The Voice of Podiatrists

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June 04, 2009 #3,562 Publisher-Barry Block, DPM, JD

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By Jeffrey A. Ross, DPM, MD

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FL Podiatrist Provides Foot Hygiene Advice

“A lot of people think that if they shower every day, their feet are getting clean; that’s not true,” says Dr. Geovanny Chico of Orlando’s Center for Foot and Ankle Medicine and a spokesperson for the Florida Podiatric Medical Association. Chico recommends using a pumice stone or cleansing scrub to gently exfoliate the soles and sides of the feet, followed by a thorough washing with soap and water.After drying the feet, apply moisturizer, but not between the toes, advises Chico. Doing so could encourage bacterial and fungal growth.

Dr. Geovanny Chico

At the end of a long day, a good soaking remains an effective treatment for tired feet. Chico says cool, rather than hot, water is better for that purpose. “Your whole body will feel refreshed,” he says. “There are millions of nerve cells in your feet; by stimulating those nerves in a positive way, it produces a positive energy throughout the body.”

Source: Denise Bates Enos, Orlando Magazine [6/1/09]

CA Podiatrist Offers Free Visits to Community Struggling with Health Costs

Dr. Alireza Khosroabady, a local foot specialist is doing what he can to help the community by offering a free visit to patients in need. “I realize that some people have lost their jobs and consequently their health coverage,” said Khosroabady.

Dr. Alireza Khosroabady

“I wanted to give back to the community that has supported me, so I  thought the best way I could help is to offer my services for free to those in need. I am  telling my current patients to let their family and friends know that if they are in need of a foot doctor and have no health insurance, just call our office. We have dedicated two appointments per day for this matter.”

Source: Beacon Media News - Pasadena,CA  [6/2/09]

Three U.S. Podiatrists Speak at Indian Diabetic Foot Conference

Kochi, India held their first annual diabetic foot conference May 22-24. Among those invited to speak were: Drs. Stephanie Wu, David L. Nielson and Aprajita Nakra. Several lectures were given and a live Charcot surgery took place that was televised to over 150 general surgeons.

Dr. David Nielson (with mallet) , Dr.  Aprajita Nakra (looking on), and Dr. Stephanie Wu (viewing monitor).

Dr. Arun Bal was the organizer of the event. He is a general sugeon by training, but has found a great need for setting up a wing of the hospital dedicated to diabetic foot infections and complications. Dr. David Armstrong was instrumental in setting up the conections in the U.S. for the conference.
 

Query: Calcific Mass of The Plantar Heel

I would appreciate any recommendations regarding treatment options for this 65 y/o diabetic female with a slowly enlarging mass of the plantar medial heel over the past 7 months. The mass has enlarged to the point where it has become painful with ambulation. There is a visible protuberance at the plantar medial heel and the mass is firm with palpation and only tender with deep palpation. There is no history of trauma, but she does admit a history of "heel spur injection" to this foot by her PCP at least several years earlier. She is a well-controlled diabetic with good vascular status and appears to be a good surgical candidate if it should come to that. 

Calcific Mass of The Plantar Heel

MRI report as follows: "a probably benign extensively calcified mass medially in the plantar part of the foot near the calcaneus that measures 3.0 x 2.3 x 2.8 cm. Most of the mass is calcified. There is a soft tissue component that does enhance mildly. The etiology of it is not certain. The adjacent plantar fascia appears to be normal so it does not appear to be related to plantar fibromatosis."
 
Would needle biopsy be recommended prior to total excision? Partial vs total excision? If total excision is indicated,  are there any recommendations regarding the soft tissue defect that would result following excision of such a large mass?
 
James Anderson, DPM, Lewisburg, PA
 

Query: PADnet Vascular System
From: Chris Seuferling, DPM
 
I am seriously considering obtaining the BioMedix PADnet vascular system for my office. I am excited about its potential benefit for our PAD patients. I'd like some feedback from other users of the system,   regarding billing/insurance issues, user-friendliness (i.e.; how long does it take to perform exam?), impact on schedule and office flow, or any other input? Any advice would be appreciated. 
 
Chris Seuferling, DPM, Portland, OR
 

Query: Coding a Thrombectomy in the Foot 

What code would you use to bill a dorsal venous arch thrombectomy performed in an outpatient facility? The thrombosis measured approximately 8.5 cm in length in the inferior aspect of the dorsal venous arch.

Judy Manley, Office Manager, Itasca, IL

Response: The delay in a response probably corresponds to how uncommon it is to perform a true thombectomy in the foot. Usually a thrombosed vein is tied off and excised.

Accordingly, if what was done was an excision of vein/lesion within the subcutaneous tissue, then I would recommend coding the procedure as CPT 28043 (excision, tumor, foot; subcutaneous tissue).

If, however, a thrombectomy was truly performed where the thrombus was identified in the venous arch, the vein was incised, the thrombus removed, and the vein repaired (I, for one, would love to see the op report description of this), then the only code you have available to bill is CPT 37799, unlisted vascular surgery. If you utilize the unlisted procedure code, you must submit (with your operative report and claim) a letter explaining the medical necessity for what you did. You should consider incuding any reference to thrombectomy performed on the foot, and consider providing the CPT code of an existing procedure noting you believe that procedure's work is of equivalent value to what was performed.

Rick Horsman, DPM, Olympia, WA

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

RE: Prepare for the Unexpected (Bret M. Ribotsky, DPM)
From: Jerry Peterson, DPM

I was sorry to hear of  Dr. Ribotsky’s tragic news. I had the same experience with the fire occurring the day before my daughter’s wedding, so it was somewhat worse in a way. Dr. Ribotsky was well-prepared with the video of his contents. This was very smart. I told everyone the same thing after our fire, as I had not done that before it happened to me. It is so simple to do, but who ever thinks it will happen to them!

Also, have the insurance company come out every 2-3 years to make sure you have enough coverage even if you have replacement coverage. It doesn't mean it will cover everything! I lost $100,000 in the fire coverage because my policy wasn't adequate, due to increased costs versus the inflationary percent in the policy.

None of these things can replace the memories you lose, but it at least makes the pain of the experience a little easier to deal with. My heart goes out to Dr. Ribotsky and his family on the loss of those precious memories but at least he was ahead of the crowd on your preparedness.

Jerry Peterson, DPM, West Linn, OR, DRP@ifixft.com

RE: Post-Op Care for Alzheimer's Disease Patient (Daniel Cohen, DPM)
From: Multiple Respondents

I suggest that Dr. Cohen put the patient’s foot in an instant total contact cast.  

Dwight L. Bates, DPM,  Dallas, TX,  dlbates04@yahoo.com

Is there any way a "clam-shell walker" could be fabricated by a local orthotist/prosthetist (would qualify since patient is diabetic) and
then zip-strip it on, and remove/replace the zip-strips before/after wound/dressing change?

Robert Boudreau, DPM, Tyler, TX, rbftdoc@aol.com

Knowing now that the patient is in a skilled nursing facility clarifies the matter and I apologize to Dr. Cohen if my earlier message implied that the patient was being treated outside of such a facility. Be it as it may, we still need to come up with ideas on how to prevent the patient from mutilating himself. I have worked with specialists who have superior training in managing patients in the hospital or at home who have emotional problems either secondary to or in conjunction with serious medical problems. These psychiatrists take fellowship training over and above their regular psychiatric residency training.

I would recommend that Dr. Cohen contact the Academy of Psychosomatic Medicine and Liaison Psychiatry and ask for a list of liaison psychiatrists in your area and find out which ones make calls to patients in your area. If, in the event there are no specialists who service this facility, find a liaison psychiatrist who can coach you on how to approach this situation. There may be protocols involving psychiatric medications that may help this patient. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

ASSOCIATE POSITION - CHICAGO AREA

EQUIPMENT FOR SALE

Amfit Orthotic Making System. Includes new computer, recently updated digitizer, and orthotic mill, and $2,500.00 in supplies (which would generate about $20,000.00 in orthotics). skip the middleman. Cost $35,000.00. Asking $23,000.00 OBO AMERICAN FOOT CLINIC 405-733-2783 OR 405-820-6887 americanfoot@email.com

PRACTICE OPPORTUNITY - DALLAS TEXAS AREA

New practice started in Irving Texas by two 15 year established podiatrists from Austin. We've decided to stay in Austin and travel only for research. Opportunity for new practitioner podiatrist to start practice immediately with no money out-of-pocket. Write to MRobsonDPM@aol.com

PRACTICE FOR SALE -BRIGHTON, MICHIGAN

Outstanding opportunity to purchase 12 year established general podiatry practice. Now working one day per week seeing approx. 20 patients. with 3-4 new patients per week. Steady flow of returning patients. Selling because of disability. Turn-key.  First quality equipment, furniture, and build-out. Priced to sell for the value of the equipment.  Call (248) 538-5958. e-mail: DocPod@aol.com

PRACTICE FOR SALE - FLORIDA

Part-time non-surgical practice for sale Palm Beach County Florida. Established practice (32 years) for sale. Fully-equipped office in area heavily populated with seniors. Storefront location with excellent exposure. Practice includes one nursing home. Great opportunity for expansion. To inquire, please call  561 965-3300

ASSOCIATE POSITION - SOUTH JERSEY

Ethical, highly-motivated, personable, PSR-24/36 trained  ABPS-certified/eligible individual proficient in surgery, biomechanics, palliative care, wound care. Hospital privileges available. EMR , Diag U/S, digital radiology, etc. Benefits include competitive salary, health and malpractice insurance, and seminar allowance. Email CV and three references. Toetrukr@aol.com

OFFICE SPACE/ MRI RENTAL – NYC, LI   
 
Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or 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/WASHINGTON, DC/SILVER SPRING, MD

Excellent opportunity to join a multi-doctor practice with its own Certified Surgical Center. Practice is full-scope with an emphasis on sports medicine. Competitive salary plus bonus structure. PSR 24+ only. Send CV to hgodpm@verizon.net

PRACTICE FOR SALE - FLORIDA

Who wants to continue making good money in a down economy, and who would like to live in Florida on the coast? I have been working for over 45 years and have had enough. My business grosses over $940,000 dollars a year and my net is over $250,000. I see approximately 40 patients a day in a coastal Florida town and am sitting on a little gem. Office is 2000 sq. ft. Hospital very close with surgical center. Large scope of practice in Florida. Contact me if you are ready to step up. $585,000 dollars. Contact me at: hagen5644@yahoo.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 

LOCUM TENENS POSITION - FLORIDA

Florida licensed podiatrist needed for an on-going locum tenens position for a large group practice in Central Florida. Payment is $400 per day plus a travel if coming from out of the area. Please email response and resume to gregr@orlandofootandankle.com

SALES REPRESENTATIVES WANTED

SureFit has immediate openings for three sales representatives – one for Midwest, Mid-Atlantic and Southeast territories. Responsibilities include but are not limited to obtaining new business, executing sales strategy, initiating contact with customers, identifying their needs and selling appropriate products to meet those needs. Ideal candidate will be enthusiastic, highly motivated individual with a positive attitude who prefers a team environment. Minimum requirements include Bachelor’s degree, 3+ yrs sales experience, preferably in Podiatry and/or O&P Industries. Position requires up to 70% travel with residency in each territory. Please e-mail resume and references to: James R. Grady, Director of Sales SureFit jgrady@surefitlab.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

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

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

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