The Voice of Podiatrists

Serving Over 9,500 Podiatrists Daily

July 07, 2007 #2,980 Editor-Barry Block, DPM, JD

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OH Podiatrist Uses Platelet-Rich Plasma Treatment to Heal Wounds

John Schafer ripped his Achilles tendon. St. Luke's podiatrist, Dr. Ed Szabo, used an old technology in a new way to help it heal. It’s called platelet rich plasma treatment. Blood is drawn from the patient and it is separated in a centrifuge. Then, the clear plasma and dark red protein plasma are injected back into the patient right where it hurts.

Heart doctors, dentists and ortho surgeons have been using these rich platelets for years. It also helps diabetes patients heal faster. Dr. Szabo is the only doctor using it to stop foot pain. "Growth factors are things that are recruited to an area that are injury that create revascularization. New blood flow the area and they also increase the rate of cell turnover so you can go from damaged injured cells, painful cells to healthy, new non-painful cells."

It takes your body about 6 to 8 weeks to replace the cells in an area of the body. Since you are using your own blood, it is very safe. The entire procedure can be done right in the office, getting patients up and running in no time. Dr. Szabo says about 80 percent of his patients are back on their feet in less than 8 weeks.

Source: Kelly Heidbreder, WNWO-TV [7/5/07]

TX Podiatrist Passes Foot Surgery Legacy to His Son

Larry and Scott MacTavish are a father-son team of podiatrists who practice together under the same roof, specializing in treating foot and ankle disorders. Making their situation even rarer, one of the doctors has a special tie with his workplace. "My son was born in the Houston Northwest Medical Center," Larry said. "He's the only one who was born here and has come back to practice."

Drs. Larry and Scott MacTavish

Larry has been in the foot business for 33 years - and expects to practice another 15 years - and has made major breakthroughs in the field since he began. "I was really a pioneer in the field of foot surgery when I first came along, because a lot of general medicine didn't entertain or like feet," Larry said. "The results were poor and antiquated procedures were performed.

When Scott began working with his father, he realized he enjoyed surgery and became board-qualified in forefoot and reconstructive rear foot procedures. "It's an incredible feeling working with my dad," he said. "We get to assist each other in surgery. He's one of the more successful guys in town, so there's a little bit of a shadow, but it's a very good shadow." Working together allows Larry to pass knowledge onto his son that may not be found in a textbook. "You know the basics of medicine and surgery, but when a gunshot wound comes in, there's no textbook that says 'this is what you do,'" Larry said. "It's like a Picasso. It's a unique individual case and has to be tailored accordingly."

Source: Valerie L. Clifton, Houston Community Newspapers [7/4/07]

RACs Set to Start Audits in MA Starting Next Month

A recovery audit contractor (RAC) is slated to begin Medicare reviews in Massachusetts this month, and work in other states is not far behind as the national rollout of the Medicare contingency-fee auditors gets under way. Connelly Consulting, the contractor that CMS selected to be the RAC for Massachusetts, will start requesting medical records from hospitals and other providers on Aug. 1, 2007. Also, providers in South Carolina and Arizona will soon face RAC audits.

RACs are the first Medicare contractors to be paid only when they find Medicare errors — both overpayments and underpayments, though so far RACs have found far more overpayments. The 2003 Medicare reform law established a three-year RAC demonstration program in three states — California, Florida and New York. CMS considered it such a success - hundreds of millions of dollars in overpayments have been identified and recovered from providers — that the 2006 Tax Relief and Health Care Act mandated the extension of RACs to all states by 2010. CMS is way ahead of the game, with some RACs setting up shop in mid-2007. CMS plans to have RACs in place in all states by 2008.

RACs have denied claims for excisional debridement, a surgical procedure, if the word "excisional" wasn't in the medical record. But some providers call this a bad-faith denial and find it alarming because it indicates RAC reviewers didn't understand medical-record terminology. If a physician notes in the chart that he used a No. 10 blade for a wide removal of necrotic purulent tissue, "that is excisional debridement whether or not the doctor [wrote] 'excisional,'" says Marge Beal, director of hospital billing compliance at UMass Memorial Health Care in Worcester, MA.

Source: Report on Medicare Compliance [7/2/07]

Query: Scanner Use & Quality

I am interested in recommendations for scanners in terms of: Improved quality, lowered number of adjustments needed, fast turnaround, and pricing options. I am also intrigued by a few 3-D scanners I have seen. Does anyone have any personal experience that could lead me in the right direction.

Rick Matteau, DPM, Foot Fixer Podiatry

Query: Bundling IP Fusion with Tendon Transfer

I performed an interphalangeal joint fusion of a second digit (CPT 28285) along with a flexor transfer (CPT 27690) on a Medicare patient. Appropriate modifiers were used. Medicare is denying the fusion saying it is included in the payment for the flexor transfer. I have not run into this before. Is this correct, or should I appeal it?

Neil Levin, DPM, Sycamore, IL

Response: CPT 27690 is a "transfer or transplant of single tendon (with muscle redirection or rerouting); superficial tendon" with the primary muscle redirection or rerouting occurring at the ankle/lower leg. Performing a flexor tendon transfer as part of a hammertoe surgery would be inclusive of the hammertoe procedure correction (procedural option) since the transfer work you are doing is essentially at the digital level. The proper code to bill for the surgery you performed is CPT 28285. If you feel that the work involved is significantly greater than CPT 28285, you can always append a "-22" modifier, submit the op report, and a letter of explanation.

Tony Poggio, DPM, Alameda, CA

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RE: Overuse of Sandals Can Exacerbate Foot Problems
From: Jeffrey A. Root

There have been several issues of PM News with articles or letters expressing concern about sandal related foot problems. There are a number of orthotic laboratories that now offer sandals which are specifically designed to incorporate the use of a functional orthosis. These sandals have an extra-depth foot bed which is removed and replaced with a custom orthotic device. For patient’s who want to or simply insist on wearing sandals, these products are an excellent alternative to regular sandals. Several of the labs that offer these products can be found on the Prescription Foot Orthotic Laboratory Association (PFOLA) website at www.pfola.org (see member directory).

Jeffrey A. Root, Western Representative, PFOLA, jroot@root-lab.com

RE: AAOS and Podiatry (Bryan C. Markinson, DPM, 7/3/07)
From: Jeffrey Kass, DPM

I read with interest the postings regarding the Orthopedic Society versus the podiatric community. I always find with great interest which issue we feel is most important to combat at a particular time. I have always felt that doctors, no matter what kind should always be paid the same amount when the same procedures are being performed. I was looking over my coding manual today after having done a procedure and noticed something I felt was unfair. CPT code 27630 excision of lesion of tendon sheath or capsule (cyst, ganglion) leg and or ankle and CPT code 28090 excision of lesion of tendon sheath, or capsule (cyst, ganglion) foot

The "podiatry manual" 2007 shows CPT 27630 pays $483.65 while CPT 28090 pays $385.47. I looked further every like procedure paid more in the leg/ankle compared to the foot. This makes no sense to me. A ganglion about the ankle or dorsum of the foot are equivalent procedures in my eyes. I think disparity in pay is an issue that needs to be dealt with as well.

Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

Editor's Note: This topic is now closed.

ASSOCIATE POSITION FLORIDA - NORTHEAST REGION

Busy, well established, full scope podiatry practice seeking highly motivated, hard-working, reliable, responsible and especially likeable to the average human, Associate. Surgical training a plus. Prefer PPMR or RPR. This is an Associate position with lots of potential. Team players only. Email CV to: healthparkmgr@bellsouth.net or fax CV to: 904-826-1586

EQUIPMENT FOR SALE-CENTRAL NJ

Boyd chairs(3), x-ray processor, view boxes, densitometer and much more all in working order. smaller items can be shipped chairs to be picked up please call me at 908-730-8881 or contact me at larrydpm2002@yahoo.com

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PRACTICE FOR SALE - NORTHERN CALIFORNIA

Great opportunity to own a well-established turn-key podiatry practice located in modern medical office building in East Bay; Electronic billing, good payor base, no HMO contracts; Biomechanics, general podiatry with great potential for surgery. Please send CV and letter of interest to: norcalpod@hotmail.com

ASSOCIATE POSITION – SOUTHERN CALIFORNIA

Seeking a position in a warm, friendly, and productive environment? Well, look no further! A well established podiatry facility in North Hollywood , California has an immediate position available for a podiatrist. He/She must be motivated, reliable, and dedicated. Depending on performance, partnership is possible. If interested, email your resume to drnickoghosyan@yahoo.com

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

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Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

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PRACTICE FOR SALE -FORT LEE, NEW JERSEY AND MANHATTAN

Nice mix of commercial insurance, Medicare, cash, routine care, surgery. Experience the NY metro life with shopping, dining, professional sports, culture at your doorstep. AMERICAN DOCTOR SALES 614-918-3000 or email us at sell_my_practice@yahoo.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

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Busy, well established, full scope podiatry practice seeking highly motivated, hard-working, reliable, responsible and especially likeable to the average human, Associate. Surgical training a plus. Prefer PSR 24+. This is an Associate position with lots of potential. Team players only. Email CV to: healthparkmgr@bellsouth.net or fax CV to: 904-826-1586, Attn: Amy

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