The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

April 30, 2011 #4,148 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.

NY Podiatrist Discusses Treatment of Hammertoes

If a hammertoe develops, it’s important to see your doctor, says, Dr. Tzi Bar-David, New York-Presbyterian/Columbia podiatrist. While the condition can be treated using pads and gel protectors, surgery is sometimes necessary. The contemporary approach involves placing tiny metal implants inside the affected toes to realign the bones. Recovery is fairly quick: Patients can lace-up in comfortable shoes in as soon as two weeks. These implants improve on the older, wire-based approach, which took longer to heal and had a higher infection risk, explains Dr. Bar-David. 

Dr. Tzi Bar-David

In rare cases, hammertoes can be a sign of muscle, nerve, or joint damage from a congenital deformity or conditions such as osteoarthritis, rheumatoid arthritis, stroke, or diabetes. “In particular, people with diabetes have to be extra careful with hammertoes because the condition can cause infections and other problems,” says Dr. Bar-David.

More Attention Needs to be Focuced on Discharged Patients: NY Podiatrist

National health officials and local hospital executives on Wednesday unrolled an Obama administration initiative to save as many as 60,000 lives by reducing medical errors and patient complications after they leave a hospital. 

Dr. Jaime Torres

Much more attention needs to be focused on the "handoffs," when patients are discharged to nursing homes or home care, to make sure they get the right medication and a follow-up phone call within 24 hours, said Dr. Jaime Torres, a podiatrist and Health and Human Services director for the region that includes New Jersey, New York, Puerto Rico, the U.S. Virgin Islands, and eight tribal nations.

Source; Lindy Washburn, Herald News [4/28/11]

HHS Proposes ‘Mystery Shoppers' for Docs

HHS is proposing to use a “mystery shopper” program to gauge primary-care physicians' timeliness in accepting new patients, according to a notice in today's Federal Register. The plan calls for contacting 4,185 primary-care physicians—465 in each of nine as-yet-unnamed states—twice, once by someone pretending to be a new patient who has private insurance and once by someone pretending to be a publicly insured patient. Scenarios will involve patients with both urgent medical concerns and those requesting a routine medical exam.

The purpose of this program, according to the Federal Register item, is to assess the timeliness with which primary-care services could be provided, gain insight into reasons why availability is lacking, and provide current information on primary-care availability and accessibility.

Source: Andis Robeznieks, Modern Physician [4/28/11]

Query: Neuroma Injection Complication?

I use 1 cc of a 6% anhydrous alcohol in 0.25 Marcaine for my neuroma injections. I had a patient with bilat neuroma pain, so I had injected both feet 3-4 metatarsal areas. He returned after the second week of injections complaining of redness, swelling, and 3-4 degrees temperature elevation unilaterally on the posterior medial lower leg and ankle. I stopped the neuroma injections. I diagnosed cellulitis, put him on oral antibiotics, and spoke to his PCP.

The PCP thought it might be from his Norvasc, and took him off it for a while. The temperature elevation decreased dramatically over the next visit, and there was less swelling and redness. The blood work found no WBC elevation. Now, at three weeks, there is still slight swelling and redness. Could the injections have caused this type of side-effect?

Ron Werter DPM, NY, NY

Query: Keryflex Toenail Restoration

I was wondering if anyone has experience with Keryflex Toenail Restoration and could offer some "pearls."

Susan Papp-Mlodzienski, DPM, Philadelphia, PA

Query: Duty to See Patients in Isolation

I see patients in a local convalescent hospital. At times, some of the patients are in isolation.  I make it a point to avoid seeing these patients because I do not want to risk cross-contamination. The social services department at the facility is insisting I see these patients.  I have expressed my concerns but I do not think they understand.  How have others handled this situation? 

JM Cortez, DPM, Simi Valley, CA, jmcdoc@roadrunner.com

Query: Ulcer Debridement Billed with Nail Debridement

I billed CPT 97597 (selective debridement) and CPT 11721 (debridement, nails; 6-10) performed on the same day only to get a deny despite using a "-59" modifier. Is CPT 11721 billed first and then CPT 97597-59, or does it not matter?

Patrick Grisafi, DPM, Jamaica Estates, NY

Response: The "-59" modifier should be appended to CPT 11721.

According to the 2011 Correct Coding Initiative file, CPT 11721 is mutually exclusive of the "comprehensive" (according to the CCI) code, CPT 97597.

Robert Weatherford, Jacksonville, FL

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

RE: Distal Hallux Nail Growing Into Distal Nail Edge (David Kahan, DPM)
From: Robert Kornfeld, DPM, Geoffrey Bricker, DPM

Excise the hyponychium down to the bone. The regenerated tissue is much flatter and solves the problem.

Robert Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

The patient probably has a subungual exostosis. I recommend treating this by taking a fishmouth wedge with a generous skin resection and bone resection, and the nail should grow out. If there is any cryptosis at the borders, that should be addressed via a Winograd at the same time.

Geoffrey Bricker, DPM, Springfield, MO, geoffreybricker1@msn.com

RE: Liquid Nitrogen for Warts (John Moglia, DPM)
From: Michael Krischer, DPM, Pete Harvey, DPM

I have been using liquid nitrogen for the past five years for treating verrucae. It is highly effective and cheap. However, it is bulky and takes up a lot of space. We (IHS) find it practical for a large clinic where numerous doctors utilize it daily. But for a small practice with low numbers of warts, it may take up too much space.

Michael Krischer, DPM, Cooper City, FL,  mskrischer@cnhsa.com

Like most doctors, I use a variety of methods to treat warts. Those might include monochloracetic acid, liquid nitrogen, candin injections, 5FU with sal acid, etc. I seem to get the best results with monochloracetic acid. I do not keep a full dewar of liquid nitrogen on hand at all times. Periodically, if a wart has not responded to other methods, I’ll use liquid nitrogen.

I order it locally from a welding supply. They bring a truck to the office and then take my dewar outside to their truck where they then fill it. The cost is about $45. The full dewar will last about three weeks due to evaporation. I apply liquid nitrogen with a cotton-tipped applicator.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

RE: Exogen Bone Healing System (Tip Sullivan, DPM)
From: Simon Young, DPM

I have not used Exogen or any system for all fractures/osteotomies for 30 years (except for an occasional Jones fracture and two non-unions). They all healed within the prescribed time frame. I certainly am no fan of insurance companies.

Why so many practitioners choose to prescribe such an expensive modality for common pathologic malady boggles my mind. If podiatrists can't handle these common pathologic problems, they should be referred to a competent local practitioner who can. These modalities should be used as a last resort, not as a first line of defense. Why we are such enthusiastic salespeople confuses me more.

Simon Young, DPM, NY,  NY, simonyoung@juno.com

RE: More Malapropisms

A patient came into the clinic complaining of a painful “farmer’s wart.” I asked, “Did you mean “plantar wart?” He replied, “I knew it had something to do with agriculture.”

Evan Meltzer, DPM, Jackson, MS

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 NEEDED - MIAMI, FL

Full-time. Very Busy practice. Rearfoot/forefoot/wound care. Salary + % gross. Send CV to footdoctorinmiam@aol.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA

Busy podiatrist looking for assistance with treating home-bound patients. Flexible hours, independence, and great compensation. If interested, email CV to homefootcare@hotmail.com

ASSOCIATE POSITION - TEXAS

Need a good paying job in San Antonio or Austin? Just ask the other podiatrists working with us. Good hours and great support staff. Consider us first! Check out www.footmobile.com and reply to footcenter1@sbcglobal.net

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 - SOUTH/CENTRAL PENNSYLVANIA

PSR-24/36 trained individual for busy practice in family-friendly college town. Seeking personable, ethical, motivated individual to join our well established practice providing all aspects of podiatric care. Competitive salary and benefits package. Reply with letter, CV and photo to Jagerone@aol.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 – 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 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

PRACTICE FOR SALE - NORTHWEST SUBURBS, CHICAGO, IL

Great Opportunity! Present owner to stay on for transition. Average 20% growth over 3 years while open only 4 half days a week. Excellent growth potential with increased hours. Perfect for a new practitioner or a 2nd location. contact podiatrynwsuburbs@gmail.com for information.

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.