The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

May 09, 2009 #3,541 Publisher-Barry Block, DPM, JD

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MD Podiatrist is IT Medical Pioneer

If the healthcare industry evolves as some say it will, podiatrist David J. Freedman may one day be regarded as a medical IT pioneer.  Freedman had an electronic records system installed at his Silver Spring practice way back in 1997. Last October, he decided to have a new electronic billing system set up, one that is compatible with the records system.

Dr. David Freedman (Photo Naomi Brookner)

Freedman, president of the Maryland Board of Podiatric Medical Examiners, said most of his colleagues are still largely shunning such information technology, using paper-based systems and filing cabinets. Only 1.5 percent of hospitals nationwide have fully computerized medical record systems, according to a recent study published in the New England Journal of Medicine.

"The system has not only saved us time and money, but it has improved our efficiency," said Freedman, who presides over Ambulatory Foot & Ankle Center. "For instance, we know right away whether patients are covered" by medical insurance.

Source: Kevin James Shay, Maryland Business Gazette [5/8/09]

Attendees from Five States Attend Chicago SOS Staff Training Workshop

In a full room at the Oak Brook Renaissance Hotel on May 1st, doctors, managers and staff from IL, IN, WV, OH and IA found out what the SOS Staff Training Workshop is all about. Lynn Homisak, Workshop coordinator and trainer says, “Staff is a practice’s greatest asset and there is a need for proper training. We completely focus on this simple concept: Nurture your Staff…Nurture your Practice by teaching attendees how increasing staff productivity increases overall practice efficiency and we do it in a fun, learning environment.” 

SOS Staff Training Workshop

Nancy Zarate, PMA, explained, “I learned how our role can make a difference in more (practice) revenue vs. lost revenue!” Lynn and Dr. Josh White of SafeStep spend a full day providing doctors and staff with the necessary management and training tools for mutual achievement. Dr. Michael Chin of Chicago, stated, “The information was greatly appreciated and we will implement this into my practice to improve communication and work flow. It was time well spent; well worth it!”

Query: Intractable Arch and Heel Pain

Any suggestions on treatment plan for a 24 year old healthy OR scrub tech with intractable arch and heel pain exacerbated while working in the OR and standing on that slate floor. She has to wear compression hose and wears one piece Dansko clogs. There is no vascular disease whatsoever. BMI is normal. She had temporary relief with hard and soft orthotics cast in subtalar neutral, but has intense pain at the end of each day after standing all day at work. Is there a better hose or a better shoe for the patient who works in the OR?
 
Charles Gilarski, DPM, Ames, IA

Query: Repair of Ultrasound Unit

Does anyone know of someone who repairs ultrasound therapy units?

Fay Sharit, DPM, Hackensack, NJ

Query: Casting Supply Codes

What are the current casting supply codes for both fiberglass and plaster?

David Sands, DPM, Great Neck, NY

Response: The coding of cast supplies depends on the payer.

For most non-Medicare payers: A4580 is "cast supplies (e.g., plaster)" while A4590 is "special casting material (e.g., fiberglass)." These are billed "per roll" (put the number of rolls used in the unit box, 24G.)

For Medicare: Use Q4029-Q4051, depending on whether the patient is a child or adult, type of cast/splint applied, and type of material used. You only bill the "Q" casting supply codes once.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at:
http://www.codingline.com/subscribe.htm

RE: Is this Raynaud’s (Debby DeRose, DPM)
From: Multiple Respondents

This is not Raynaud's. This is acrocyanosis. This condition is frequently confused with Raynaud's and also erythermalgia. This is due to dysfunction of the sympathetic nervous system. Options for treatment include posterior tibial nerve blocks (which are local sympathectomy blocks) and sympathectomy. Extremities should be protected from cold. Warm weather helps. Niacin may help with vasodilation.

Mike Boxer, DPM, Woodmere, NY, mcbdpm@aol.com

Assuming that there is an increased temperature gradient and there were skin lesions prior to instituting the medication, it is most likely pernio as diagnosed by the dermatologist. My experience has shown that there is almost always an excitatory neurotransmitter dominance leading to severe peripheral vasoconstriction. Balancing neurotransmitters can be very helpful, as can MicroVas therapy. We also use L-arginine and ginkgo biloba as an adjunct in patients who are not on Coumadin. 
 
Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

Anytime I see cyanosis of the toes, the first thing I look for is heart or hypertension meds. Most vasodilators like ACE inhibitors and beta-blockers will cause vasoconstriction in the fingers and toes as a side-effect. The worst offender I've seen is atenolol, but Coreg and the other dilators will do the same thing. This is listed as a side-effect in the literature but, for some reason is overlooked. Unfortunately, when many MD's come across this, their solution is MORE vaso-dilator medication which, of course, worsens things.

Oftentimes, this can be treated by changing meds (if possible) and spraying the bare feet twice a day with underarm antiperspirant. This will help keep the feet warmer. In a young person, you may see this with some asthma meds as well. If she is not on meds, more than likely, she is lying about recreational drugs or truly does have Raynauds. You didn't say if you did a sed rate or a rheum profile. If you did not, now is the time. If it's Raynauds, then you need to rule out lupus and scleroderma.
 
Gary S Smith, DPM, Bradford, PA, penndoc@verizon.net
 

RE: Brevio Nerve Conducting Test (Lawann Scott, DPM)
From: Steven Goldstein, DPM

It is important to remember that no matter what CPT-4 codes are used, one must be able to interpret these results with accuracy. Should a malpractice action surface as a result of test interpretation, you will be held to the same standard as a neurologist. Billing for these tests with the sole purpose of increasing your bottom line may come back to haunt you at a later date.

Steven Goldstein, DPM, Royal Palm Beach, FL, Stevefootdr1@yahoo.com
 

RE: Venous Stasis Hyperpigmentation (Elliot Udell, DPM)
From: Art Hatfield, DPM

Dr. Leroy Numbers taught us about the venous heart dressing back in 1970 at the Old Illinois College of Podiatric Medicine. As I recall, he used a piece of foam rubber not necessarily cut in the shape of a heart over venous stasis ulcers. It was called a venous heart dressing because any motion of the leg would cause the Unna boot or Ace wrap to apply gentle pressure through the foam to the ulcer. This would assist the incompetent communicators in moving blood away from the ulcer. I have never heard of it being used to treat hyperpigmentation.

By the way, it does work. It has probably gone out of favor recently because of the popularity of multiple layer wraps. I still do use it however, occasionally between layers of a Porfor dressing.

Art Hatfield, DPM, Long Beach, CA, Afootjob@Juno.Com

RE: International Podiatry
From: Dave Williams, DPM

There has been a significant amount of discussion regarding the practice of podiatry overseas. As someone who has lectured in Europe, here are some of my observations:
 
The future of podiatry is bright. Countries all over the world are now recognizing podiatric care as being essential to the overall practice of medicine. However, when we move away from the U.S. and Canada, there is a significant issue waiting in the wings. The problem, as I see it, centers....

Editor's note: Dr. William's extended length letter can be read at: http://www.podiatrym.com/letters2.cfm?id=26217&start=1 

ASSOCIATE POSITION - HENDERSON, NEVADA

Associate wanted for thriving, well-mixed 3-doctor digital office, leading to partnership. Surgery, diabetic, pediatric, and general podiatry. Great office and location, fun area to live. Need 2+ years surgical residency. Must be energetic, self motivated, great patient skills. Salary plus bonuses. Email CV to gtorgesen@yahoo.com

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

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, and Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

ASSOCIATE POSITION – ILLINOIS 
 
Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested, fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE POSITION - CONNECTICUT

Nice community outside of New Haven. Well-established, busy practice seeking part-time or full-time associate. Excellent opportunity for a highly motivated and ethical professional. Must have good patient skills. PSR-12 or higher with excellent skills required. Send resume and cover letter to fax # 203-439-7916.

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

EQUIPMENT FOR SALE - ESWT

High Energy Shockwave Device (NEW);FDA approved as Class 1, payable by Medicare for treatment of Plantar Fasciitis (28890); Payable to surgery centers for Achilles tendinosis; 2 units available; Under $30,000. CONTACT: weil4feet@aol.com

PODIATRISTS NEEDED – DALLAS/ FT WORTH – TEXAS AREA

Texas Home Footcare Associates, a podiatry exclusive company specializing in house calls and visits to facilities for the elderly, is looking to hire podiatrists. We are located in the Dallas area. Full and part-time positions are available. Immediate Openings Available. Must have a Current Texas license. Competitive Compensation Package. If interested fax curriculum vitae to 972 931-4819 or e-mail gjmdpm@tx.rr.com. For further information, call 972-380-8028.

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.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

EQUIPMENT FOR SALE- ALLPRO IMAGING 2010 XRAY DEVELOPER

This processor is only two years old. It is in good working order and has always been regularly maintained. We are in the process of changing to digital films. Will sell for $1300. New Hampshire e-mail wcgcoach@aol.com

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