The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

June 05, 2010 #3,876 Publisher-Barry Block, DPM, JD

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IN Podiatrist Favors Walking Over Running as an Exercize

Podiatrist Dr. Dennis J. Chubinski isn’t anti-running, but warns of its effects. “You have the shock absorption of the joints, is what it comes down to,” Chubinski said. “A lot of the things we deal with are the plantar fasciitis and heel spurs, Achilles tendinitis. Those are all considered overuse syndromes; it’s just based on mileage and years.

Dr. Dennis J. Chubinski

“I have a lot of patients I talk to about walking a lot because you can do it until you’re 100 years old, whereas we know if you’re a serious runner, there comes a point where you’re going to have to stop doing that activity. “When you’re dealing with a serious runner, you don’t tell them to stop running because they just don’t hear it.”

Source: Steve Warden, The Journal Gazette [6/3/10]

NY Podiatrist Installed as Honorary Police Surgeon

June 1, 2010, Dr. John Zboinski was sworn in by New York City police commissioner Raymond W. Kelly at One Police Plaza. This ceremony, performed every five years, swore in forty-nine honorary police surgeons. These honorary police surgeons were selected from many specialties of medicine, dentistry, and podiatry.

Dr. John L. Zboinski

Zboinski is currently Chief of Podiatric Surgery at New York Downtown Hospital. Additionally, he has privileges at Beth Israel Medical Center, Vassar Brothers Hospital in Poughkeepsie, NY, and at the Fishkill Ambulatory Surgery Center in Fishkill, NY.

Query: Oasis Application Coding

I'm not familiar with the Oasis wound matrix. How would I go about coding the application of this product on a Medicare patient? Does the procedure have a global period?

Cristina Marquez, El Paso, TX

Response: The coding for application of Oasis is:

CPT 15430 - acellular xenograft implant, first 100 sq cm or less (90-day Medicare global)
CPT 15431 - acellular xenograft implant, each additional 100 sq cm

Based on CPT and Texas Medicare rules, you cannot report CPT 15430 or CPT 15431 in conjunction with debridement codes, CPT11040-11042 or wound prep code, CPT 15004.

If you are applying Oasis in your office, you may bill for the product using Q4102 (dermal [substitute] tissue of non-human origin, with or without other bio-engineered or processed elements, with metabolically active elements, per sq cm). The TrailBlazer Medicare LCD also notes that the "-58 modifier cannot be used in the global period. That means that during a 90-day period, you may only bill Trailblazer Medicare for the application code (CPT 15430, CPT 15431) once. You may, however, bill the product "Q" code for each application.

Paul Kinberg, DPM, Dallas, TX

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

RE: Standard of Care for Post-op Cast (Charles Lombardi, DPM)
From: Lowell Scott Weil, Sr., DPM, Martin M. Pressman, DPM

Having reviewed medical malpractice cases for over thirty five years and testified for both plaintiffs and defense, I find Dr. Stabile's testimony incredulous and based on personal opinion, NOT standard of care. I hope the jury found this testimony not credible. Applying a cast in the operating room after surgery is so common, some of the jurors may even have experienced it. Yes, care needs to be taken viz a viz swelling, etc., however, it is clear that the application of a cast in the operating room is NOT a deviation from the standard of care. How could he say that under oath?
 
Martin M. Pressman, DPM, New Haven, CT mpress4@optonline.net

Dr. Lombardi is correct. In my opinion, the standard of care (SOC) was not breached by Dr. Lombardi by applying a cast in lieu of a posterior splint following surgical repair of a peroneus brevis tendon. The procedure is quite "benign" in the respect that it does not require extensive dissection, interruption of significant blood supply, nor does it cause significant post-operative swelling. The application of a cylindrical cast is certainly within the SOC when repairing a tendon since total immobilization of that repair is essential in the early stages of healing.

With a fracture and ORIF, one may use a posterior splint due to potential swelling, but in that case, the fracture has been immobilized by rigid fixation. Typically, it is not possible to rigidly immobilize a tendon repair and the risk of a patient "moving that part" and injuring the repair is far greater than problems from a cylindrical cast.

The expert for the plaintiff is DEAD WRONG.

Lowell Scott Weil, Sr., DPM, Des Plaines, IL, weil4feet@aol.com

RE: Charcot STJ Complete Dislocation (Tip Sullivan, DPM)
From: Multiple Respondents

Dr. Sullivan, this is one of those times where you should refer the patient to your local orthopedic surgeon and keep in touch with the patient. If all goes well, then you are a very good member of the medical team (a hero) in your community. If it goes bad, you can use this case and patient to help you strive to make changes to the law in Mississippi that allow DPM's to treat this pathology. Your story could be "If I would have treated this patient, the patient would still have a leg."  Tip, you can turn this into a win-win situation for yourself and our profession in Mississippi.

Bret Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

From the case presentation given, healing the wound first is not the right approach since the deformity is the cause of the wound. Since your state laws do not allow you to apply a proper external fixation device that would require a tibial component, I would refer this patient to an orthopedic foot and ankle surgeon in your state, or to a trusted podiatric colleague in a nearby state who can treat this kind of deformity. You can perform wound care while the deformity is being corrected (if it needs gradual derotational correction), or while the frame is in place, after the deformity is corrected.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

In regard to the hindfoot Charcot, I agree that all wounds need to be addressed first, however, this may be difficult due to the existing deformity.  Relocation of the STJ with a simple frame may be very difficult due to the longevity of the dislocation. I would be prepared to perform an open procedure to release soft tissues, etc. which will obstruct the relocation. You also need to consider total stretch of the tibial artery, etc. If the amount of correction is too great, then you risk injury/loss of blood supply.

What are the goals? Plantargrade the foot to go into a CROW walker?  Have you considered doing a primary triple arthrodesis with internal fixation? I wouldn’t suggest applying an ex-fix, unless you can do so appropriately. Only having one point of fixation in the talus is doomed to failure and poor application of external fixation techniques, and really isn’t providing the patient with any benefits of true external fixation. If you are sold on the idea of ex-fix, then I would have an ortho colleague assist, so proper application of ex-fix can be done. If this cannot be done, then I would consider triple arthrodesis. Use of the ex-fix could also be done staged, to relocate the rest of the tissue in the new position. Then plan for definitive triple arthrodesis…but again you need to fixate into the tibia.

Tim Mineo, DPM, Portland, OR, TMINEO@LHS.ORG

RE: Maceration, Pitting Keratolysis, and Hyperkeratosis (Jacqueline Chen, DPM)
From: Multiple Respondents

I use Benzaclin 5% bid for 3-6 weeks, and it works like a charm.
 
Peter Bregman, DPM, Tewksbury, MA, footdoc@painfreefeet.com

I have been under the impression that the standard of care for treating a skin infection with oral anti-fungals was for a maximum of 30 days, and not 3 months. Is this an appropriate dosing regimen and could it be considered excessive should the patient ever sustain complications from the medication?
 
Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

Another treatment for malodorous feet where there is a superficial bacterial infection at play is the same treatment we use for our hands prior to doing surgery. Have the patient wash the feet daily with povidine soap or any of the other antibacterials we use in the operating room for our hands. I sometimes give these patients an actual hand washing sponge that I would use to prepare for surgery in my office, and very often the use of it for even a day or two might cure the problem. If you use povidine iodine, do warn the patient that it might make their feet temporarily orange. 
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: CRPS (Alan Mauser DPM)
From: Peter J. Bregman, DPM

I would refer this patient to an AENS member (www aens.us) and get her evaluated for possible nerve entrapment. Often what cannot be seen is overlooked. Pain specialists almost never recognize this. She may have injured her common peroneal nerve or tibial nerve. Depending on what was injured during the accident, decompression may help. 

Peter J. Bregman, DPM, Tewksbury, MA, footguru@comcast.net

RE: Big Bother is Too Nosy
From: Teresa N Tobin, DPM

I was recently surveyed by an insurance company for my demographic info. They actually had a space for "ethnicity" that they were requesting. When I called to object to this level of info, they at first stated that it was to determine what other languages were spoken at my office. When I told them that their question was not worded correctly, they then told me that the state Department of Welfare was requiring them to obtain this info. I objected to this and refused to answer. Like most Americans, I am of multiple "ethnicities." If they want to know my race, they can ask me that more directly. If they want what languages I speak, they can ask that too. Why does the state Dept of Welfare care about practitioners' "ethnicity" and not qualifications? Nowhere did they ask about my certifications or continuing education! Who are these geniuses, and why are they asking these intrusive questions?

Teresa N Tobin, DPM, Huntingdon Valley, PA, tntdpm@comcast.net

RE: First Endowed Scholarship Established at WesternU Podiatry College
From: Bret M. Ribotsky, DPM

What a great accomplishment for Dean Larry Harkless and the Western University School of Podiatric Medicine. It is said, "A walk of a hundred miles begins with the first step," and I know that the passion that Dr. Harkless exudes is so contagious, and am sure that many more companies will follow the bold lead set by OsteoMed. Dr. Harkless' talk on Meet the Masters continues to be a big hit with hundreds of individual downloads each month. One person wrote, "if we could bottle Harkless' energy, there would be no energy crisis." In summary, once Larry gets going, watch out! Bravo to a true master.

Bret M. Ribotsky, DPM, Boca Raton, FL, ribotsky@yahoo.com

EQUIPMENT FOR SALE – CHAIRS, ETC.

Doctor retiring, office equipment for sale, including patient’s treatment chairs, one chair is one of the first podiatry chairs made ,can be used as a display in waiting room or use in treatment room, all in excellent condition, photos on request. E-mail Robin superrang@bellsouth.net

ASSOCIATE POSITION NORTH CAROLINA - ASHEVILLE/MOUNTAINS

Well established, multi-doctor, multi-office diverse practice has immediate need for associate doctor leading to partnership. Associate doctor will be very busy from day one. Attractive compensation and benefits. Buy-in potential after one year. Contact at smfc2@charterinternet.com or 828-734-1535

ASSOCIATE POSITIONS – MULTIPLE LOCATIONS

Looking for podiatrists to join group to work in nursing facilities in: Texas (Ft. Worth, Dallas, Houston) Washington, DC, Philadelphia, Northwest Pennsylvania, Delaware, Upstate New York, Massachusetts (Brockton). Please respond to: doconcall02@aol.com

ASSOCIATE POSITION - WEST CENTRAL FLORIDA

General podiatry. High-level surgical skills are not required. Good diagnostician, compassionate and hard working individual is needed for busy high-tech practice. E-Mail: flpodiatrist@tampabay.rr.com

ASSOCIATE POSITION – QUEENS & NYC

Part-time podiatrist needed for multi-office practice in Queens and NYC. PSR- 24+ a must. Experience preferred. Willing to train the right new graduate. Must be punctual, very personable, ambitious, and ethical. Job will involve usual podiatric medicine and surgery. Will also include significant networking and marketing to help build the practice. You must be well-trained and have people skills for this position. Possible full-time position leading to partnership for the right person. Please e-mail cover letter and resume to hansfeet@aol.com

PODIATRIC ASSOCIATE POSITION - CHICAGO, IL

Excellent Associate Opportunity for full or part-time position. Group practice with diversified mixture - Surgery Qualifications: 3 years Trained Resident Salary: Commensurate with training, benefits included Fax CV/Resume to 773-374-5860 J.B. Jenkins & Associates transcribe1706@aol.com

LOCUM TENENS WANTED - MANHATTAN

Due To Family Emergency looking for locum tenens for the month of July and August 1-2 days per week. Office located in Manhattan Upper West Side Fax CV to 212 362-9896. For more information you can call 212 724-4457. frottenberg@juno.com

ASSOCIATE POSITION – VICTORIA, BRITISH COLUMBIA

Beautiful Victoria, British Columbia, on the ocean, fast growing area. Associate for multi-office, full-scope practice. Reply to dr.cole@shaw.ca or phone 250-516-7440

LIMB PRESERVATION RESEARCH AND SURGICAL FELLOWSHIP

Boston University Medical Center offers a unique fellowship position
Be part of this unique opportunity at a major internationally-known teaching medical center. During this time, he/she will become a knowledge expert who will contribute significantly to research, surgical procedures, teaching, and innovations in limb preservation and tissue repair. Requirements: Completion of a two or three year surgical residency; Annual Salary: Year 1 $61,000, Year 2 $66,000 plus excellent benefits. Submit a CV and letter of interest to: Erin Springhetti @ erin.springhetti@bmc.org and Dr Vickie Driver @ vickie.driver@bmc.org

CANADIAN PODIATRISTS COME BACK HOME!

An Edmonton, Alberta group of DPM’s requires an additional Podiatrist. Interest in biomechanics essential. Given Canadian visa restrictions, this position is open only to Canadian Citizens or permanent residents. Very attractive compensation package. Fax C.V. or letter of interest to: (780) 483-5796.

PODIATRISTS WANTED BALTIMORE/CHICAGO/NORTHWEST INDIANA

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 Jake Shimansky, Director of Physician Recruitment. Phone 773-342-5221 FAX 773-486-3548 E-Mail jshimansky@homephysicians.com www.homephysicians.com

ASSOCIATE WANTED DELRAY BEACH FLORIDA

Rapidly growing well established practice seeking part-time leading to full-time. PSR 12-36. Great opportunity for highly motivated, personable individual. Please reply by emailing a CV to nursebsf@aol or fax (561)498-9068.

ASSOCIATE POSITION IN NORTH BROOKLYN, NY 
 
Well-established practice in a multispecialty medical center seeking a full time associate. Spanish speaking ability a plus. Compensation possibly in six figures with buy-out opportunity. Contact/Send resume to: bklypodiatry@aol.com

PRACTICE FOR SALE – MAINE

25 year full scope in medical building, podiatrist friendly hospitals, appreciative and cooperative patients, excellent expansion potential, physician referrals. Wonderful place to raise a family. Retiring seller will stay for transition. mainefootdoc@yahoo.com

ASSOCIATE POSITION – NEW YORK
Great Opportunity - NY podiatric practice – multiple locations –seeks well trained, ethical DPM Per Diem and full-time positions available. Competitive salary. Send resume and CV to: info@advancedfootcare.org

ASSOCIATE POSITIONS – TEXAS

Full-time podiatrist(s) needed in Austin or San Antonio. Current Texas license required. Unique mobile podiatry practice. Better pay, fine working conditions with excellent support staff. Check out our website www.footmobile.com. Reply to footcenter1@sbcglobal.net

ASSOCIATE POSITION - SW FLORIDA, BEAUTIFUL GULF COAST AREA

Well-established podiatry practice with excellent mix office/surgery seeking full-time associate PSR 12-36. Excellent salary & benefits for the right hardworking, personable candidate. Email resume to pudos@aol.com or fax to 239-573-9201.

PRACTICE FOR SALE - MINNESOTA

Practice Grossing over $500K yearly. Good mix of surgery, orthotics, DME, diabetic care, general podiatry. Commute < 5 miles to work. Friendly Midwest lakes area with arts, good schools, affordable living, restaurants, shopping. Option to purchase building. Will consider associate to buy-in/ buy-out. Midwestpractice@gmail.com

PART-TIME POSITION - NEW JERSEY

Available for a Board certified/qualified podiatrist. Located in Toms River and Manchester. We have a high-volume practice that treats routine care, trauma, sports-related injuries, hospital consults, and ER Consults. Possibly leading to full-time position for the right person. Please fax CV to (732) 349-0228 or email CV to njfeet@aol.com

ASSOCIATE POSITION- MONROE, MICHIGAN

Excellent opportunity to join a modern, growing 3 doctor/2 office practice located in SE Michigan between Detroit and Toledo. Responsibilities will include a mix of surgery, office, hospital and nursing home/housecalls. Salary, bonus and benefits. Learn more about us at monpod.com. If you are a personable, reliable team player with solid skills and a patient first attitude please contact dr.hughes@comcast.net for more information.

ASSOCIATE POSITION – TEXAS

Dynamic, growing practice in Dallas/Fort Worth area, seeking PSR 36 surgically trained, and/or Board Certified/Board Qualified Podiatrist. Excellent salary and benefits compensation package, for the right candidate, with partnership/buyout opportunity. Must have Texas license. Contact/Send resume to: jmh6122@yahoo.com

TN PRACTICE FOR SALE (SOUTH OF NASHVILLE)

Active, established practice with new equipment (digital x-ray, ultrasound, computer network, etc.). Great referral network with an excellent scope of practice. Turn-key operation with seamless transition. Grossed over $350K last year. Call 931-446-5724 or email mchad500@gmail.com for more information.

PM News Classified Ads Reach over 12,000 DPM's and Students

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