The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

July 18, 2012 #4,517 Publisher-Barry Block, DPM, JD

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 PM's Facebook Contest

Podiatry Management is proud to announce the launching of its new Facebook page www.facebook.com/PodiatryManagement We encourage you to visit it. 

Dr. Shashank Srivastava

The winner of this week's contest is Dr. Shashank Srivastava of Rockville, MD. There has been an overwhelming response to our new Facebook page, so we are giving away another prize this week. Simply "like us" and be eligible to win a free registration for the Greenbrier Coding and Practice Management Workshop (Value $395). Enter now. The contest ends July 22nd, 2012. No Purchase necessary.

Patients Wait Until Bunions Become Symptomatic: TX Podiatrist 

A bunion often is described as a simple bump on the side of the big toe. But, according to the American College of Foot and Ankle Surgeons, it’s much more serious; the bump actually reflects changes in the framework of the foot.

Dr. William Arrington, II

“Most patients don’t address the condition until it reaches a critical level,” says Dr. William Arrington, II, a podiatrist on staff at Texas Regional Medical Center at Sunnyvale and who also practices at Beltline Foot & Ankle Specialists in Mesquite. “Usually, they come into my office when they are already experiencing a significant degree of pain, or they’ve reached the point where it’s hard for them to even wear normal shoes.”

Source: Neighborsgo.com [7/15/12]

Flip-Flops Can Cause Bunions and Hammertoes: CA Podiatrist

“When you talk about injuries that can result from flip-flop wear, we think about trauma or something that gets hurt, but the main problem with flip-flops is the structural problems they can cause in the feet like bunions or hammertoes," says Dr. Ali Sadrieh, a doctor of podiatry at Evo Advanced Foot Surgery in Los Angeles. "Flip-flops can cause them just as much as high heels.”

Dr. Ali Sadrieh

When the feet have no structural support, Sadrieh says, it’s like a “free for all” for your feet. Tendons in the feet won’t contract, or end up contracting too much and cause the toes to develop bunions or hammertoes. “In a normal shoe, you’ll see calluses on hammertoes, but with flip-flops, they can remain hidden because there’s no top layer of the shoe to rub and cause a callus,” says Sadrieh.

Source: Kathryn Tuggle, Fox Business News [7/13/12]

Walking Irregularities a Harbinger of Cognitive Decline?

Gait disturbances — including slowing of walking pace or variations in stride — may be an indicator of cognitive decline, new research suggests. New studies presented here at the Alzheimer's Association International Conference (AAIC) 2012, suggest that observing and evaluating gait in older patients may be a valuable tool when trying to determine the need for further cognitive evaluation.

In the first study, investigators from the Basel Mobility Center in Basel, Switzerland, showed that gait speed slowed and became more variable as cognitive decline progressed. Similarly, the Mayo Clinic Study of Aging (MCSA) showed that study participants with lower cadence, velocity, and amplitude of the stride length experienced significantly larger declines in global cognition, memory, and executive function.

Source: Caroline Cassels, Medscape News [7/15/12]

Query: Botox for Over-active Tibialis Posterior

I have a patient who has an extremely over-active Achilles tendon and extremely over-active tibialis posterior muscle on the right side. Neither I nor the patient can stop or prevent the foot from plantarflexing and inverting. X-rays show no bony abnormalities. I sent the patient in for a neurological work-up, but it showed no abnormalities. I would like to inject the muscle with Botox so he can walk better. How much Botox should I inject to get the desired result?

Sean S. Ravaei, DPM, Philadelphia, PA

Query: "Press Ganey" Surveys

Has anyone heard of or had to deal with "Press Ganey" surveys?
 
Marjorie C. Ravitz, DPM, Smithtown, NY

Query: Foot Orthotic Denials from Medicare

Can you please provide information on the correct way to bill L3000-RT and L3000-LT so that Medicare denies the claim, and forwards it to the patient's secondary insurance for payment? We have not been submitting those claims with the "KX" modifier - only adding "LT" and "RT" modifiers, and they still are either paying it in error or taking months to process it.

Amannda Richline, DPM, Belvidere, NJ

Response: You would bill Medicare as follows: L3000-GY-LT L3000-GY-RT.

The "GY" modifier is the payment modifier, and indicates the HCPCS code is statutorily NOT covered by Medicare. This modifier generates a "PR" (patient responsibility) denial on the EOB that results in either a cross-over to the patient's secondary insurance or, if there is no other plan, notes it is the patient's responsibility to pay.

Paul Kesselman, DPM, Woodside, NY

Editor's note: Dr. Kesselman is a featured speaker (and available for your questions) at the Codingline-PM News Coding & Practice Management Workshop, August 20-22 (following the APMA Annual Meeting) at the Greenbrier - www.podiatrym.com/greenbrier.cfm

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Failed Phenol Procedures (Charles F. Ross, DPM)
From: Carl Solomon, DPM
           
I don't know whether to laugh or cry after reading the individual testimonials (lowest level of evidence) supporting different methods of eradicating ingrown nails. That's the most common procedure we do! Yet nobody can cite a standard of care or even a single study that looks at the efficacy and safety of a given technique. The only one I recall was in JAPMA several years ago, but it was poorly controlled.

Carl Solomon, DPM, Dallas, TX, cdsol@swbell.net

RE: The Art of Podiatric Medicine and Surgery
From: Peter Vannucchi, DPM

There is a lot of talk about evidence-based medicine in podiatry and elsewhere. The real issue is that podiatric surgery is more of an art with a little bit of scientific underpinning. After you have been out of residency and fellowship training for a few years, you understand this better. You get comfortable with a few basic procedures for the great toe and you perfect your surgical craft. But your whole success is always dependent on patients' expectations and your communication skills. So how do you quantify this?

I am skeptical that our patients are so willing to compare their feet to someone else’s in any kind of study. We learn our skill craft by being tutored and apprenticed under great teachers in residency. It has been that way since ancient times. So how can that be scientific? The Romans called it the art of medicine and surgery. And those terms have been around for a long time. So isn’t that what it really is? 85% pure artistic craftsmanship and 15% patient satisfaction and physician communication skills. Could all of this nonsense be an attempt on the part of insurance and other payers to diminish our reimbursements? Time will tell.

Peter Vannucchi, DPM, Dallas, TX, vannucchi@att.net

RE: Employees are #1 (Bob Levoy)
From: Joel Lang, DPM

As a reply to Bob Levoy's advice regarding patients abusing staff, I can recall just a few such instances. In each instance, I personally approached the patient and clearly informed him/her that the issue with my staff needs to be resolved. My position was made clear to the patient that I saw new patients all the time and patients were relatively easy to find, but good help was hard to find, so if I had to make a choice, my choice would be clear. This usually resolved the issue.
 
Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net

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