The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

May 17, 2008 #3,248 Editor-Barry Block, DPM, JD

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TX Podiatrist Offers Shoe Fitting Advice

Dr. Sean Schwarzentraub, a podiatrist, offers shoe shoppers these shoe fitting tips for selecting a shoe that's right for their feet. "Shoes should fit snugly around the heel and mid-foot so that your heel is not slipping as you walk and your foot is not sliding from side to side," Schwarzentraub said.

Dr. Sean Schwarzentraub

Be sure that the area for the toes is fairly deep and wide. A thumb's width should fit between the toe of the shoe and your longest toe, he said. The back of the shoe, or the heel counter, should be rigid, but the sole of the shoe at the ball of the foot should be flexible. "You should not be able to twist the sole of the shoe and it should not flex anywhere except at the ball of the foot," Schwarzentraub said.

Don't forget your arches. People's arches can be classified into three groups: high arches, average arches and low arches, Schwarzentraub said. People with high arches should look for a cushioning shoe, he said. People with average arches should look for a stability-type shoe, he said. And people with low arches should look for motion-control types of shoes, Schwarzentraub said.

Source: Kristen Hackney-Redman, Avalanche-Journal (Lubbock, Tx) [5/15/08]

CMS Releases Pressure Ulcer Prevention White Paper

The new CMS policy – CMS Acute Care Present on Admission (POA) Indicators / Hospital Acquired Conditions (HAC) Policy – is the most significant regulation to affect pressure ulcer care in the United States in this millennium. Concerned about the impact of these regulations on pressure ulcer care across the continuum of care, eight thought leaders in wound care, including David Armstrong, D.P.M., Ph.D, came together on February 2, 2008 in Chicago to dialogue about the issues.

This meeting was sponsored by an educational grant from Medline Industries, Inc. The result is the consensus paper titled: New Opportunities to Improve Pressure Ulcer Prevention and Treatment: Implications of the CMS Acute Care Present on Admission (POA) Indicators / Hospital-Acquired Conditions (HAC) Policy.

The International Expert Wound Care Advisory Panel invites all providers to read this consensus paper. This regulation goes into its full effect in October 2008.

Source: CMS

Healthcare Costs Up 7.6% for Families of Four in 2008: Report

The cost of healthcare for the average U.S. family with employer-sponsored health coverage will increase 7.6% this year, due in part to rising prescription drug prices, according to a Milliman study released on Wednesday, Dow Jones reports. The fifth annual Milliman Medical Index analyzed historical claims data and trends in provider contracting and examined the drivers and components of medical spending.

According to the study, the cost of medical services, including premiums, will increase by $1,109, from $14,500 in 2007 to $15,609 in 2008 for an average family of four enrolled in an employer-sponsored PPO. The study also found that the cost of pharmacy services is expected to increase by 10.6% to $2,302, compared with single-digit increases for physician services, inpatient and outpatient care (Knight, Dow Jones, 5/14).

Source: Dow Jones via American Health Line [5/15/08]

Query: Pre-molded Orthotics

Can anyone recommend pre-molded orthoses to dispense in-office for patients with cavus foot types, mainly to treat plantar fasciitis?

Jennifer B. Ryder, DPM, Rapid City, SD

Query: Medicare Unna Boot Application Denial

Can someone help me get paid from Medicare for the application of an Unna boot for a fractured cuboid. The claim was denied stating "This payment is adjusted based on the diagnosis," and "Payment has been adjusted because the information furnished does not substantiate the need for this level of service." The diagnosis code I used is listed as one of the diagnosis codes that support medical necessity on the Medicare website, and I did include the modifier indicating to which foot this was applied. Can anyone explain the reason the reimbursement was rejected?

Michael Perlstein, DPM, Brooklyn, NY

Response: According to the local coverage determination (LCD), L6979, from NGS Medicare's website on Unna boot application (CPT 29580), foot fractures and venous ulcers are the only two indications for which reimbursement is available.

If you billed a surgical CPT for fracture treatment of the cuboid for the same date of service, the Correct Coding Initiative (CCI) would kick out the Unna boot code as being included in the 'surgical' code allowance. If you also bill for an E/M service (CPT 99201 - CPT 99215) for the patient's initial presentation of cuboid fracture, an E/M visit would be allowed. One would need to amend the E/M CPT code with a "-57" (decision for surgery) modifier.

Subsequent Unna boot applications with a diagnosis of cuboid fracture in the global period of the fracture care should be allowed as long as you amended the CPT 29580 with a "-58" modifier (staged procedure).

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found by clicking here

RE: Contact Dermatitis from Chinese-Made Sandals
From: Dennis Shavelson, DPM

Below is a photo of the severe contact dermatitis that was produced by a pair of sandals manufactured in China, bought at Wal-Mart. This patient had no prior history of contact sensitivity.

Sandal-Induced Contact Dermatitis

The podiatric community should to be on the lookout for this condition. I am wondering if the Chinese are using a strong chemical glue or material with an irritant, as in the mercury-based paints they use.

Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com

RE: Billing Programs (Mark Williams, DPM)
From: Robert K Hall, DPM

We began billing programs in 1992, starting with DR software (DOS based/default/non-HIPAA), then Medisoft, then an outside billing service. For the past 3 yrs, we have used CollarorateMD (formerly ClaimGear). It is an Internet-based mainframe (read: no data loss due to crashes). It offers a flat start-up fee, depending on the features you want, gives daily updates on payor issues & a flat fee (not PER claim). Other options include auto-posting, Insurance verification, paper claim filing, etc. You can print multiple reports & access the program from ANY computer by logging on & entering password (Changed monthly, per HIPAA mandate). They offer free updates with no periodic upgrade fees or charge for support. This seems good to me.

Robert K Hall, DPM, Ft Lauderdale, FL, robertkhalldpm@bellsouth.net

RE: Faxing Consultations (Jeffrey Kass, DPM)
From: Mark J. Tuccio, DPM

The merits of faxing notes and consultations to referring physicians is without debate but as we all know too well, this can be a time-consuming and labor intensive process over the long haul not to mention the true costs of handling paper. If you are somewhat computer savvy, Symantec has an older program called Winfax Pro 10. We have used this software for about 7 years now and it really reduces costs of doing faxes considerably.

It can be set up in a networked fashion or as a stand-alone system. It requires one computer and a modem at bare minimum. I would caution against the use of the 30 dollar USB modems and spend the money for a more robust US Robotics serial connection modem. Faxes can be sent and received without ever printing them. They can be marked up and signed without ever printing them and received faxes can be stored on disk in the patient’s electronic chart. I would recommend, without reservation, this program and can speak from experience that it reducesthe true costs of faxing to the bare minimum.

Mark J. Tuccio, DPM, Jamestown, NY, drtuccio@stny.rr.com

ASSOCIATE POSITION - SOUTH JERSEY

Busy group practice. Digital x-ray, Diagnostic U/S, EMR. Located between Philadelphia and the Shore. Need ABPS Eligible/ Certified, PSR 2-3, hard-working, energetic, team player with good hands. Previous experience a plus. Must be willing and able to provide quality palliative care. Competitive financial package. Resume and references to dalilfeet@aol.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. 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

SOUTH CENTRAL PENNSYLVANIA-PM&S 36 ASSOCIATE WANTED

Large, busy podiatry group looking for associate interested in future partnership. Practice facilities and technologies include: Surgical Center, Physical Therapy Department, 6 appointment locations, EMR, MRI, Clinical Trials and Digital X-ray. Full compensation and benefit package offered. Mail CV to Martin Foot and Ankle, 1203 S. Queen St. York, PA 17403 or email johnreitzelmfa@aol.com

ASSOCIATE POSITION – HOUSTON, TX

Seeking a well-rounded resident for associateship in Houston. Candidate must be motivated, personable and goal oriented. Practice is well equipped with excellent support staff. Opportunity for buy-in following attainment of performance goals. Part-time position also available. Please send CV and letter of interest to drvargas@drvargas.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

ASSOCIATE POSITION – NW INDIANA (1 HR FROM CHICAGO)

Great opportunity for financial and personal success. Start at $150K plus incentive compensation, good benefits, and ownership potential. Must be highly motivated, have a great bedside manner and excellent surgical skills (forefoot and rearfoot). E-mail resume to friendlyfootcare@comcast.net or fax resume to (219)662-7290. Learn about us here

ASSOCIATE POSITION- SAINT LOUIS, MISSOURI

Busy office seeking associate interested in future partnership. Must be ethical, well trained in all areas of podiatry, strong surgical background, board eligible or board certified. Office includes Doppler, ultrasound and digital x-ray, EMR. Competitive salary and benefits. Email CV to stlfootdoc@yahoo.com

PRACTICE FOR SALE - FLORIDA

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.

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

PRACTICE FOR SALE - CORAL GABLES, MIAMI AREA (FLORIDA)

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.

ASSOCIATE POSITION - SOUTHEAST MICHIGAN

Seeking a quality-oriented, patient-focused RPR-trained associate for a fast paced, established group practice in Southeast Michigan. This is a secure, long-term position, emphasis on diabetic foot and wound care. Gain surgical experience while earning an excellent living. Our outstanding staff allows you to concentrate on optimal patient care without the responsibilities of practice management. Partnership possibility for the right individual. If you are highly motivated, ethical and have good communication and clinical skills, please fax your CV with a letter of intent to 734-981-0487.

ASSOCIATE POSITION - SAN ANTONIO, TEXAS

Seeking three-year trained resident for associateship, hopefully leading to partnership. Competent in all phases of podiatry particularly reconstructive rearfoot surgery. Outstanding opportunity for the right individual. Reply to Richard Pollak at 210-692-0279, or fax resume to 210-692-0028 or e-mail drpllk@hotmail.com

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