June 22, 2006 #2, 612 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2006- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

“Fit Your Feet, Not Your Head” – CA DPM

San Leandro podiatrist Dr. Tim Dutra says flip-flops are fine as a fashion shoe, but they're not functional footwear. "They offer absolutely no support," he says. "They're fine for lounging, a casual type of footwear, but unfortunately many people are running around in them. You can get a lot of overuse type problems — arch, heel problems — with using flip-flops exclusively as your runaround shoe."

They have a couple of problems. That spongy sole is slippery. And the only point of contact with your foot is the stem between your first and second toes. Stability in a shoe, he says, comes from contact with your heel. "(In a flip-flop) your foot is very unstable," Dutra says. "It flops around. And yet they're so popular — a lot of students, that's all they wear. The one advantage of flip-flips is they do allow the feet air and to dry."

"The main thing with fashion is you want to fit your feet not your head," Dutra says. Still, the fact remains that many women are more than willing to suffer to look good.

Source: Elizabeth Jardina, Oakland Tribune, [6/20/06]

Lawmakers to Pass Bill to Prevent Payment Reduction

House Ways and Means Committee Chair Bill Thomas (R-CA) and other committee members have indicated that they plan to pass legislation to prevent a reduction in Medicare reimbursement rates for physicians scheduled to take effect in fiscal year 2007, CongressDaily reports.

Under the Medicare Sustainable Growth Rate formula, reimbursement rates for physicians will decrease by almost 5% in FY 2007 and by a total of 37% over the next nine fiscal years. Some lawmakers who support legislation to prevent the reduction in Medicare reimbursement rates for physicians in FY 2007 have "caveats," and they "probably will not go as far as the physicians' lobby would like," CongressDaily reports.

Source: American Health Line [6/20/06]

Don't' Miss the 9th Annual International Conference on Foot Biomechanics and Orthotic Therapy

This conference provides lectures and workshops featuring internationally renowned clinicians and researchers. The Prescription Foot Orthotic Laboratory Association (PFOLA) uses the proceeds from this meeting to provide educational grants for clinical outcomes studies using custom prescription foot orthoses. Mark your calendar! December 1–3, 2006 Chicago, IL For details, go to www.pfola.org or call Myrna at 415-928-6141

------------

For a list of all meetings go to: www.podiatrym.com/meetings.pdf

Query: It's Their Debt, But It's Your Problem

Studies show that employees saddled with debt are more stressed, less productive, and absent more often than others. They make more personal calls about money, they send more personal faxes, and they talk about the issue longer with coworkers. Their physical health is worse. They waste about 20 hours of work time a month dealing with money problems

My question: Has anyone provided counseling, books, or any other form of help to employees who are having difficulty making ends meet?

Bob Levoy, Great Neck, NY, b.levoy@att.net

Query: Down-coding Surgery

I performed an Austin bunionectomy on a patient's left foot on March 10, 2006 (CPT 28296). After getting low reimbursement from Horizon Blue Cross/Blue Shield of New Jersey (actually, Horizon Healthcare Administrators, who process claims for many unions), the patient went on to uneventful recovery.

The patient then underwent an Austin procedure on the right foot on May 26, 2006. I coded this procedure 28296-RT. I included the "RT" modifier so that the claim could be distinguished from the first procedure. When I got my EOB, I actually got paid LESS for the second procedure, and the "RT" modifier was changed to a "50" modifier (bilateral procedure). When I called, I was told that by putting the "RT" modifier, the insurance company will actually pay LESS because of the modifier! This is the proverbial "last straw" for me. The difference is only $25, but the principle of the thing is what is driving me crazy. Any suggestions?

R. Kurt Meier, III DPM , Brick, NJ

Response: Typically, the application of a "-50" modifier should "reduce" the second procedure payment by 50% (in other words, both - bilateral - procedures should be valued at 150%). The "-50" modifier is applied to a single procedure code (Medicare), but represents performance of bilateral procedures (2) performed in a single session. The "-50" modifier is one of those "standard transaction code sets" that is not standard. Non-Medicare payers use the modifier to represent codes differently...but usually always procedures performed in the same surgical session.

Horizon should be challenged regarding its bundling of your two surgical sessions (over two months apart). Your original billing should have been CPT 28296-LT for the March surgery, and CPT 28296-RT-79 for the May surgery (you most likely performed the second procedure in the global period of the first, and need to inform the payer that the second procedure is unrelated to the first). The second procedure should have paid 100% of the fee schedule allowance, just like the first procedure in March.

There is a principle involved here. You should complain and appeal. You should involve the patient, your state association, and the APMA Health System Committee (through their online complaint form) for Horizon's practices.

Tony Poggio, DPM, Alameda, CA

Additional responses appear at www.codingline.com

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

RE: Patient Extortion? (Barry Block, DPM, JD)
From: Terence S. Pedersen, DPM, Michael M. Rosenblatt, DPM

If you let the lady get away without paying by being a bully, she will continue to do it to others. Sometimes you have to take the "high road" and do what is right, no matter the consequences. Doing what is right is usually the harder thing to do. Doing what is wrong because it is easier is just plain wrong.

Terence S. Pedersen, DPM, Yankton, SD

TPedersen@SHHServices.com

Most of us, if we accept responsibility for other than extremely conservative patient care, will occasionally encounter patients who make extortionate demands. For me at least, any time a patient (or a patient’s family) made any accusations about my truthfulness, honesty or character, I would always dig my heels into the ground. This situation is different from a complaint about a surgical result, procedure or other patient-treatment issue.

All we have is our word and honor. When mine was questioned, I would respond by writing a polite but firm registered letter, return receipt requested that the patient should “be very careful about publicly alleging any statements or comments questioning my character or honesty.”

I made a policy separation between a “treatment result and dissatisfaction” on one hand and character assassination against me on the other. Under those guidelines, for me at least, a personal payment to an angry patient might be reasonable, as long as their complaint did not include any imprecations about my honesty and character.

Obviously this is a difficult, unhappy moment in practice life. I have found that standing up for my personal honor must take precedence, even over the risk of being in a data bank.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

ASSOCIATE POSITION - PITTSBURGH, PA AREA

Excellent opportunity for a hard working, surgically trained podiatrist to join a well-established, high volume, multi/location practice in the suburbs of Pittsburgh. Must be willing to perform all aspects of podiatry. Incentive-based salary, compensation package, with potential for partnership. Must presently have Pennsylvania license. Would like to fill position asap. Fax resume to 412-831-2115.

ASSOCIATE POSITION - MINNESOTA – MINNEAPOLIS SUBURB

Busy, well-established, full-scope podiatry practice, seeking highly motivated podiatrist for a full-time position with buy-in opportunity. Looking for PSR 24/36 trained individual, to help increase surgical volume. Excellent opportunity for long-term growth with unlimited income potential. E-mail CV to employment@associatedpodiatrists.com or fax to (612) 866-5875 Attn. Jennifer.

EQUIPMENT FOR SALE-X-RAY DEVELOPER

Near-new podiatry/medical x-ray developer for sale. All-Pro Model 2010. Excellent condition. $2500. Call (216) 261-7662 or email: fergusondpm@aol.com

TEMPORARY POSITION – LONG ISLAND

Doctor broke arm and needs a NY-Licensed DPM to cover for a period of time. (516) 637-2671 Mel2222@peoplepc.com

EQUIPMENT FOR SALE - ESWT

If you are using or thinking of using ESWT, I have a new machine that has only been used twice. There is no Orbasone in the country priced like this one. Will provide training and installation. Take a look at http://www.orbasone.com Call 1-856-229-2939.

ASSOCIATE POSITION - NAPLES- FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills. Hospital privileges available at 548 bed hospital system and multiple surgical centers. Candidate should want to perform rearfoot surgery including Charcot reconstruction. Candidate needs to be ethical and motivated and have a current Florida license. Established practitioner or new practitioner OK. Base, percentage, benefits including insurance and 401K. Fax CV to (239) 566-8778.

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901.

ASSOCIATE POSITION – MIAMI DADE COUNTY FLORIDA

Part time work available. Clinic sessions-nice environment / assistants supplied 8am-12pm / 1pm-5pm. Miami Dade County. Hourly Salary. E-mail response to: podoffice@aol.com

PRACTICE FOR SALE - NORTHWESTERN US

Selling 3 well developed satellite offices with substantial potential of continued growth. All offices in areas of abundant outdoor recreational activities including skiing, fishing, hiking, etc. These offices are priced to sell quickly! Please only serious inquires only and contact via e-mail: offmgr4464@hotmail.com

RESIDENCY POSITION – VIRGINIA

One Year Foot and Ankle/Rearfoot Surgical Fellowship with excellent salary/benefits available July 1, 2006. If you are finishing a PSR-24 and don't have a job yet, this is an excellent way to learn additional surgical and business skills. Please fax resume to 703-
491-9994.

WEEKLY SPECIAL - One week of ads (6x) for only $75

PM Classified Ads Reach over 8,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most- effective way of reaching over 8,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.