The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

May 23, 2009 #3,553 Publisher-Barry Block, DPM, JD

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OTC Products Will Not Correct Bunion Deformity: SC Podiatrist

While bunions are associated with older feet, Dr. William Parker of Conway Podiatry Center says that bunions are sometimes seen in young children, that flat feet make one more prone to bunions, and that sufferers need to be on the lookout for the development of arthritis in the big toe joint.

Dr. William Parker

Parker said it is wise to "have a bunion evaluated in early stages of development." Even if no treatment is needed at that time, a physician can watch to see if arthritis is developing and can address mechanical issues in the arch with supports or custom orthotics.

"A bunion that hurts should always be evaluated by a podiatrist," he said. "There are no over-the-counter treatments that will correct the deformity or cause the bump to disappear."

Source: Joan Leotta, The Sun News [5/19/09]

UA "SALSA" Surgeons Publish Guidelines for Amputation Prevention

Professors David G. Armstrong and Joseph L. Mills, co-Directors of the University of Arizona 's Southern Arizona Limb Salvage Alliance (SALSA) published a landmark "roadmap" for developing teams for amputation prevention. "We wanted to develop what we consider to be an essential set of skills for teams, worldwide, who want to develop successful programs for preventing amputations", noted Armstrong, the work's senior author.

Dr. David G. Armstrong

The paper describes seven skills that doctors, nurses and other providers require to care for patients in a "complete" program caring for the diabetic foot. These programs are becoming increasingly necessary, in response to the rising tide of amputations in the USA and abroad. In fact, there is one diabetes-related amputation performed every 30 seconds, worldwide. The manuscript is published in the online edition of the plastic surgery journal, e-Plasty.

Query: Charcot Foot and Gout
 
I recently had a mid-60's female diabetic present with what appeared to be late stage Charcot foot deformities with the typical midfoot destruction of navicular and cuneiforms, LisFranc's type lateral dislocation of the lesser metatarsals, and rocker bottom appearance.  She also noted that she had been treated for chronic systemic gout for the past year and a half. She underwent a CT scan and the radiologist noted that the midfoot destructive changes appeared consistent with an inflammatory arthritis such as gout.
 
Prior to this, I've had two or three other patients over the past year that had what appeared to be Charcot changes of the foot along with severe tophaceous gouty arthritis. I do not recall any particular connection between the two, so is this a frequent occurrence, and is it possible for chronic gout to cause the same pattern of bone destruction and collapse of the foot like Charcot?  If so, would the resulting foot deformities be treated like Charcot feet?
 
Leonard Kuzmicki, DPM, Spring Valley, IL

Query: HIPAA and Fax Transmissions
 
My son broke his glasses today.  I needed to get his most recent Rx from his ophthalmologist to his optometrist so we could order a new pair of glasses.  The ophthalmologist’s office refused to fax an Rx to the optometrist citing HIPAA regulations.  Wouldn't that make our calling in an Rx for any medication the same violation? I think they are using the rule to a) be lazy and b) make it more difficult for their patients to go elsewhere for their glasses.  I realize this is not a podiatry question but I think it definitely applies to us as well.

Chuck Langman, DPM, King of Prussia, PA

Editor’s comment: PM News does not provide legal advice. HIPAA’s Privacy Rule allows covered healthcare providers to share protected health information for treatment purposes without patient authorization, as long as they use reasonable safeguards when doing so. These treatment communications may occur orally or in writing, by phone, fax, e-mail, or otherwise.

For example:
• A laboratory may fax, or communicate over the phone, a patient’s medical test results to a physician.
• A physician may mail or fax a copy of a patient’s medical record to a specialist who intends to treat the patient.

Source: U.S. Department of Health & Human Services

Query: Celestone J Code

What J code is used for Celestone? What does Medicare allow for reimbursement?

Michael Munson, DPM, Columbia, SC
 
Response: J0704 - Celestone - betamethasone sodium phosphate, per 4 mg.

The 2009 Medicare allowance is $1.133 (non-par, $1.076) per 4 mg (or 1 mL).

Harry Goldsmith, DPM, Cerritos, CA

Codingline subscription information can be found at:
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RE: MTI 527 Podiatry Chairs (Lawann Scott, DPM)
From: John Scholl, DPM, Matthew Larsen, DPM

I purchased an MTI chair in February and so far I am very happy with it. The motor is smooth and quiet. Patients seem to be comfortable and it has no trouble lifting the heaviest of patients. I would not hesitate to buy another one.

John Scholl, DPM, The Villages, FL, drjms@embarqmail.com

I purchased the MTI 527 last year and love it. It sits lower than the Midmark, runs smoother and quieter, and has a removable stainless steel debridement tray. I have not had any mechanical issues either.  I wish I could replace all my chairs with the MTI!

Matthew Larsen, DPM, Racine, WI,  mlarsen@tds.net

RE: Digital Processors (Jeffrey Kass, DPM)
From: Kenneth Meisler, DPM

I read Dr. Kass’ response about digital processors. I too agree that switching to digital imaging was one of the best investments I have made in 30 years of practice. I do not agree with everything he said. I bought one digital system that he mentioned and after many thousands of x-rays was not happy with the quality of the image. I researched and switched to a 20/20 Imaging system and have been thrilled since then. He mentioned that there are only three companies that “promote to podiatry.” Dr. Kass left out 20/20 Imaging, formerly Reina Imaging. They have more than 650 units in podiatry offices.  They are probably #1 or #2 in the number of podiatry offices that are digital. In addition, their units are being used at NYCPM, TUSPM (two units), Scholl, and Barry U.

20/20 Imaging is also a sponsor of Present E learning systems, corporate sponsor to the AAPPM and they are the leader in podiatric DR (Direct) Systems (no processing at all!); their 4th generation of digital technology since introducing it to podiatry in 2002. I think it is very important for anyone considering digital to compare the image quality of different systems; it is the most important factor to consider when purchasing a digital x-ray system, followed by customer support.   

Disclaimer: I am a digital consultant for 20/20 Imaging

Kenneth Meisler, DPM, NY, New York, kenmeisler@aol.com

RE. Orthotics and Newspaper Interviews (Kevin Kirby, DPM)
From: Ivar E. Roth DPM, MPH, Michael M. Rosenblatt, DPM

Dr. Kirby hit the nail on the head. For those of you that have never been interviewed, the article you were quoted for, and what you actually said may be very different. I personally was very misquoted while on the stand in a trial last year and I was blasted by my fellow podiatrists for what was printed. I produced the transcripts for the newspaper and they wrote a full retraction later on but the damage had already been done in the minds of some of my colleagues.  As a suggestion, perhaps before the article is published, ask the writer to let you check it for accuracy. Otherwise demand a retraction if the facts are incorrect.

Ivar E. Roth DPM, MPH, Newport Beach, CA, ifabs@earthlink.net

Over the years, I have seen several "friends and associates" of controversial podiatrists send in "apologia" for their friends. In this particular case, a friend of a controversial podiatrist reminds us that the press often "colors" interviews, and the resultant article may bear little resemblance to the actual interview content.
 
While that is indeed true, it is also a fact that controversial podiatrists also have a voice and are fully capable (and permitted) to speak on issues right here in PM News, for everyone to read and decide for themselves.
 
While it is laudable to defend your friends, I would prefer that when controversies erupt here, the actual genesis of the controversy speak up for themselves. If they were articulate enough to express their controversial views publicly, they are also articulate enough to justify them here, with good data to prove their points. 
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

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  

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

EQUIPMENT FOR SALE

Used Acoustic Imaging Diagnostic Ultrasound. Comes with 10 MHZ linear probe. Printer included. Unit is a console on wheels and cannot be shipped due to its weight, must be picked up.. See website www.hurtheel.net for more details. Price: $3,000 Contact Information Henry Slomowitz  E-mail hslomowitz@gmail.com Phone 973-479-6305.

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 

1-YEAR PODIATRIC SPORTS MEDICINE FELLOWSHIP

Monrovia, California. Applicant must be a licensed podiatrist and have completed a podiatric residency program. Monthly Stipend $4,000 to $5,000. Please email your curriculum vitae to victoriamanagers@gmail.com Thank you for your interest in our Program.

SEEKING PODIATRIST FOR SUNDAYS - HOWELL, NJ
 
Our practice of over 18 years is looking for a DPM to provide treatment on Sundays at our Howell office located approximately 1 mile from Lakewood , NJ. Speaking Hebrew preferred, but not required.  Please reply by emailing a CV and cover letter to: toetoe@optonline.net or by faxing to 1-888-645-0241.

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

ASSOCIATE POSITION - NORTHWEST IOWA

Great opportunity for hard-working, ethical podiatrist to join Midwest multi-physician, podiatric group with multiple locations. A well-established, successful, growing practice with strong hospital affiliations seeking FT and PT surgically trained physician. Applicant should be well-trained in all aspects of surgical care, completed a 24-36 month residency, & at least board eligible. Diverse practice offering high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume to: 712-258-9977

ASSOCIATE POSITION- HUDSON VALLEY REGION, NEW YORK

Unique opportunity for the right person! We’re looking for a personable, motivated individual who is seeking opportunity and security in a high end multi-office group practice. This is an incredible position for the right person. Please reply to Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com

DIAGNOSTIC ULTRASOUND FOR SALE

Mindray 6600 with Sony thermal printer. Machine comes with a 10 Mhz linear probe. Split screen allows two images on one screen. All digital machine. Comes with factory warranty for 1 year from Atlantic Medical LLC. Price when new is close to $11,000.00. Price for this machine with printer is $5,500.00. For further information see website

CASE CONSULTING
                                                                  
Dennis Shavelson, DPM is accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds, pigmented & derm lesions, PRP and diagnostic dilemma’s from DPM’S. Full reporting with second opinion only and rapid return after care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

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

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