The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

May 04, 2011 #4,151 Publisher-Barry Block, DPM, JD

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The link to the complete version of the PM Jury Reporter was inadvertently left out of yesterday's PM News. To access this Jury Verdict Reporter, click here. 

MN Podiatrist Urges Self-Foot Care for Diabetics

Podiatrist Dr. Jengu Lai of the Rochester Clinic, PLC says self-foot care is important for diabetics. He advises cleaning your feet very well while showering and, afterward, making sure your feet are completely dry. Inspect your feet daily and wear good-quality socks made of material other than cotton. 

Dr. Jengu Lai

Cotton, Lai says, retains a moist environment for athlete's foot and increases friction that can cause blisters. Shoes should have good insoles to relieve foot pressure, Lai says. People with diabetes should buy their shoes and then take them to a podiatrist to make sure they fit properly.

Source: Jeff Hansel, The Post-Bulletin, [5/2/11]

NYCPM To Celebrate Centennial on May 18th

In two weeks, the New York College of Podiatric Medicine (NYCPM) will be celebrating its 100th birthday. To commemorate this historic occasion, Podiatry Management is publishing  an article by historian Dr. Gerald H, Grayson on the history of the college. You can read this fascinating article by clicking here.  

NYCPM - Then and Now

You can order tickets to the Centennial gala by contacting Dr. Stanley Kornhauser, Vice President, Institutional Advancement, at (212) 410-8498, or skornhauser@nycpm.edu

OH Podiatrist Visits White House on Historic Day After Demise of Bin Laden

Mike and Julianne Shlonsky of Lyndhurst stopped by the White House on the Monday morning after Osama bin Laden's death to find the usual collection of tourists milling around outside. "It's more subdued than I would have expected," said Dr. Mike Shlonsky, a Cleveland Clinic podiatrist who was in Washington to pick up his son, Matt, at the end of his freshman year at American University. 

Dr. and Mrs. Mike Shlonsky (Photo Sabrina Eaton)

Shlonsky said he found it reassuring that U.S. forces spent years working behind the scenes to bring bin Laden to justice. He said Matt and his friends were among the throngs who gathered outside the White House until 2:30 a.m. today to celebrate bin Laden's demise.

Source: Sabrina Eaton, The Plain Dealer [5/2/11]

CMS Finalizes New Rule on Telemedicine

A final rule from the CMS will change the process that hospitals use to credential and grant privileges to physicians and other practitioners who provide care through telemedicine. According to the CMS, the agency's regulations before the final rule had required hospitals—including critical-access hospitals—to grant practice privileges to remote-site physicians and other practitioners who were already credentialed in distant-site facilities after they considered qualifications on a practitioner-by-practitioner basis. As a result, those practitioners could not provide care through telemedicine services unless they had been granted privileges by their home hospital and the remote hospital or critical access hospital where the telemedicine services were delivered.

The new rule—which takes effect in 60 days—says a hospital or critical-access hospital that provides telemedicine services to patients through an agreement with a so-called distant hospital or telemedicine entity can now rely on the information from the distant hospital or telemedicine entity when making the credentialing and privileging decisions for those physicians and practitioners at the distant site who will supply the services.

Source: Jessica Zigmond, Modern Healthcare [5/2/11]

Query: Recurrence of Club Foot

This patient is a 55 year old white male. His medical history is uneventful, except that he was diagnosed with a club foot as a child and was cast for it. He stated that about a year and half ago, his foot started turning in and he walks on his toes now. He states that he feels as if he is walking on his ankle. 

Recurrence of Clubfoot

Upon examination, the right foot is completely plantarflexed and completely inverted. It is nearly impossible to get any dorsiflexion or eversion from the right foot. X-rays are unremarkable. It appears  that this patient's club foot has returned. What are the reasons, and how can this condition be fixed?

Sean S. Ravaei, DPM, Beverly Hills, CA

Query: Microfracture Talus Arthroscopy Question

What is the coding recommended for an arthroscopy ankle with repair of a microfracture talus with a chondral injury?

Brigitte Rose, Grand Junction, CO

Response: You would bill CPT 29892 - arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy).

Vincent Marino, DPM, San Francisco, CA

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

RE: Neuroma Injection Complication? (Ron Werter, DPM)
From: Neil Levin, DPM, Michael M. Rosenblatt, DPM

On very rare occasions, patients will experience a "flare reaction" to the alcohol injections. I typically warn patients prior to an initial alcohol injection that this is a possibility. Usually, these reactions are minor and last for 24 - 48 hours. Occasionally, I have had to place patients on Medrol Dosepak. I do not re-inject these patients and will move on to a different treatment.

Neil Levin, DPM, Sycamore, IL, drfeet1@aol.com

Along with the risks of DVT for which Medrol Dosepak was administered, there is a complication of high doses of cortisone that podiatrists should be aware of. If a patient has a history of alcoholism, esophageal varices, stomach ulcer, etc. the cortisone can precipitate an erosion of the lining of the ulcer and result in an precipitous and fatal hemorrhage, leading to sudden death.

Anyone who prescribes a Medrol Dosepak should closely question...

Editor's note: Dr. Rosenblatt's extended-length letter can be read here.

RE: Distal Hallux Nail Growing Into Distal Nail Edge (David Kahan, DPM)
From: Michael J. Schneider, DPM

Block the toe, free up the distal edge, and have the patient use an "orange stick" to keep the edge from growing in. Keep the nail soft under occlusion with A&D (after it has healed).

Michael J. Schneider, DPM, Avon-Frisco, CO, vailfootdoc@aol.com

RE: TrakNet EMR (Laura R Lefkowitz, DPM)
From: Alan L. Bass, DPM

I am a long-time user of the TRAKnet PM-DPM EMR program. For the last couple of years, I have been working closely with Biomedix as a consultant, and I am a big supporter of the program. The templates are podiatry-specific and the billing module that integrates with Gateway EDI as a clearinghouse is first-rate. The charting is easy and I am able to complete charting in the treatment room before I see the next patient. Referral letters are generated with just a couple of clicks as soon as the note is completed.

Disclaimer: I am no longer a consultant for Biomedix. I am now part of the Collaborative Practice Solutions, LLC (CPS) team.

Alan L. Bass, DPM, Manalapan, NJ, abassdpm@optonline.net

RE: Duty to See Patients in Isolation (J M Cortez, DPM)
From: Richard A. Simmons, DPM

The concern is about cross-contamination of patients. Autoclave sterilize your instruments in separate packs, one for each patient seen at the facility regardless of where the patient is located. If necessary, wear a sterile gown for each patient in isolation along with a mask. Carry a spray bottle of alcohol, dilute povidine or dilute antibacterial soap to prep each patient's feet. If grinding of the nails is necessary, then you will need a sterile sleeve for the drill and a sterile bit for each patient. I sense Dr. Cortez's trepidation, but simply ask the question: "If not me, then who?" As podiatrists, this is included in what we do.

Richard A. Simmons, DPM, Rockledge, FL RASDPM32955@gmail.com

RE: Complex Regional Pain Syndrome In Left Foot (New York)
From: Frank Lattarulo, DPM, Jeffrey Kass, DPM

I find  the prevalence with which some plaintiff "experts" names continue to appear in this forum quite interesting .
 
Frank Lattarulo, DPM, Elmsford, NY, DOCLATT@aol.com

While we are limited to reading the "jury verdict" and not all the details of this case, I would like to comment in hopes of not having to read about fellow podiatrists being sued.

1. Never discard anything that you remove from surgery. Send it to pathology.

2. Whenever inserting metal - always take an immediate post-op film. This way, that is your proof you put it where it belongs. If the patient slips, falls, gets run over, takes it out, or whatever, you prove it was originally there.

I think the more important issue, in this particular case, is whether the patient actually has complex regional pain syndrome. The focus of the jury verdict did not appear to be on that issue.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

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

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 - 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

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 - 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 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 – 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

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