The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

June 20, 2012 #4,493 Publisher-Barry Block, DPM, JD

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Barry Establishes Dr. Marvin and Ruth Steinberg Scholarship for Diabetic Research 

The Paul & Margaret Brand Research Center at the Barry University’s School of Podiatric Medicine is pleased to announce the establishment of the Dr. Marvin D. Steinberg and Ruth M. Steinberg Scholarship for Research in Diabetic Limb Preservation. The Steinberg family pledged $30,000 over five years, which will provide one annual $3,000 research scholarship to a qualified podiatric medical student at Barry. The faculty will choose the best publishable research paper in the area of diabetic limb preservation, and one $3,000 contribution will be added to the Dr. Marvin and Ruth Endowed Scholarship. 

Dr. & Mrs. Marvin Steinberg

This scholarship honors Dr. Marvin D. Steinberg and his wife Ruth M. Steinberg. Steinberg is one of the early pioneers and leaders in the field of podiatric medicine. Throughout his distinguished career, Steinberg’s influence and involvement in both podiatric practice and podiatric education earned him the name “Father of Modern Podiatric Medicine.”

IFAF Holds Quarterly Meeting

The International Foot & Ankle Foundation (IFAF) Board of Directors Quarterly Meeting was held at the Washington Room of the Capital Grille Restaurant in Seattle. Many new and exciting seminar plans were discussed, including the upcoming 2012 series of meetings in Seattle, Alaska Cruise, Portugal, Las Vegas, and Hawaii. 

(L-R) Drs. Mary Crawford, Chair, Board of Medical Advisors; Dock Dockery, Chairman of the Board; Gerald Kuwada; Byron Hutchinson; Rex Nilson, Cherie Johnson; Tresha Carter, Director of Administration & Marketing; and, Dr. Marc Kravette.

Discussions also involved the popular online journal, Foot and Ankle Online Journal (Faoj.org), and IFAF's continued successful commitment to Barry University Yucatan Crippled Children Project.

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky: Should there should be a merger of ABPS and ABOPPOM?

Dr. Kathleen Satterfield

Katlenn Satterfield: I am a proponent of a merger. I just speak for myself only, not the other board members. I think that if we’re going to be proponents of this “homogenous training”, then we need to have one board representing us. I want to to give full credit to Lester Jones, who used to be ACFAOM president. He’s academic dean at WesternU and a noted biomechanics expert. He’s currently the president of ABPOPPM, which has agreed now through its membership to become the American Board of Podiatric Medicine. I think that’s a very good move.

Dr. Harold Glickman

Meet the Masters is broadcast each Tuesday night at 9 PM (EST). This week's guest is APMA past president Dr. Harold Glickman. You can register for future events by clicking here

Query: HPV Vaccine for Plantar Verruca

This query concerns the use of an HPV vaccine (e.g., Gardasil) for cases of refractory plantar verruca. I have noted two favorable outcomes in case studies documented in literature (Venugopal, et al., and Kreuter, et al.) Does anyone know of larger supporting studies or does anyone have anecdotal experience with this treatment? Have you noted a decrease in recurrence after administration of this vaccine?

Heidi Newkirk, DPM, Salem, NH

Query: Not Getting Paid for CPT 29581

I have been having issues with Medicare and private insurance companies when I am billing CPT 29581 (application of multi-layer compression system; leg (below knee), including ankle and foot). I was told by Blue Cross that if I bill an office visit and CPT 11042, they will not also pay for CPT 29581 on that date of service. Medicare's argument is that this code, CPT 29581, is not covered when performed during the same session/date as an additional procedural service (CPT 11042).

I am not sure what modifier to use for this to get paid. I also do not think it is fair that I am not getting paid for this service - especially when the patients really need it. If I bill an office visit and this casting service together with NO procedure code (CPT 11042), Medicare does pay. Most of these patients need both debridement and a cast on a weekly basis to help them heal their wounds. How can I get them to pay for CPT 29581 and CPT 11042? Do I need a modifier? And if I do, which one do I need to use?

Neil Hecht, DPM, Sherman Oaks, CA

Response: If the patent is coming in for regular serial wound debridements and multilayer compression system applications, why bill for an E/M code unless there is a new problem? The work is appropriate and needed and done well. However, there is really no new significant E/M service.

Walter Pedowitz, MD, Linden, NJ

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RE: Non-Surgical Approach to Plantar Fibromas (Chuck Ross, DPM)
From: Terry L. Spilken, DPM, Jeffrey Kass, DPM

Cryosurgery is an excellent treatment option for patients with plantar fibromatosis. It is an ambulatory procedure performed in the office.  It requires one day of rest and elevation after the procedure. Within one week, the patient is back to full activity. We have had patients from across the country come to our office. The success rate is close to 80%.

Terry L. Spilken, DPM, Livingston, NJ, TLee10@aol.com

I believe you are looking for PDLabs for the transdermal Verapamil 15%.  You can call 800-687-9014. I used it a handful of times over the years, and while I did not have great success, there have been many posters on PM News in the past who have reported good success.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Is This MTPJ Salvageable? (Alan Berman, DPM)
From: Estelle Albright, DPM, Michael Theodoulou, DPM

Is This MTPJ Salvageable?

Does this patient have gout?

Estelle Albright, DPM, Indianapolis, IN,  estellealbright@hotmail.com

One does not treat a radiograph. Unfortunately, the clinical history and limited x-ray does not provide us with enough information to give a valid response. But if we can extrapolate from what is given and seen, this is an individual with severe hallux valgus. There is notable metatarsal primus varus and a subluxed joint. Of concern are the erosive changes of the first metatarsal head which suggests potential rheumatic process; high on the list would be gouty arthropathy or rheumatoid arthritis.

This is of concern as joint sparing reconstructive osteotomies will not resolve the underlying pathologic process, with potential for continuation of disease. Arthrodesis of the joint is a truly acceptable alternative for such severe deformity in light of the subluxed joint and potential rheumatic process. However, without visualization of joints more proximally, this cannot be completely advocated. Arthrosis of the first tarsometatarsal joint is a relative contraindication to distal fusion.

It has been my experience, that if one does fuse the first metatarsophalangeal joint, there is seldom need for proximal re-alignment osteotomies as the joint is decompressed and the first ray re-aligns. Finally, please do not overlook the completely dislocated 2nd MTPJ with probable plantar plate disruption given the longstanding transfer loading.
 
Michael Theodoulou, DPM, Cambridge, MA, michaelhtheodoulou@msn.com

RE: Chronic Calcaneal Apophysitis (Jeffrey Kass, DPM)
From: Eric Edelman, DPM

I recently had an unusual presentation of what I thought was calcaneal apophysitis in a 10 year old boy who was otherwise healthy and physically fit. Similar to Dr. Kass' case, the parents had brought the child to several doctors to try to figure out what the issue was, and I was his 3rd of 4th treating provider. No amount of rest, stretching, ice, or immobilization had been helpful, and the child had pain that seemed far out of proportion to what I have seen in other cases of Sever's Disease. He had several x-rays, MRI, and a bone scan.

I wound up ordering blood work, thinking about rheumatologic disease. Out of habit, I ordered him a serum uric acid test. It turns out, that my 10 year old patient is hyperuricemic. A few days on allopurinol, and he was back to normal, and returned to the pediatrician for long-term care. Consider bloodwork. Sever's disease seems to be somewhat self-limiting anyways, since when it's painful, the kids will stop their own activities from the pain.

Eric Edelman, DPM, North Syracuse, NY, ericedelman@gmail.com

RE: Bilateral Pain Sub 2nd Mets (Robert Bijak, DPM)
From: Susan Bartos
 
I apologize to Dr. Bijak, and any other PM News subscriber if I have caused you dismay. My intention was NOT to offer advice, or to give a clinical opinion, but to share some possibilities for a pathology that might require further research. I think if you reread my response, you will find that I meant no harm. Although I am well-versed in biomechanics of the lower extremities, I am not a podiatrist, and do not claim to be one. I have the upmost respect for your profession and the body of knowledge you possess. Again, I am sorry if this caused any offense.
 
Susan Bartos, President, Earthwalk Orthotics, Inc., eworthotics@neo.rr.com

RE: Disentangling from Athena EMR (Jay C. Goldstein, DPM)
From: John Scheland, DPM

I have made just about every error one can make trying to implement meaningless use. Athena Health was one of those errors. The amount of complication you will have will depends on how much of it you have already implemented. There are a few things to keep in mind.

First and foremost is the maintenance of the health record. Second, is the maintenance of the billing portion, and lastly is the maintenance of the scheduling portion. You have to call them and then send a letter of your intentions. They will try to keep you by offering different packages. In the end, you will be given a certain amount of transition time, I think two months, to access your account.

They will send you password-protected disks of your records to...

Editor's note: Dr. Scheland's extended-length letter can be read here.

RE: Snap Fixation Pins (Mark H. Sugar, DPM)
From: Charles Morelli, DPM, Tip Sullivan, DPM
 
Wright Medical has a 2.0 snap off screw, and I believe Integra makes one also.

Charles Morelli, DPM, Mamaroneck, NY, podiodoc@gmail.com

Here is a suggestion regarding “snap off” wires. Make your own. Back in 1985, Dr. Nathan Schwartz had us scut monkeys taking threaded 0.045 in K-wires and 0.062 in threaded wires. Measure them at 16, 18, 20 and 22mm, and mark them with a skin marker. Then take a jeweler's file and file a notch at each mark about < 50% through the wire.  There you go — flash them and you have a fancy snap-off wire. You can use the skin marker mark to help you determine depth as you put the wire in, although nowadays you could use a “C” arm with comparable ease.
 
Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net

RE: Lawmakers Rip Waste in Anti-fraud Programs (David E. Gurvis, DPM)
From: Michael M. Rosenblatt, DPM
 
Fraud and anti-waste measures are an important political tack for those who want to get elected and re-elected. For one thing, this stance allows them to avoid describing cuts they would make in government spending. For another, it allows them to look "tough" in front of voters. Problems occur however, when bean counters actually BELIEVE this rhetoric.
 
This occurred in Washington State many years ago. A state-wide private insurer decided that they would "fight abuse" on a basic level. They instituted a policy of every procedure that cost over 100 dollars require a second opinion. You might guess the result. Second opinion clinics opened like an uncontrolled wild fire, and those clinics charged consulting fees that would easily dwarf the 100 dollar limit. Worse, for that insurer, it turned out that most surgical procedures were actually indicated, and surgery was not being abused.
 
It was a debacle for the insurer. The entire project was discontinued with a whimper after just a year. Gradually, the second opinion clinics closed down and surgical procedures continued as before, with very little fraud and abuse. I'm not saying it doesn't occur. We all know it does. But endemic issues that result in unabated increases in healthcare costs probably have little to do with fraud and abuse.
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

Codingline & PM News In conjunction with AAPPM Present
The Greenbrier Coding & Practice Management Workshop - August 20-22

(Following the 2012 APMA Annual Scientific Meeting in Washington, DC)

The Infinity Pool at the Greenbrier

Coming to Washington D.C. for the National? Don't miss out on being treated like a President and First Family. Enjoy world class amenities including golf, tennis, spa, casino and children's programs.

Speakers: Harry Goldsmith, John Guiliana, Barry Block, Michael Brody, Paul Kesselman, Jonathan Moore, Rem Jackson, Chad Schwarz, and other nationally-known authorities in morning-only presentations.

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SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact: podiatrypracticesale@gmail.com

ASSOCIATE POSITION - BOSTON/CAPE AREA

Boston/Cape Area Practice looking for physician experienced in surgical and medical care in office, clinical, and nursing home settings. Practice will provide opportunity to utilize training immediately. Both surgical and non-surgical applicants. Email CV to drjaa@verizon.net

ASSOCIATE POSITION- WASHINGTON

A well-established practice with 4 locations in and around Seattle is seeking a full time/part-time associate podiatrist. Position involves clinical, nursing homes, laser therapy. Applicant should be well trained physician and a motivated, energetic self-starter, completed minimum a 24-month residency. Please send inquiries to isbinc2006@gmail.com

ASSOCIATE POSITION - WORCESTER MASSACHUSETTS

Podiatry practice in Worcester Massachusetts is looking for an associate podiatrist. Busy 2-person practice. High surgical numbers. No nursing homes. Call to hear free recorded message for more information. Call 641.715.3800 Access Code 32299 and message 4 to learn about the practice. Visit our website www.centralmasspodiatry.com

ASSOCIATE POSITION - BRONX, NY

Full-time highly motivated, ethical, hard-working associate wanted for multiple office locations commencing 8/2012. All phases of podiatric medicine (Surgery, Biomechanics, DME, Palliative Care). Competitive base salary, malpractice insurance, bonus structure. Please email resumes to bronxpodiatrist1@gmail.com

ASSOCIATE POSITION - OHIO

Ohio practice with excellent reputation and patient base seeks to hire a Podiatric Surgeon. The offices are state of the art including Digital X-Ray, EMR, Diagnostic ultrasound, Padnet Vascular Testing, CO- 2 Lasers all aspects of DME. The base salary is $120,000 with a bonus structure and benefits also would like to have this individual buy into the practice eventually. Please send CV to: Ohiopodiatrist@aol.com

ASSOCIATE POSITION - GEORGIA

Podiatrist needed in the State of Georgia to start ASAP. At least one year post residency experience preferred. Contact Dr. Azuka Nwaedozie at (404) 908 9042 or email me at anwaedozie@aol.com.

ASSOCIATE POSITION – WILMINGTON, DELAWARE

Seeking full time associate, PSR 24/36 Board Qualified/Certified that is personable, highly motivated, ethical and hard working. Established 25 years old, well rounded, and busy practice. In large primary care based medical building with lab, X-ray, CT, ASC and medical aid unit. Multilingual is beneficial. Offering competitive salary with bonus opportunities and wide range of benefits. Partnership potential. Cover letter / CV to Del.DPM@gmail.com

ASSOCIATE POSITION - ST. LOUIS 

Multi-location group practice seeks motivated DPM with initiative and leadership skills to contribute to our growing group practice. Foot Healers Podiatry Group enjoys a strong reputation within St. Louis and looking for the right individual to complement our team. Must have the confidence to lead you own clinic and the willingness to draw on the expertise that exists within our group. Base salary starts at $100k, with incentives to grow income to $200k+, malpractice coverage, health insurance, 401k, group bonus/profit sharing. Please send CV to jmurray@foothealers.com and visit our website www.foothealers.com

ASSOCIATE POSITION - CENTRAL FLORIDA

Podiatrist licensed in FL to work in practice in central Florida with buy-in option. Practice in building built for podiatry. Excellent opportunity for new or experienced podiatrist to work, purchase practice,  lease, or purchase building in great area to live and grow. CV tofootsailor@earthlink.net
 
ASSOCIATE POSITION – MANHATTAN
 
Podiatrist needed for busy state-of-the-art offices in Manhattan. Offices are located near Penn and Grand Central Station. 10+ years experience only and an out-of-network doctor for most insurances. Please forward your information and CV to: roni@myfcny.com
 
ASSOCIATE WANTED - BRONX, NY
 
Part time Position Available Bronx New York for busy, growing office.  All aspects of podiatric medicine and surgery. Excellent salary with incentives. E-mail CV and letter of intent to Dr. Barry Finkelstein atbf1818@aol.com.

ASSOCIATE POSITION - SAN JUAN, PUERTO RICO

Well-established practice seeking associate with opportunity for buy-in. Must have a minimum of 2 years surgical residency, or have 10 years practice experience with rear foot surgical skills. Great opportunity for growth with in-house surgical center, 2 hospitals within walking distance & more. Puerto Rican License required. Send CV/Resume toadmin1@podiatrycenterpr.com

ASSOCIATE POSITION - NEW JERSEY

Busy, two office practice with a good mix of patients is seeking a very personable, highly motivated full-time associate with good clinical/surgical skills to fill an immediate position. Competitive salary with early partnership opportunity for the right individual. Please email CV to afsdocs@gmail.com.

ASSOCIATE POSITION - TEXAS

Podiatrist needed to join our fast growing practice both in house calls and office. An enterprising individual with good clinical and surgical skills. Texas license required, salary and benefit very attractive. Email your CV to divinefootcarecenter@yahoo.com or contact Joe at 972 790 2800.

ASSOCIATE POSITION - CENTRAL NEW JERSEY

Podiatry office in Central NJ- Looking for a three year surgically trained associate who has entrepreneurial spirit for a very busy office. You will see new patients and have the potential to become board certified in two years. Partnership guaranteed within three years for the right person. Must be very outgoing and personable. Great opportunity for a person who is confident and a go getter." Please fax your CV to: 732-968-8821.

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Full-time/Part-time, motivated, outgoing associate wanted for immediate job opening. Multi-office, multi-doctor practice based in Orange County, is looking for hard-working individual to treat wide range of patients. PSR 24 training a must and Spanish speaking a definite advantage. Email your CV to: ocpodiatryoffice@gmail.com

ASSOCIATE POSITION – PHOENIX, WEST VALLEY SUBURBS
 
A well-established, solo-physician practice seeking a Full Time Associate Podiatrist. Applicant should be well trained physician with sound surgical skills and applicant must have completed a 24-36 month residency, & be board eligible/certified. Practice offers a state of the art practice setting, with a good general mix of all aspects of podiatric medicine and surgery. Competitive salary and benefits. Partnership opportunities available. Fax resume: 623-935-5783 or email to: AzPodiatrist@gmail.com
 
ASSOCIATE POSITION - NYC BORO

Podiatrist needed for NYC practice. Must be on Health First, Health Plus, GHI, Affinity, or, most of these plans. All phases of podiatry. Excellent opportunity. E-mail resume to include currentemployment.rrranch7@yahoo.com
PRACTICE FOR SALE- LONG ISLAND part-time. Inquiries rranch7@yahoo.com

ASSOCIATE POSITION - MASSACHUSSETTS

Looking for an extremely hard working podiatry associate for part-time work, opportunity for full time. Busy and expanding podiatry practice in the Merrimack Valley. Will work in both office and nursing home setting. In office, we have laser technology, electronic medical records, diagnostic ultrasound, x-rays, etc. Please email us at resumesent11@comcast.net if you have interest in this position. If we find the right person, this opportunity could lead to partnership. Looking forward to hearing from you.

ASSOCIATE POSITION - ST AUGUSTINE, FL

A well-established, solo-physician in St Augustine, FL; is seeking a full-time associate. Applicant should be well-trained with sound surgical skills, applicant must be board eligible/certified. Practice offers a state-of-the-art practice setting, with a good general mix of all aspects of podiatric medicine and surgery. Competitive salary. E-mail resume todrfootwound@gmail.com

ASSOCIATE POSITION - SOUTHEASTERN MICHIGAN

Immediate opening for a full time/part-time PSR 24/36 podiatrist in a 30 year old, well established practice with an excellent reputation and referral base. State-of-the-art office with EMR, digital x-ray, diagnostic ultrasound and beautiful office. Generous base salary, malpractice insurance, health insurance, benefits and bonus structure. A well rounded and energetic podiatric surgeon needed for this group of 4 board certified podiatric physicians and surgeons. Please send CV to: michiganfootandankle@gmail.com

ASSOCIATE POSITIONS – NEW YORK CITY

Looking for someone with some working experience in a podiatric office. Two sessions (1/2 day) a week for July and August for Upper West Side of Manhattan. References a must. One 8 AM to 12, one 12 to 5 PM. Reply to fabienne.rottenberg@gmail.com

ASSOCIATE POSITION AVAILABLE - NORTH CAROLINA

New associate position available that may lead to partnership. We are a very busy practice providing care in both office and hospital settings. We are fully integrated in a large tertiary teaching hospital. We are located in the beautiful mountains of western North Carolina. Research opportunities are available. Applicant should be ethical, personable, hard working, and committed to quality in patient care. We are offering a competitive salary with bonus opportunities and a wide range of benefits. All interested candidates should send a CV toMFAS828@aol.com

EQUIPMENT FOR SALE

Retiring from practice. Equipment For sale. Mini x-ray. One year old Ultrasound with MS arterial/venous X-ray plates. Great condition Ritter chairs. Drills, surgical tools. So much. Just ask, I probably have it: Footcare@comcast.net

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