The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

July 16, 2008 #3,299 Editor-Barry Block, DPM, JD

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Dayton Appointed to IA State Podiatry Board

Paul Dayton, D.P.M., of Trimark Foot and Ankle, was appointed as a member of the State Board of Podiatry. Dayton's term on the board will run through April 2011. As a member of the board, Dayton will assist licensure and peer review activities of the board.

Dr. Paul Dayton

Dayton has been practicing with Trimark Foot and Ankle since 1990. He is board certified by the American Board of Podiatric Surgery in foot and reconstructive rearfoot/ankle surgery.

Dayton is also a provider for Trinity Wound Healing Center at Trinity Regional Medical Center, serves on the Trimark Board of Directors and Iowa Podiatric Medical Society Board of Directors. Dayton practices podiatry with Drs. Mark Hartman and Mindi Feilmeier at Trimark Foot and Ankle.

Source: The Messenger [7/13/08]

Bush Plans to Veto Medicare Bill as Cuts Loom

President Bush plans to veto a Medicare reform bill Tuesday that would stave off cuts to physician payments through 2009 and make other adjustments to the program, HHS Deputy Secretary Tevi Troy announced. The veto would coincide with a 10.6% cut to physician payments that is scheduled to go into effect Tuesday. Both the House and Senate approved the bill by a veto-proof margin. Troy admitted the White House was in a “tough position politically,” as it doesn’t have enough votes to sustain its expected veto.

Votes to override the presidential veto are expected to occur after the president officially rejects the legislation. The bill would halt a 10.6% cut to physician payments for the next 18 months and includes a slight pay bump in 2009.

The CMS had put a hold on the payment cut for two weeks. Once this hold expires, “contractors presumably will have no choice but to process the claims with the 10.6% cut” unless the president signs the bill into law, said Jeffrey Harris, president of the American College of Physicians in a written statement.

Source: Jennifer Lubell, Modern Healthcare [7/14/08]

New Pharma Ethics Rules Eliminate Gifts and Meals

Coffee mugs and pens bearing the names of drug companies or their products may vanish from doctors' offices in 2009 under new guidelines adopted by the Pharmaceutical Research and Manufacturers of America.

The association, which represents pharmaceutical and biotechnology companies and is made up of executives from companies in the industry, updated its "Code on Interactions with U.S. Healthcare Professionals" Thursday. The rules bar sales representatives from giving doctors items including pens, mugs and other knickknacks bearing company and product logos. Sales representatives are also prohibited from providing restaurant meals and entertainment or recreation.

The new rules take effect Jan. 1. PhRMA said meetings between sales representatives and doctors should be focused on informing health care professionals about products, sharing scientific and educational information and supporting research and education.

Source: Marley Seaman, AP [7/10/08]

How to Sort Through Resumes - Part 1

It's feast or famine. Sometimes you have to search to find great job candidates. At other times, you are bombarded with resume's. In either case, recruiting can be a frustrating and time-consumung process. Here are some resume'-reading strategies that ease the hiring burden:

Check length of service. A candidate with several short-term employers (less than one year) could have a hard time committing to a job. On the other hand, that could indicate that the candidate has been caught up in the recent employment turmoil.

Best bet: Check references carefully. You don't want to hire someone else's deadwood.

Query: Coding Nerve Conduction Testing

What CPT code should be used to report nerve conduction testing? I billed CPT 95937 (neuromuscular junction testing [repetitive stimulation, paired stimuli], each nerve, any one method) x 6 units (6 separate nerves were tested) to Tricare, and they have denied the claim 3 times, citing an invalid CPT code was reported.

I have appealed this with supporting documentation, the actual study, physician interpretation, the CPT description, copies of the Coder's Desk Reference for Procedures' Description, etc.... Despite all my efforts, I am still receiving a denial asking for a "completed coding scenario." Any suggestions?

Terri Phillips, CPC, Metro Tulsa Foot and Ankle Specialists, Tulsa, OK

Response: The code you have selected indicates that you are doing repetitive stimulation of a motor end-plate on a nerve, per unit/nerve tested. This code, CPT 95937, is not likely the appropriate code...unless you are doing an invasive EMG study with needle electrode, looking for diseases or conditions that are neuromuscular in nature, and affect the motor endplate... pre/post synaptic things... myasthenia gravis, etc.

If you are doing sensory and motor nerve conduction velocity (NCV) testing, with amplitudes, latency, you may want to look at CPT 95903 and CPT 95904 and related codes... but please look up the LCD and be familiar with the machine, the specific test done, whether you are doing the complete test, or just the technical component, whether you are measuring "H" reflex and "F" waves. Recent changes in the LCD last year went much further to include post-graduate training or documentation to show that you are a little more than familiar with the topic. Previous posts last year encouraged readers to seek out such training.

Carl Ganio, DPM, Vero Beach, FL

Codingline subscription information can be found here

RE: EHB as a Spacer for Keller Procedure (Greg Caringi, DPM)
From: Jerry Cosentino, DPM

I have used a piece of the Achilles' tendon, the extensor hallucis longus, brevis as well as the extensor digitorum longus as a spacer. The easiest tissue spacer to harvest is a hypertrophied capsule which can be divided, or you can fillet, if thick enough, to be used to cover the head of the first metatarsal. I suture the material within the capsule in all planes. Obviously the plantar sutures are the most difficult, due to the sesamoid apparatus.

I designed this procedure for use in my sports medicine practice in order to avoid the complications of silastic or metallic implants in the athlete. They have been very successful, but you must also evaluate the first metatarsophalangeal joint biomechanics, in the younger patient, which may indicate the usage of an oblique osteotomy in order to plantarflex and decompress the joint. The article can be found in The Journal of Foot and Ankle Surgery, September/October 1995.

Jerry Cosentino, DPM, Tampa, FL, gcosenti@tampabay.rr.com

RE: Shoe Project For Darfur
From: Alex Kor, DPM,MS

As a child of two Holocaust survivors, I have always been sensitive to victims of genocide. As a podiatrist, it is rare that an opportunity presents itself that would allow me to help persons that are in such dire circumstances. About 6 months ago, I became familiar with Manny Ohonme, founder of Samaritan's Feet. Manny's goal is to equip 10 million impoverished children with 10 million shoes in 10 years.

I would like to help Manny by delivering 1 million shoes to the children of Darfur. By working with the C.A.N.D.L.E.S. Holocaust Museum and Education Center in Terre Haute, IN and other synagogues, churches, Jewish community centers, etc. I am looking for concerned podiatrists around the country that would like to participate and help. Upon request, I can provide additional information.

Alex Kor,DPM, MS, Washington, DC, akisok15@hotmail.com

RE: E-Prescribing (Dennis Hershey, DPM)
From: Charles R. Oehrlein, DPM

I use e-prescribing in the office and absolutely love it and it did not cost me a dime. BCBS of AL provided smart phones and hand-held devices (our choice) and set up the system in our office. All of the patients ever seen who were BCBS, Medicare or Medicaid were then uploaded from BCBS to the handheld. I can add patients that have different insurances as well to my patient list. Then when writing a script it is a few taps, and it is sent directly to the pharmacy. A paper copy is printed for the chart. I get e-mails when patients need refills and those are refilled quickly.

I have no idea if BCBS AL is still doing this free set-up, but I do know I love the electronic prescribing and do not see going back to handwriting prescriptions. I would like to know where to register that I am doing this to get the Medicare bonus.

Charles R. Oehrlein, DPM, Hoover, AL, droehrlein@yahoo.com

RE: APMA Wins Medicare Victory (Paul Kesselman, DPM)
From: Robert Scott Steinberg, DPM, Barry Drossner, DPM

I can see how, on the surface, many of you look at our recent "victory" as something good, and of great value - at least 10.6% worth. But our victory came at what cost? How much did the APMA have to spend to achieve this victory? Think about it. There is a law in place that automatically reduces payments to physicians, unless the Congress acts to stop it. This to me is an annuity for the members of Congress. We and so many other organizations representing providers must spend millions of dollars lobbying so we can all continue to provide care - at a basic loss, but provide that care at less of a loss if the cuts went through. Some business model.

While I just love the APMA, we are small potatoes compared to the AMA, ADA, and all the hospital organizations. When is everyone going to stop for a minute and think? Maybe if we would, we would hear the cry, "WE ARE FED UP AND WE ARE NOT GOING TO TAKE IT ANY MORE!"

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

I have been a member of the APMA since 1977. I applaud the recent efforts of the APMA and feel strongly that if you are a podiatrist, you should belong to your national association. There are lawmakers who can easily create problems for our profession. The adage of there being safety in numbers is true. We are a small profession compared to others. It is vitally important that we have a say in what happens in Congress. Unfortunately, without membership and money, our profession will not be heard. Let's not be naive. There are other professions that can perform foot surgery, wound care, and other aspects of our profession. The fact that podiatrists are the best physicians in treating the foot will be a meaningless fact without a strong voice to advocate for us. Thank-you APMA.

Barry Drossner, DPM, Pembroke Pines, FL, Bdroz50@aol.com

PRACTICES FOR SALE - BROOKLYN & QUEENS

Well-established practices grossing high $200's for sale with approximately 90% C & C and 10% SX. Great locations and visibility. Well-respected doctors and staff willing to stay. Ask about 90-125% financing options with little to nothing down. American Doctor Sales; 614-918-3000 or email us at sell_my_practice@yahoo.com. Please visit us our website

ASSOCIATE POSITION – CALIFORNIA

Central Valley/Southern CA. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Surgery Center and hospital based with no HMOs/no rest homes. Bilingual in English and Spanish. Offering a permanent position/partnership in a multi-million dollar hi-tech practice. E-mail CV to: Tonya@wetreatyourfeet.com

ASSOCIATE POSITION - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background for this practice, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

ASSOCIATE POSITION - WEST CENTRAL MN

Associateship possibly leading to equity ownership. Compensation package of $100,000. Option for partnership or purchase as soon as associate feels ready. 260 402-7490.

PODIATRIST POSITION – SOUTHERN CA

Medical group in Southern CA seeking a residency trained DPM. Practice includes general podiatry, biomechanics, wound care, surgery, diabetic feet, trauma. Part-time position available may lead to full-time. Excellent salary/benefits. Position available in mid July 2008. Please reply to E-mail: slowed2@yahoo.com; 4476 Tweedy Blvd, South Gate, CA 90280.

ASSOCIATE POSITION - NEW JERSEY

Established practice in Ocean County seeks hardworking, ethical, energetic and well-trained (PSR 24/36) individual. Must be willing to do all aspects of podiatry! Base salary $100,000 to start plus benefits package. Hospital & surgical center privileges. E-mail CV to NJFeet@aol.com

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