The Voice of Podiatrists

Serving Over 10,900 Podiatrists Daily

June 07, 2008 #3,266 Editor-Barry Block, DPM, JD

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Callus Removal is Wonderful, if Done Properly: NY Podiatrist

Dr. Howard Dinowitz, a Brooklyn, NY, podiatrist, says the first step in taking care of your feet is to visit the foot doctor to make sure you don’t have any complications you’re not aware of. Once you’re cleared, though, “callus removal is a wonderful thing,” he says. Simple, over-the-counter remedies like the PedEgg can reduce some of the foot’s roughness and dryness in a non-invasive way, he says, but don’t overdo it.

Dr. Howard Dinowitz

“Overzealous usage of any type of product that causes friction can definitely lead to problems with the skin,” he says. That’s particularly true for “someone who might be a diabetic and has a condition known as neuropathy” (i.e., the lack of peripheral sensation or feeling of the feet). Used in moderation, though, he says the PedEgg is “probably a great thing, especially if you use it in conjunction with a nice hydrating cream.”

Source: Diane Mapes, MSNBC Health

Barry Holds White Coat Ceremony

More than 400 friends and family members turned out to watch the Barry University School of Podiatric Medicine Class of 2010 receive their white coats in a ceremony held May 30 at the Broad Center for the Performing Arts on the Miami Shores campus.

Barry Class of 2010 at White Coat Ceremony

Keynote speaker Dr. Robert Schwartz told the 51 members of the class of 2010 that they would now begin to build upon that “strong academic foundation in [their] clinical training.” Schwartz also presented his daughter, Jaclyn Schwartz, with her white coat.

GOP Medicare Bill Very Similar to Dem Proposal

Senate Finance Committee Republicans, led by ranking member Chuck Grassley (R-IA), on Wednesday released an outline of legislation that would halt a 10.6% reduction in Medicare physician fees scheduled to go into effect July 1, among other provisions, CQ Today reports. The bill will compete with legislation outlined by committee Chair Max Baucus (D-MT), which also focuses on halting the payment reduction. The bills share some similarities, including creating electronic prescribing requirements, adding quality reporting programs and payment increases for physicians in underserved areas.

In addition, both outlines do not contain provisions that Democrats and Republicans have disagreed on, including financial assistance for beneficiaries enrolled in the Medicare drug benefit. Both bills also would halt the payment reduction for 18 months. However, Grassley's measure would provide physicians with a 1.1% increase next year, compared with a 0.5% increase proposed by Baucus.

Source: CQ Today Via American Health Line [6/5/08]

Business Cards Serve Many Purposes

When you travel, use your business card as a bookmark. This increases the chances of your getting your book back should you lose it.

Additionally, it assures that you will always have a business card ready should the need to hand it out arises.

Query: Surgical Excision of Lipomas

Has anyone any pearls to offer re: the surgery to remove/reduce the large cyst-like masses that form on the inferior aspect of the lateral malleoli? I have opened them up and found 1) lipomas, 2) distended tissue. Is there a reference, or an article that is available? Has anyone done a plastic smile to reduce the redundant tissue?
,
WJ Tronvig, DPM, Aberdeen, WA

Query: Screw Removal Coding

I am removing a cancellous bone screw placed in my patient's foot about 10 years ago by another surgeon. She has had pain ever since it was first put in because the screw was not countersunk, and it is rubbed by all of her gear.

I found a diagnosis code of E878.1 (surgical operation with implant of artificial internal device; internal orthotic device) which I believe is the correct ICD-9 code. Please let me know if this is incorrect, or if there are additional ICD-9 codes to consider. What would be the appropriate CPT code?

Bob Kornfeld, DPM, Lake Success, NY

Response: I would recommend ICD-9 V54.01 (aftercare encounter for removal internal fixation device [screws/pin]).

The correct CPT code would be CPT 20680 (removal of implant; deep [e.g., buried wire, pin, screw, metal]).

Mark Schilansky DPM, Catskill, NY

Codingline subscription information can be found by clicking here

RE: Rash (Joseph Borreggine, DPM)
From: Gary S Smith, DPM

This looks like a drug or food allergy. Even if she has taken a certain medication before or "for years", she can still present with an acute reaction.

Gary S Smith, DPM, Bradford, PA, penndoc@verizon.net

RE: Tennis Serve Metatarsalgia
From: Kenneth Meisler, DPM

I have used Otto Bock's carbon foot plates for hallux limitus and metatarsalgia. They come in varying degrees of stiffness. Interestingly enough, I first learned about them more than 20 years ago when a doubles partner showed me his severe hallux limitus. I had played with him many times and he told me the only thing that allowed him to keep playing without surgery were these insoles that an orthopedist had suggested he use. He was a great player and it didn't hinder his play.

They are very thin and work almost like a post-op shoe in limiting MPJ motion. They can go under the insole from the sneaker or under an orthotic. I would suggest starting with the medium or firm models. They also come in different sizes. Many patients have been extremely happy with them, some aren't, just like any other treatment.

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

RE: Correction to PM News Posted Story

Editor’s note: The Southtown Star printed the following correction to a story it printed on April 1, 2008 regarding the expert testimony given by Dr. Ivar Roth on behalf of Dr. Anthony Overton. Dr. Overton was found guilty and sentenced to six years in prison.

“Dr. Ivar Roth testified that the podiatrist’s license and training gave Anthony Overton the legal right to perform a breast, vaginal and rectal examination. He did not tell the court [that] Overton’s physical exam of the patient was proper procedure in treating her sprained ankle. Also Roth was reading from a professional journal in some of the comments attributed to him.”

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