July 22, 2006 #2,637 Editor-Barry Block, DPM, JD

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Never Wear a Shoe That Hurts: MO Podiatrist

Podiatrist Christian Wunderlich doesn't have much of a sense of humor when it comes to high heels. "It's not a normal position to bear weight. The foot is not meant to do that," says Wunderlich, of Kirkwood Podiatry, who has been in the foot business for 23 years.

He says the long-term effects of wearing stilettos - hammer toes, bunions, metatarsal and other foot problems - aren't the least bit sexy. Wunderlich strongly discourage wearing high heels.

So what's an unrepentant heel-wearer to do? "The simplest thing is to never wear a shoe that hurts," Wunderlich said. "It's common sense." Wunderlich says rounded-toe shoes are preferable to pointy ones, and as luck would have it, rounded toes are making a fashion comeback. Your foot should stay in contact with as much of the shoe as possible while you walk. Straps should be snug and toes should have wiggle room, but not room for the foot to slide around, he says.

Source: Debra D. Bass, St. Louis Dispatch, [7/20/06]

Barry Makes History with Unique 3+4 Podiatric Medical Program

The Barry University Division of Medicine and the Massachusetts College of Pharmacy and Health Sciences (MCPHS) are pleased to announce the development of a new joint seven year pre-podiatric/podiatric medicine and surgery program of study. The highly innovative 3 + 4 program will begin seating students in fall 2007. Allopathic and osteopathic schools have utilized the 3 + 4 program model before, but it is unique to podiatric medicine.

Barry Students

Students will be recruited directly from high school to begin the program at MCPHS. They must have a 3.2 GPA and an SAT score of 1400 to gain admission. Students will first complete three years of a program in pre-medical and health studies at MCPHS. By maintaining a 3.2 average and scoring 21 or more on the MCATS, students will seamlessly begin their first year of podiatric medical school studies at the Barry University School of Podiatric Medicine. After successfully finishing their first year at Barry, students will receive their Bachelor degree from MCPHS.

According to Marc Weiner, assistant dean of medical admissions for the Barry University Division of Medicine, "this program is unique in podiatric medicine as Barry University is the first of the podiatric medical schools to offer this significant and exciting new program. We expect, in the first year, to recruit five to six students into the program. But, as other high school students in Massachusetts, Pennsylvania, New York, and Connecticut learn about this tremendous opportunity for pursuing a medical career at two high quality institutions, we will see further growth."

Prescription Problems Harm 1.5 million: IOM Report

Errors in the way medications are prescribed, delivered and taken harm 1.5 million people every year and, in the hospital setting alone, cost more than $3.5 billion a year to treat, according to a new report from the Institute of Medicine. Hospitals see roughly 400,000 preventable drug-related injuries each year -- on average, more than one per day -- while 800,000 more occur in long-term-care settings, the report states. An earlier IOM report predicted that roughly 7,000 deaths occur each year because of medication errors.

The latest report, Preventing Medication Errors, outlines seven recommendations that medical staff, pharmacists, the government and patients should follow to lessen the risk of error. Additionally, the report recommends that all healthcare providers should have plans to write prescriptions electronically by 2008. By 2010, the IOM committee said, all providers should be using e-prescribing systems and all pharmacies should be able to receive prescriptions electronically. The report also calls on drug manufacturers, federal agencies and quality-improvement organizations to develop a plan to address problems associated with drug naming, labeling and packaging by the end of next year. The study was sponsored by HHS and the CMS. –

Source: Matthew DoBias, Modern Healthcare [7/20/06]

Query: Partial Numbness of Toe

I recently had a patient who complained of numbness on the bottom only of her right 4th toe. She denies history of trauma, exposure to chemical agents, diabetes, etc. Has not had surgery in this area. Physical exam does reveal lack of sharp-dull, soft touch or monofilament testing on the plantar aspect of the right 4th toe only. Has normal feeling on the dorsal, medial and lateral aspect of that toe. Normal color of the toe. Good pulses, color and skin temp. Has anyone had a similar presentation?

Patrick J. Nunan, DPM, West Chester, OH, PJNDPMRUN@aol.com

Query: Austin Bunionectomy with Hemi-Implant

What is the accepted coding for the Austin-type bunionectomy with resection of joint and insertion of a metalic hemi-implant?

Darryl Burns, DPM, Salinas, CA

Response: I would suggest billing CPT 28293 for the implant procedure. If the osteotomy is within the metatarsal for angular correction of its distal segment, then all bill CPT 28306-59 (osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal) as a secondary procedure

Tony Poggio, DPM , Alameda, CA

RE: Instrument for MPJ Cartilage Removal (Evan Meltzer, DPM)
From: John Steinberg, DPM

In response to your query about a 1st MTPJ arthrodesis system: Integra Lifesciences Corporation makes a ‘cup and cone reamer system’ under their grouping of instruments called New Deal. You can probably track down your local representative through this link: http://www.integra-ls.com/products/?product=233 I have used the system several times with great success.

John Steinberg, DPM, Washington, DC, steinberg@usa.net

RE: Amerihealth Insurance Coverage for E/M Visits for Diabetics
From: Ken Malkin DPM

I just received coding guidelines from Amerihealth. It includes the following:

"Peripheral neuropathy is a nerve disorder that can affect the upper and lower extremities of an individual with diabetes. Peripheral neuropathy leads to loss of protective sensation (LOPS), whereby an individual is unable to feel minor trauma from mechanical, thermal, or chemical sources. Sores or blisters may appear in some areas, and the reduction in autonomic nerve functions may also inhibit wound healing. Injuries that are not promptly treated may lead to amputation due to spread of infections to the bone.

Evaluation and Management (E and M) of diabetic peripheral neuropathy with LOPS is considered medically necessary and therefore will be covered every six months for individuals with a documented diagnosis of diabetic sensory neuropathy and LOPS."

This is just more confirmation of the medical necessity of E and M coverage of diabetics which allows proper compensation for evaluating plantar pressure, evaluating shoe gear, and diabetic foot care education reinforcement.

Ken Malkin, DPM, Caldwell, NJ, drmedicare@aol.com

ASSOCIATE-PARTNER WANTED MICHIGAN-DETROIT AREA WESTERN SUBURBS

Great opportunity-must be hard working, reliable, responsible and good with patients & staff surgical training a plus-partnership after 1 yr. Michigan license required. Fax resume to 248-478-1370 Starting salary $200,000. plus benefits plus percentage. Serious inquiries only

FOR SALE MICHIGAN-DETROIT AREA

Michigan practice Detroit western suburbs for sale. 3 offices, great locations approx 1.5m gross, Buy outright or overtime. Call 561-213-9400 after 7:00 p.m. Serious inquiries only

PRACTICE FOR SALE -ST PETERSBURG, FLORIDA

Well established (27+ years) general Podiatry practice. Great location -surrounded by 4 retirement communities. Must sell quickly due to health reasons. Contact Irwin Ayes DPM at ayesent@earthlink.net or 727-544-5425.

LONG TERM CARE PRACTICE OPPORTUNITY- DOWNSTATE ILLINOIS, & CHICAGO AREA

We specialize in providing conservative ethical care to residents in long term care settings. Immediate part-time positions available in downstate IL, and the Chicago metropolitan region. Competitive compensation and expenses. Contact Dr. Brian Aronson. Phone-773-775-0300 Fax-773-775-0883.

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

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

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