)
From: Philip McKinney, DPM

Debride the fissured area and then apply cyanoacrylic glue to the site in a thin application. This will hold the fissure closed for 7-10 days. In the meantime, you can work with any of the exfoliate topicals to reduce the callused area.

Philip McKinney, DPM, opodiatry@oregonpodiatry.net

RE: Patient Grateful to DC Podiatrist Who Really Listened
From: Stephen Pribut, DPM, Michael M. Rosenblatt, DPM

Editor’s note: These letters can be read at:
http://www.podiatrym.com/letters2.cfm?id=25561&start=1
 

ASSOCIATE POSITION - CHANDLER/GILBERT/PHOENIX, ARIZONA

PRACTICE FOR SALE - CENTRAL FL

Practice and medical building for sale, in beautiful, high quality of life, growing area, Central Fl.; 2000 sf bldg. fully equipped/ designed for podiatry; excellent location, features & exposure; near hospital, wound and HBO center. Great opportunity for expansion & investment; good insurance climate. 352-223-2713 / E-mail: windnwave@earthlink.net

ASSOCIATE WANTED - FLORIDA

Associate needed for a dynamic multi-doctor practice in the Tampa Bay area. Partnership opportunity for the right candidate. Preference given to a PSR 24+ resident completing their education this spring/summer, and must have a Florida license. Well-established practice, high tech with EMR and digital x-rays, with specialties in sports medicine, surgery and wound care. No nursing homes or HMO's. Excellent hospital privileges available. Choose an area of practice concentration that you are passionate about and enjoy a lifestyle for yourself and your family that is second to none. E-mail: kimvelez@tampabay.rr.com

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

PART-TIME NON-SURGICAL PRACTICE FOR SALE - NORTH JERSEY    
 
23 yo practice recently relocated to a spectacular newly-constructed and equipped storefront next to a busy supermarket with ample parking and senior citizens in vibrant downtown. Accepting Medicare and Blues only with great potential. Perfect for expanding to full-time, a second office or new practitioner with means and office experience.  Priced to sell. Financing possible. E-mail interest with contact to Mikedup1215@yahoo.com

PODIATRIST NEEDED FOR MIAMI-DADE COUNTY

Multi office practice needs doctor of podiatry for full time and/or part time for private office, clinics, and nursing homes. Great opportunity to grow with and unlimited income potential. Offices in Miami, Hialeah, Westchester, and Cutler Ridge. Email to feetdoctor@aol.com

ASSOCIATE NEEDED- SOUTHEAST MICHIGAN

Well-established practice needs to replace a departing partner and is looking for a reliable, personable podiatrist to step into a busy practice. This is an outstanding opportunity with full benefits that may lead to partnership. Please contact dr.hughes@comcast.net

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

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 11,500 DPM's. Write to  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 Ext 110.

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