The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

May 12, 2008 #3,243 Editor-Barry Block, DPM, JD

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IL Podiatrist Provides Advice for Plantar Fasciitis

Marlene Reid, DPM, a podiatrist in private practice in Westmont, IL, and past president of the American Association for Women Podiatrists, tells WebMD that plantar fasciitis can best be prevented by walking in sturdy shoes, with good stability and arch support, rather than flimsy sandals or flip-flops. Once it starts, the disorder -- which usually hurts worst right after taking the first steps in the morning -- can go on for months, gradually getting worse rather than better.

Dr. Marlene Reid

If the pain lasts more than two months, Reid recommends seeing a doctor. "You could stretch gently in the morning before walking," she says. "There also are different types of heel cups you can buy. "The doctor might also recommend physical therapy or night splints," Reid says. "Cortisone can be injected, and there are shockwave and cryogenic treatments available to destroy the inflamed tissue and promote normal healing."

Source: Star Lawrence, WebMD [5/9/08]

TN Podiatrist Publishes Self-Help Foot Care Book

Michael A. Perrone, D.P.M., OCPM class of 1958, recently wrote a book for the consumer market, The Foot Care at Home Book. Although the main focus of this self-help book is for those who live far from podiatric professionals, the book is also seen as a value to LPNs, RNs, and podiatric assistants. In addition, the book can serve as an introductory text for those beginning their studies in the field of podiatric medicine.

Dr. Michael A. Perrone

Since his graduation, Dr. Perrone has served as the President of the Tennessee Podiatric Medical Association, as a member of the Tennessee Podiatric Examining Board, and on state committees which aided in establishing medical and surgical privileges for podiatrists in all Tennessee hospitals. While practicing podiatry, Dr. Perrone also served as a teacher/clinician. He was honored with the Stickel Award for his work in research, and became a pioneer in the application of the rotary surgical instruments and minimal invasive procedures. In 1972, he wrote the book, Podiatric Nail and Bone Surgery with a Rotary Airmotor. After 37 years, Dr. Perrone retired from a very successful private practice in Nashville.

Source: OCPM

NPI Deadline: Insurers Won't Pay Claims with Old IDs After May 23

Starting May 23, physicians must use only their National Provider Identifiers in place of any other IDs when filing all electronic claims and some paper claims with Medicare and other payers. The Bush administration already has extended this deadline by a year, but organizations representing doctors and others warn that even more time is needed before they will be ready to make the final transition.

Near the end of April, about 20% of all Medicare claims were being submitted with NPIs only, according to the Centers for Medicare & Medicaid Services. CMS will continue to monitor physicians' progress on the identifier in the days leading up to May 23 and will evaluate if any administrative action on its part is necessary.

CMS is urging all physicians to work to file the NPI-only test claims right away, and the agency expects the roughly 20% figure to rise rapidly over the last few weeks leading up to the deadline. On May 7, participating clearinghouses held a "Legacy Free" day by stripping all old ID numbers from claims processed with dual identifiers. Physicians who still needed to fix their information in the new NPI system or Medicare enrollment files would see those claims rejected but would have some time to set the record straight before the deadline.

Source: David Glendinning, AMNews [5/12/08]

Query: Medical Crocs

At some of the major seminars the company that makes Crocs is offering a line of "medical Crocs." They are especially designed and only available through doctors. Has anyone had experience with selling CrocRX in their offices? If so, what have your experiences been?

Elliot Udell, DPM, Hicksville, NY

RE: Traumeel for Capsulitis/Plantar Plate Injuries (Neil Levin, DPM)
From: Multiple Respondents

I have started using Traumeel in my practice as an alternative to steroid injections particularly in areas where a steroid might be contraindicated such as Achilles tendonitis and for the same reason in the case Dr. Levin mentioned. Traumeel is a combination of 14 homeopathic medicines. Its benefits according to company literature are no GI side- effects, no platelet aggregation inhibition, no known adverse drug interactions and no sodium and fluid retention. It is listed in the PDR (page 1664, 2007 edition.)

Based solely on my own clinical experience, I do not find it to be very successful. When I compare cases of equal magnitude (pain, severity of injury) people do not respond as well as say, if I gave a steroid injection. In cases where I would not give a steroid injection, it appears to me immobilization and an oral anti-inflammatory gave me a better result than immobilization and a Traumeel injection.

In plantar plate injuries, I find immobilizing and stabilizing the MPJ by padding the second mpj area with a "u" pad and strapping the toe in a plantar-flexed direction to be the single most important part of the treatment. Supplementation with an oral NSAID works for me. I encourage Dr. Levin to experiment and find what works for him, and I do not feel there is any contraindication of using the Traumeel in his case.

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

One Monday morning, the acupuncturist who practiced next door to me came in my office and handed me a tuberculin syringe and said, "Would you please inject this into my 1st met-cuneiform joint"? I asked what was in the syringe and he told me it was .5 cc. of Traumeel and .5 cc. of 2% lidocaine. I was very skeptical, but went ahead and injected it. He convinced me to use it on my patients, which I did, for trigger points, MPJ pain, plantar fasciitis. As I recall, the results were every bit as good as with steroids and without the side-effects. Some 3 years later, I asked if he had any further M-C joint pain and he told me that the single dose took care of it. Actually, Steve Subotnick, DPM is the most experienced with the use of Traumeel.

Mitchell R. Mosher, DPM, Belmont, NC, bowenfootdoc@yahoo.com

The use of Traumeel injections for any non-degenerative inflammatory process is something I have been doing for over twenty years. It is important to understand the mechanism of action so that you understand why you should not inject it intra-articularly. Traumeel is an upstream kinase modulator. It has an effect on cell signaling and facilitates a conversion of inflammatory pathways from chronic to primary. As such, if you inject it into a joint, two things may happen.

First, you will lose efficacy because it functions best in the extracellular matrix. Second, if you inject a "therapeutic dose" into the joint, you may foster an acute inflammation in the area, instead of a therapeutic primary inflammation. When used properly (and in this case peri-articularly), you will enliven the pathway of detoxification and cellular repair. One must also note that there are other things that are helpful systemically when promoting a more efficient inflammatory response. This comes under the realm of functional medicine and is an integral part of these protocols.

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

RE: Total Contact Casting with Wound Care
From: Eric Jaakola DPM, Rober Wunderlich, DPM

My office used 1030 total contact casts last year without a reimbursement denial. We use them for post-Apligraf aplication as well as post-operative treatment such as partial amputations and Charcot surgeries. We apply them on a weekly basis or sometimes twice weekly, if need be, without reimbursement issues. For more specific coding questions you could contact MedEfficiency who produces a Total Contact Casting Kit. They can address issues on a state-by-state basis.

Eric Jaakola DPM, Denver, CO, ejaakola@yahoo.com

If you apply a total contact cast (CPT 29445) on the same date of service as a debridement or other procedure, they will bundle the cast in with that other procedure (i.e., you won't get paid for the cast). However, you can apply the cast any time thereafter (including the next day, if you want) and you will be paid for the cast application and materials. My experience has been that casting is separately reimbursable within ANY global period (whether it be for offloading an ulcer, immobilizing a fracture, or for immobilizing an osteotomy), and the only modifiers I use are either -RT or -LT.

P.S. - Don't forget to bill for your casting supplies! (Q4037 for plaster and/or Q4038 for fiberglass)

Rober Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com

Re: PR-96 Denials for Therapeutic Shoes for Persons with Diabetes
From: Paul Kesselman, DPM Woodside NY

In the 4th quarter of 2007, the National Government Services, Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Appeals unit received an increase in the number of redetermination requests for therapeutic shoe claims originally denied with ANSI code PR-96 (Non-covered charge.) This specific denial for therapeutic shoes often indicates that the supplier filed the claim without the required KX modifier.

Modifier KX is required on claims for therapeutic shoes when the supplier has secured the appropriate documentation within their files as outlined within the documentation section of the Local Coverage Determination (LCD) for Therapeutic Shoes for Persons with Diabetes.

Close review of the re-determination requests received for therapeutic shoes during the 4th quarter of 2007 reveal a 59.0% reversal rate. In most cases, suppliers are requesting a re-determination due to the omission of the KX modifier. In cases where claims for therapeutic shoes are submitted without the KX modifier in error and the claim is denied as a non-covered charge (PR-96), suppliers are encouraged to resubmit the claim appending the appropriate KX modifier rather than requesting an appeal.

In addition, to avoid multiple re-determination/reopening request and the cost to resubmit a claim, suppliers should thoroughly review the Documentation section of the LCD for Therapeutic Shoes for People with Diabetes to determine whether modifier KX is required on the claim. Suppliers are also encouraged to review their claim(s) prior to submission to the DME MACs to ensure that the HCPCS and all applicable modifiers are appended to the claim correctly.

The local coverage determinations can be located on the National Government Services website

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

RE: Don’t Believe Everything I Write

One of the attendings was leading Board Review for MD/DO Family Medicine Residents at UTSW/ Parkland in Dallas. This attending is one of the most prolific authors in our department. She disagreed with an answer given in a journal-sponsored CME-type exam. We then looked up the journal's reference which cited the source for the answer as an article written by this same physician.

Dwight L. Bates, DPM, Dallas, TX

ASSOCIATE POSITION – MANHATTAN & QUEENS

Seeking new Residency graduate for growing three-office practice in Manhattan and Queens, start 07/08/08. Must be PSR-24 trained minimum. Must be ethical, well-trained, vibrant personality and ambitious. Willing to work hard and be a team player. Good base salary plus bonus incentive plan. Guaranteed partnership after one year. No long term employee. Apply only if interested in partnership and if you meet the outlined criteria. Please e-mail resume and cover letter to: hansfeet@aol.com

ASSOCIATE WANTED - KNOXVILLE, TN AREA

Busy multi-doctor, multi office practice heavily weighted in surgery. PSR-24 + experience preferred. Part-time also available. Area consistently ranked in top five areas of country to live, work or retire. Ranked third in country 2008 Boaters magazine for boating destination. First year guarantee $150,000 plus bonuses and benefits. Send cover letter an c.v. to davidphawk@adelphia.net

SEEKING RESIDENT FOR PSR-24 - BALTIMORE, MD (MERCY MC)

Position for a highly motivated individual with completed non-surgical residency or one desiring additional surgical training in well-established Podiatric Residency Program. Busy metropolitan hospital with high surgical numbers and inpatient care. Resident is integral member of multidisciplinary team. Begins mid June 2008. Includes competitive salary/benefits. Send inquiries to rsher18@yahoo.com

Well-known practice in Coral Gables,FL for over 20 years. Excellent location on Coral Way with heavy traffic, great visibility and plenty of parking. Busy, fully equipped, full-time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. For additional information contact QVAN@aol.com or 305-975-5516.

Beautiful location in the heart of Miracle Mile. Excellent opportunity for a starting practitioner. Most insurances accepted. Good mixture of surgical and general podiatry. Fully equipped with low overhead. Located in a professional building, with referrals from other doctors in the same building. Contact zoesar@aol.com or call 786-877-5149.

LOCUM TENUM COVERAGE - CENTRAL FLORIDA

The Orlando Foot & Ankle Clinic (OFAC) is seeking locum tenum coverage.
OFAC has offices in Orange, Osceola, Seminole, Lake and Brevard
counties. A covering doctor is needed whenever one of the 13 OFAC doctors is on vacation or attending an educational seminar. If interested, please contact Greg Renton, CEO at 407-423-1234.

ASSOCIATE POSITION - TEXAS

Check out San Antonio, Wonderful place to live. Full or part-time podiatrist with current Texas license. Better pay. Unique mobile podiatry practice and mobile wound care clinics, in addition to office locations. Check out our website Fine working conditions with excellent support staff. E-mail Response to footcenter1@sbcglobal.net or fax to 210-495-6484.

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