The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

April 23, 2011 #4,142 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2011- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

GA Podiatrist Discusses Treatment of Heel Pain

Heel pain is a condition that can be as simple as a blister or more complicated. It’s most often caused by plantar fasciitis. According to podiatrist Frederic Spector, DPM, "About half the people with heel pain have heel spurs. Don't worry about heel spurs. They're not the cause of the pain. The cause of the pain is the pulling and tugging of the plantar fascia or the heel. This you usually will find in people with a higher arch foot or perhaps a flat foot." 

Dr. Frederic Spector

Dr. Spector's office provides patients with various shock-absorbing shoe inserts -- which help reduce stress to the heel. A "night splint" provides more aggressive stretching. Here are some other ways you can reduce stress on your heels. "You want to avoid any type of flat flimsy shoes, flip-flops, moccasins, or bedroom slippers. These all could make the pain a good bit worse. Second, weight control is helpful. Try to lose weight if that's an issue for you." Calf exercises are good, and Dr. Spector even suggests filling a water bottle half way, freezing it, and rolling your arch over the bottle or a tennis ball.

Source: Tina Tyus-Shaw, WSAV.com, [4/19/11]

TX Podiatrist Wins Best Case Presentation at TPMF Fund-Raiser

The Texas Podiatric Medical Foundation held a fund-raising event to support the six Texas residency programs. The meeting was held at the Bandera, Texas dude ranch April 14-16. Drs. Larry Harkless and Javier LaFontaine were program chairmen. 

(L-R) Drs. Lesley Richey-Smith, Amy Riedel, Steve Brancheau, and Joe Morgan

The winner of the $500 overall best case presentation by a resident was Dr. Joe Morgan from the Hunt Regional Residency Program, directed by Dr. Steve Brancheau. The title of his presentation was  "Reconstruction of the Infected Neuromuscular Diseased Patient."

NY Podiatrist Deals with Early-Onset Parkinson's Disease

It's a condition that many of us associate with old age but Parkinson's disease can strike at any time. Beth Hochstein was 36-years-old when she was diagnosed. Hochstein says, "Your world sort of caves in on you at that moment, and you know you choose to either curl up and just don’t accept it, or you accept it and you do what you can to live with it to the best of your ability." Hochstein knew something wasn't quite right after initially spraining her ankle three years ago. The podiatrist and busy mother of two put off going to the doctor. 

Dr. Beth Hochstein

Hochstein kept her condition a secret and continued working alongside her husband Dr. Alex Hochstein at their busy podiatry practice. She was eventually forced into early retirement when her strict medication schedule made it difficult to treat patients. Hochstein says, "Since I've retired in July, my husband says I've been busier now than I was before working. I'm just dedicating my time to raise money to find a cure."

Source: My FoxNew York [4/21/11]

RE: Alleged Improper Application of Cast Resulting in DVTs and PEs (MA)

Result: Defendant's verdict ($0)

Plaintiff's experts: Jeffrey Stein, MD, NY, NY.; Pamela B. Karman, DPM, NY, NY; Jack Adler, MD, NY, NY; Ramiro J. Manzano, DPM, Boston, MA.

Defendant's experts: David R. Campbell, MD, Boston, MA, Geoffrey M. Habershaw, DPM, Hingham, MA., Frank Santopietro, DPM, Boston, MA.

Summary of Facts: Scott Vecchi presented to defendant, complaining of a right heel pain Feb. 11, 2004. Defendant#1 diagnosed Vecchi with right heel bone spur and prescribed a physical therapy regimen. Despite continued physical therapy, Vecchi claimed his right heel pain persisted. Defendant recommended a below-knee fiberglass cast to relieve Vecchi's right heel pain.

Defendant #2 of the same group affixed the cast to Vecchi's right foot April 30, 2004. Vecchi claimed neither defendants #1 or #2 informed him of the potential risks of using the cast. Vecchi complained of cramping in his calf during a follow-up visit. Upon removal of the cast, defendant #1 found edema in Vecchi's entire right lower leg. Vecchi was diagnosed with deep vein thrombosis in his right calf that developed into pulmonary embolisms in his lungs. The cast was reportedly applied too tight and extended too close to the knee joint.

Vecchi filed a lawsuit against...

Editor's note: This jury report can be read here.

Use Doctor Review Sites to Boost Your Google Rankings  

When you have patients who have had fantastic treatment outcomes, ask them to post a review for you on one of the doctor review sites such as yelp.com, ratemds.com, etc. Be sure to ask patients to use your full name in the first sentence of the review, since many search engines will pick up the first sentence or two as it is listed on the review site. These reviews will often land on the first page of Google when someone is searching for you by name. Another great way to increase your web presence is with video testimonials that can be placed on your website and then uploaded to YouTube.

Source: Gary Ignotofsky

Query: Shoes and Pre-Fab Orthoses for Small, Narrow Feet

I recently treated at 37 year old female for plantar fasciitis who is mentally challenged and slight of build. Radiographs are negative for plantar calcaneal spurs. She wears a child's size 1 1/2 or 2 size shoe. Does anyone know where she may purchase a wider variety of narrow shoes (on-line or elsewhere) and if there are any pre-fab orthoses available in that size? I suspect that custom orthoses will be the best fit, but finances may be a consideration, and I usually prefer to try OTC's in these instances.

Charles F. Ross, DPM, Pittsfield, MA

Query: Modifier *-57* Question

Is modifier "-57" (decision for surgery) appropriate to use with an established E/M service code when there's a new problem, and a procedure with a 10-day global is done? When we use the "-25" modifier, the visit gets bundled.

Susie Pfeiffer, Office of Carlos A Cadena, DPM, Las Cruces, NM

Response: The "-25" modifier (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is typically appended to an E/M service code when a procedure performed during the same encounter has a 0-day or 10-day global period assigned (i.e., "minor" procedure).

The "-57" modifier (decision for surgery) is appended to an E/M service code when a decision is made during the encounter, and a 90-day global procedure (i.e., "major" procedure) is to be performed within 24 hours. These procedures are not bunionectomies to be performed in several weeks, but procedures associated with trauma, wounds, infection, etc.

"Major" and "minor" labels are not found in CPT. These are typical of Medicare. Non-Medicare payers may have variations on those, but most follow Medicare. Contact the payer rep and ask specifically about this. If you are not getting anywhere, you may want to speak with your state podiatric medical association about this.

Paul Kinberg, DPM, Dallas, TX

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

RE: Post-op Nail Complication (Brent Rubin, DPM)
From: Juliet Burk, DPM

I had a case where a woman had a red and painful nail bed more than two months after a chemical matrixectomy. She blamed the slow healing on the fact that her kids kept stepping on it. After taking an x-ray, we discovered that the kids stepping on it actually fractured the distal phalanx of the hallux. After spending some time in a post-op shoe, she healed just fine. It doesn’t pay to assume.

Juliet Burk, DPM, Muskogee, OK, juliet-burk@cherokee.org

RE: Pecos (Richard Rees, DPM)
From: Paul Kesselman, DPM

I usually recommend one of three services for those seeking professional assistance with their PECOS registration. These individuals are well-versed in the enrollment process and can overcome most of the hurdles you have encountered, while allowing you to do what you do best - treat patients.

I usually ask that practitioners contact me first in order to determine which enrollment specialist would best suit their needs. I used one of these three when I moved my office 2.5 years ago and had all my registration issues with regular Medicare (local and Railroad Medicare) as well as the NSC for DME. This was resolved within three months.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: Finding Out Patients' Deductibles (Steven Block, DPM)
From: Christian Smith, DPM

We use Passport Health (passporthealth.com) to evaluate patients' eligibility, deductibles, etc. prior to their appointments. There is a one-time set-up charge of $250/practice to be placed on as many computers as you need. It is web-based, and it will check every insurance known to man. We do this in TN but I was told by the local rep that it is used all over the country. Each time you check a patient, it costs 26 cents.

The staff enters demographics and, within 30 seconds, you have all the information you need…if eligible, deductible amount, and how much is left, etc. It has been well worth it for our practice and the patient AR has gone down and our collection rate has gone up at the front desk. If patients aren’t willing to pay on the front end, they are not going to pay on the back end after services are rendered.

Christian Smith, DPM, Memphis, TN, christiansmith@msfas.com

RE: Cryoprobe (Mark Aldrich, DPM)
From: Jane E. Graebner, DPM

I too purchased the Cryprobe and was plagued with problems. Although I would deem it effective, the cartridges are expensive, and they have to be discharged every night, which is wasteful and expensive. The seals regularly needed replacement, and they were difficult to get in place. Rather than buying the newer version of this device, I purchased Miltex's Cryo Solutions which was less expensive, very easy to use, and seems to be much more effective. This item is available through podiatry supply companies such as Gill Podiatry.

Jane E. Graebner, DPM, Delaware, OH, footdrjane@gmail.com

RE: Exogen Bone Healing System (Tip Sullivan, DPM)
From: Russell F. Trahan, DPM

I am surprised at the degree of negative reaction to Dr. Sullivan's desire to utilize the Exogen bone healing system on most, if not all, of his fractures/osteotomies. While I understand  that, as  doctors, we should take a role to police the use of healthcare dollars, the thought of the use of the Exogen on all fractures is certainly not unreasonable: It indeed has an FDA indication for fresh fractures. What may appear as "exotic", "wasteful", or "unnecessary" today, could be standard of care tomorrow.

I am sure that the same argument was used about the use of MRIs vs x-rays 20 years ago when MRIs became widely available. Besides, if the device can get a patient healed 38% faster, the argument could be made that it can ultimately save healthcare dollars by having fewer patient encounters and the expense that goes along with that as well as reducing other costs (e.g., disability insurance costs).

Russell F. Trahan, DPM, NY, NY, dr.trahan@att.net

RE: Routinely Taking Patients' Blood Pressures in a Podiatric Setting (David Finkelstein, DPM)
From: Leonard A. Levy, DPM, MPH

Accolades to David Finkelstein, DPM for taking the blood pressure of a patient who was sitting in a car outside his office but too ill to enter. Indeed, he probably saved her life. However, taking the blood pressure of patients only if they were about to have nail or wart surgery is not nearly enough. Podiatric physicians should do this relatively simple procedure on virtually every new and follow-up patient. If time is an issue, the office assistant can be taught to do it. This often is the protocol in many other physicians’ offices. 

Most patients with abnormal blood pressures are completely asymptomatic and, before tragedies occur, could be referred for care prior to developing the sometimes life-threatening or morbidity-producing complications of such findings. What a simple and effective way to demonstrate the role of our profession as one that truly can be categorized as being part of the physician community with a major role in comprehensive healthcare.

Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL, levyleon@nova.edu

RE: Coming Down a Peg           
                                                     
One day recently, I was totally on top of my game. I performed two complicated surgeries at the surgery center, and things went perfectly. The bone cuts were precise, the screws bit tightly, and the aligment was right on. I then went to the office and saw patients the rest of the morning, nailing the diagnoses on some complex patients. I was feeling pretty good about things. Then I went into my office to do some charting and happened to look down to see that my fly had been wide open the whole time! So much with being impressed with myself. I just laughed for the rest of the day.

Doug Milch, DPM, Asheville, NC

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

ASSOCIATE POSITION AVAILABLE - THE BRONX

Excellent hospital based opportunity. Inpatient & Outpatient Care. Busy clinics. Large diabetic population. Practice all aspects of Podiatric Medicine & Surgery. Requires Surgical Skills. CV to nealblitz@yahoo.com

ASSOCIATE POSITION – NEW JERSEY

Associate wanted full-time, for practice in East Orange NJ PSR 24-36 trained. Must be motivated to grow practice, especially build wound care and surgical services. Buy-in possible after the 1st year. send CV to Drfoot44@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

ASSOCIATE POSITION - CT - (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to Dr.Kassaris@yahoo.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

PODIATRIST NEEDED - NY/QUEENS/LI

Must be min. PSR-3 with excellent training. Experienced in billing, selling non-covered services, products, Patient medical and surgical exp. with good rapport/comm. skills necessary. Unique position working in offices, clinics, hospital with orthopedist, podiatrist, P. therapists. P/T, F/T available. Growth, income potential and partnership opportunity excellent. A chance to use all your skills; foot, ankle and more. Please respond with cover letter and CV to hansfeet@aol.com

EQUIPMENT FOR SALE - COOL TOUCH LASER

Cool Breeze Cool Touch CT3 plus laser used for ugly, unsightly, toe nail infections. Less than six months old. Great price won't last long. Considering a laser? We also have the Q- Clear Q- switch laser too. This laser is perfect for you. Also a used Lumix 2 laser, best price today. Dr. Zuckerman is in the Fort Lauderdale area and will demo these lasers on your patients. E-mail footcare@comcast.net

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

  PM News Classified Ads Reach over 12,500 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 12,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

• 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.