The Voice of Podiatrists

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June 11, 2008 #3,269 Editor-Barry Block, DPM, JD

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We’ve just posted the June CME titled "Choosing the Right Pharmaceutical Vehicle " by , Tracey C. Vlahovic, DPM on www.podiatrym.com .

You can Earn 30 CPME-Approved CME Contact Hours Online

TX Podiatrists Uses EST Device to Treat Pain and Neuropathy

People with foot pain or neuropathy can now benefit from a new state-of-the-art electronic device called electro stimulation treatment (EST). According to podiatrist Brent Rubin, DPM, the new technology is used for serious foot and lower leg-related pain and circulation problems.

Dr. Brent Rubin

“The use of electricity in medicine has been around for many years,” Rubin said. “The difference is in the way technology has advanced.” The new FDA-approved EST system uses powerful electronic signals that are applied through special electrodes that can alter, correct, and manage cellular function.

Older, less powerful electrical devices had only enough power to penetrate muscle to a shallow depth. The new EST system Dr. Rubin uses can influence any part of the body, including the nerve cells.

Source: Pat Driscoll, Living Out East

Adolor Promotes Techner to VP, Medical Affairs and Medical Director

Adolor Corporation announced today the promotion of Lee Techner, D.P.M. to vice president, medical affairs and medical director effective immediately. Dr. Techner will report directly to Eliseo Oreste Salinas, M.D., MSc, senior vice president, research and development and chief medical officer, Adolor Corporation.

Dr. Techner joined Adolor in March 2001 as a director, clinical research. In January 2004, he was promoted to senior medical director, clinical research and development, during which time he served as a key contributor to the development of Adolor's first FDA-approved drug, Entereg. In 2007, Dr. Techner also assumed responsibility for Adolor's Medical Affairs functions. Prior to 2001, Dr. Techner worked for Omnicare Clinical Research as a medical director.

Source: Comtex News Network [6/2/08]

Medicare Extra Proposal Could Cover Uninsured U.S. Adults

At a panel discussion on Friday, lawmakers and health experts considered a Commonwealth Fund proposal that would provide health insurance to 44 million of the 48 million uninsured U.S. residents, CQ HealthBeat reports (Wyckoff, CQ HealthBeat, 6/6). Under the proposal, a government-operated connector authority would offer lower-cost health plans, including a "Medicare Extra" plan built on the existing Medicare system. All employers would be required to provide coverage for workers or contribute up to 7% of their payrolls into a fund to generate about $45 billion. Tax credits would be used to ensure that premiums account for no more than 5% of income for lower-income families and 10% for higher-income families. People who remained uninsured would automatically be enrolled in a plan when their taxes are filed.

The plan also calls for the overhaul of health information technology, evidence-based medicine, public health and the health payment system. The Commonwealth Fund estimates that Medicare Extra premiums would be 30% lower than employer-sponsored plan premiums. Proposal co-author Cathy Schoen of the Commonwealth Fund on Friday said that early coverage under Medicare is supported by 73% of older U.S. residents and 66% of U.S. residents between ages 50-64 who are currently covered by their employers.

Source: American Health Care [6/9/08]

Is your Office Hard to Find?

Make it easier for patients to find your office by printing a small map on the back of your business card. This map can also be used in your Yellow Pages ads, on your website, and on your letterhead.

Query: Toxic Office Syndrome

I’ve been in practice about 14 years and I’m worried about my office chemicals causing long-term harm. My sense of smell seems to have diminished, but I don’t know if it is a result of what I encounter every day at work. I’d like to know what other practitioners think about this subject.

1) I use phenol for nail borders, but use tapered cotton applicators to use a minimal amount for each application. Should I put a fan in the room or turn on the HVAC fan to dilute the air?
2) Currently I use glutaraldehyde to cold sterilize my instruments for routine care and sterilized instruments for wound care. I don’t know how much glutaraldehyde gets into the air. I’m debating about buying more instruments and autoclaving everything.
3) For injections, I use ‘cold spray’ which has butane and propane. I try to hold my breath and exhale after I spray it, to avoid breathing it in.
4) I have a vacuum system for my nail grinder.
5) I keep exhaust fan running all day in my x-ray developer closet to avoid any developer fumes coming into the office and I’m saving for a digital x-ray.

Chuck Anderson, DPM, Norman, OK

Query: Austin/Akin Procedure Billing

For an Austin/Akin bunionectomy procedure, is it appropriate to bill CPT 28296 (correction, hallux valgus [bunion], with or without sesamoidectomy; with metatarsal osteotomy) and CPT 28310 (osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe [separate procedure])?

Is it inappropriate to bill as CPT 28299 (correction, hallux valgus [bunion], with or without sesamoidectomy; by double osteotomy)?

Susie Allington, Office of Jeffrey J. Niccoli, DPM, Alameda, CA

Response: On face value, they may appear to be similiar coding, yet if you look at the CPT book in the bunion section, there are diagrams describing several bunion procedures. The illustration similar to an Austin-Akin bunionectomy procedure is described as CPT 28299.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found by clicking here

RE: Surgical Excision of Lipomas (Bryan C. Markinson, DPM)
From: Khurram H. Khan, DPM

When I was a student at TUSPM, Dr. Harvey Lemont used to call these lesions ankle lipomas "Post-menopausal" lipomas because they were usually seen in older women on the lateral aspect of the ankle bilaterally. They are usually asymptomatic and rarely ever cause pain. I agree with Dr. Markinson, if it doesn't hurt, leave them alone. You’re setting the patient up for painful scars and contractures at the ankle which can cause more harm than good.

Khurram H. Khan, DPM, Clinical Assistant Professor, NYCPM, khankhurram@hotmail.com

RE: Competitive Bidding Program Q and A Session
From: Paul Kesselman, DPM

Editor’s Note: This extended-length notice can be read at: http://www.podiatrym.com/letters2.cfm?id=20095&start=1

RE: Ethics Courses at Podiatric Colleges (Louis Levine)
From: Richard Boone, Sr, Esq.

I was happy to receive Dr. Levine's letter and even more happy to learn about it's content. I will forward it on to the source of my "understanding," (the word I used in the letter), who is himself a distinguished alumnus of the New York College. Unfortunately, I still believe that my concern that physicians graduate from school without formal education in ethics is true much more often that it should be. Judging from the responses I have received directly, the NYCPM is unique in its presentation of a formal ethics course. I did receive another letter from a NYCPM student advising me of the course he took in his second year at the College. And Dr. Hetherington of OCPM was kind enough to provide me with the ethics materials they give to their students during freshman orientation. The silence of the other schools on the subject of formal ethics training has been deafening.

Clearly, a thirty-hour course (do I correctly assume that it's two hours a week for two semesters) is a great beginning. Unfortunately, for most of Dr. Levine's colleagues it also appears to be the end of their consideration of ethics.

RW Boone, Sr, Esq, Fairfax, VA, RWBoone@aol.com

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