The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

June 28, 2007 #2,973 Editor-Barry Block, DPM, JD

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NC Podiatrist Offers Foot Care Tips

“Your feet may change size as you get older due to water retention or ligaments that relax over time,” says Jane Andersen, a podiatrist and a spokesperson for the American Podiatric Medical Association. And the skin on the feet, which is the thickest on the body, might need special moisturizing treatments.

Dr. Jane Andersen

Have your feet measured yearly (ideally at the end of the day), and vary your shoe types and heel heights. Bunions and hammertoes “come from repetitive motions,” says Andersen, “and can often be prevented with supportive shoes that fit well, plus orthotics to neutralize foot position.” (Painful bunions can lead to arthritis and should be corrected.) Weight-bearing exercises will beef up bone density. (The feet are a common site of osteoporosis.)

Andersen recommends moisturizing the feet nightly with a gentle exfoliator, like AmLactin XL or an intense moisturizing lotion to keep them soft and supple.

Source: Journal Gazette [6/25/07]

Diabetic Foot Section of ADA Celebrates 20th Anniverary

Twenty years ago this week, a group of clinicians began what is now a bona fide area of medical subspecialty, diabetic foot care. The celebration, held in conjunction with the American Diabetes Association Annual Scientific Sessions, was co-hosted by Professor AJM Boulton, ADA Foot Care Interest Group Chair, and Professor David G. Armstrong, Director of Scholl College of Podiatric Medicine’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science.

Dr. Andrew JM Boulton

The sessions attracted key scientists and opinion leaders from six continents. “This was a splendid meeting,” noted Professor Boulton. “It further acknowledges that clinicians of all stripes – from podiatric medicine to vascular surgery to endocrinology to infectious disease – can come together and create something that makes a lasting difference.”

A podcast discussion of the birth of the Foot Care Council is available at diabetic-foot.net and on iTunes.

Efforts To Reverse Imaging Payment Cuts Unsuccessful

Companies in the medical imaging equipment industry are lobbying Congress to overturn Medicare cuts that took effect in January, the AP/Arizona Daily Star reports. The cuts reduced Medicare reimbursements to doctors for performing X-rays, MRIs and other tests. For example, reimbursements to doctors for MRI scans have decreased an average of 38% nationwide. The cuts are expected to save $2.8 billion over five years. The National Electrical Manufacturers Association and the Advanced Medical Technology Association as of 2006 employed 23 lobbyists to work on Medicare issues, arguing that the cuts will cause fewer physicians to offer in-office imaging.

The groups argue that as a result, beneficiaries will have to travel farther and wait longer for medical scans. Another group -- a new organization called the Access to Medical Imaging Coalition, which claims to represent more than 75,000 beneficiaries and health care professionals -- also is lobbying Congress to reverse the cuts. The AP/Daily Star reports that "at least part of the motivations for [AMIC's] efforts is the impact that Medicare cuts are having on the industry's bottom line. No hearings currently are scheduled on the issue, and some healthcare experts are advising lawmakers that more medical technology does not necessarily lead to superior healthcare

Source: Matthew Perrone, AP/Arizona Daily Star via American Health Line [6/26/07]

Query: Metal Insoles

Can anyone provide a source for obtaining the metal, rigid shoe insoles. These insoles are about 1-2 mm. thick, are full sole and are used to decrease the dorsi-flexion of the toes. I have been using a pair for many years and have misplaced its source.

Kel Sherkin, DPM, Scarborough, ON, Canada

Query: Topaz Coding Question

Does anyone have experience performing coablation procedures for plantar fasciosis using the Topaz techique? We were wondering what CPT codes would be used, and if the reimbursements will be worth our surgicenter purchasing the unit.

David Sands, DPM, Jamaica Estates, NY

Response: There are two components to your question.

1) There is no code for this procedure so I would suggest that the unlisted code CPT 28899 is the best option to use for billing purposes.

2) I have found that because the techique is relatively new,
a number of insurance companies have consider it investigational, although more and more surgeons are performing it with success. I would recommend you get a preauthorization for the procedure (and reimbursement), make sure the patient is aware that there is a chance that their insurance company may not pay for the procedure,
and they will be responsible.

This latter point may be a concern for your ASC, if they are buying the unit. Presumably, they would have met with the Topaz people, and done their own due diligence to ensure that there would be enough revenue generated to support the purchase (or lease) the machine.

Tony Poggio, DPM, Alameda, CA

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

RE: Addiction to Oxycontin (Name Withheld)
From: Elliot Udell, DPM

In no way should you or anyone else make you feel wrong for becoming addicted to Oxycontin. Only recently has this drug made the press for being so addicting. You deserve to be acknowledged for reaching out for assistance.

Addictions are by no means rare in our society. We often look with raised eyebrows at people addicted to legal or illegal morphine-related product. There are far more common addictions that so many of us have to deal with. Smoking is one obvious one. Drinking is another. In the US overeating and subsequent obesity is probably the addiction with the greatest numbers of people. I even heard that there are help groups set up for people addicted to video games.

Dr. Block's advice on contacting the Physicians Recovery Network is one good avenue to pursue. Another one is Narcotics Anonymous. This group has 12 step meetings all over the country. There are also private psychiatrists who work with addictions. A call to your state psychiatric association might be helpful in finding practitioners in your area. Another resource is the Academy of Psychosomatic Medicine and Liaison Psychiatry, a group I belonged to for many years. There are psychiatrists in that group who specialize in treating addictions. The important thing is to act on the advice and know that you are not alone.

Elliot Udell, DPM, Hicksville, NY,Elliotu@aol.com

RE: Alcohol Injections for Neuromas
From: Paul Kesselman, DPM

The June issue of American Journal of Roentgenology contains a European
study advocating the use of a 20% dehydrated alcohol injection for Morton's neuromas under sonographic guidance. This study stipulates that 20% is the minimum concentration of alcohol which will initiate invitro neurological changes.

This study is not a RCT nor is it a double-blinded study and was conducted on 101 patients.

It is a huge step forward for those have advocated both sonography and a stronger alcohol concentration for treatment of Morton's neuroma.

Am J Roentgenol 2007;188:1535-1539.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: Shortened 5th Digits (Anas Khoury, DPM)
From: Craig Breslauer, DPM

I have had success combining a dorsal V-Y plasty and a syndactilization. This seems to provide a satisfactory improvement in length as well as a stable repositioning of the digit in the sagittal plane.

Craig Breslauer, DPM, Stuart, FL, cbreslauer@sfo.med.pro

PRACTICE FOR SALE – OHIO – SOUTHEASTERN

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Reputable, thriving, well-rounded practice available with EMR. Grossing over $320K over the last 3 years. Priced to sell at 150K. Owner relocating. Email inquiries and CV to podsx@yahoo.com

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WANTED: BIOMECHANICS CONSULTANT

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West Houston Medical and Kingwood Medical Centers are seeking a biomechanics consultant to help develop competency based curriculum/assessment forms, provide workshops, and lecture to their residents. The individual must be Board Certified by the ABPOPPM, be a Fellow of the American College of Foot and Ankle Orthopedics and Medicine, and must be able to come for quarterly visits to Houston, Texas. Interested candidates should fax a C-V and consulting fees to Dr. Samuel Mendicino, Residency Director, West Houston and Kingwood Medical Centers. 281-589-1618.

ASSOCIATE POSITION – SOUTHEAST MICHIGAN

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Seeking quality-oriented, patient-focused, RPR-trained associate for a fast-paced, established group practice This is a secure, long-term position. Emphasis on diabetic foot and wound care. Gain surgical experience while earning an excellent living. Partnership possibility. If you are highly motivated, ethical, and have good communication and clinical skills, forward CV to: fax (734) 466-8501 or email mbell6@msn.com

EQUIPMENT FOR SALE - WASH. DC

Name your reasonable price and pay shipping- Body chairs, X-Cell X-rays, Konica developer, SmartDop20, viewboxes, lakesidecart, Endoscopic unit with all attachments, topical hyperbaric O2 units, castle autoclave, xerox copier, fax machines, etc. call 202-841-5545 or email to JHALLUX@yahoo.com

ASSOCIATE POSITION - MIAMI BEACH, FL

Seeking well trained PMS 36 / PSR 24+ for Full-Time associate position. Leading to partnership for the person. practice is 50% hospital based. Must have strong Sx skills, including Limb Salvage & Trauma. Competitive Salary & benefits Package. Fax 305-652-6672 or Call 305-785-2559 Email: doctorsole@aol.com

ASSOCIATE POSITION – ORANGE COUNTY, CA

High volume surgical practice seeking well trained surgical associate for full-time position in orange county California immediately. This position can lead to separate private practice or partnership for the associate. Excellent Salary & benefits Package included. Email CV, photo, and questions to: FootSurgeonOC@aol.com

ASSOCIATE POSITION SANTA FE, NEW MEXICO

We are looking for a highly trained, personable, ethical, and caring podiatrist, to work in a two doctor, three office practice, of thirty years. Send CV to sfpodiatry@ aol.com

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