The Voice of Podiatrists

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July 23, 2007 #2,996 Editor-Barry Block, DPM, JD

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To Defeat Athlete’s Feet, Shoes Must be Treated as Well – CA Podiatrist

“The most common presentation of athlete’s foot — about 70 percent of the people we see — is a peeling between the toes,” said Philip Alway, podiatrist with Redwood Podiatry Group. “It can spread around the foot and to the other foot. You’ll have peeling, cracking and redness and the skin starts sloughing off.” Before it sloughs off, the skin may look white and soggy. The second presentation involves patches of itchy and red skin with blister-type eruptions.“The blistering type is not as common, but it’s starting to become more commonly seen,” Alway said. Both itch like crazy, particularly after the foot is warmed, be it through exercise, showers or under covers.

Dr. Philip Alway

The California Podiatric Medical Association reports the third presentation of athlete’s foot is often mistaken for dry skin. It appears as dry flaky skin covering the bottom of the foot and often causes dry cracks to appear around the heels. “Don’t see much of that,” Alway said. “We see chronic cracks in the heels mostly in Willow Creek. They wear sandals all the time. The heel dries out.”

Lotion or bag balm — the farmer’s miracle cure for treating chafed cow teats — solves cracked heels, but athlete’s foot isn’t so easy. Alway said over-the-counter medications such as Tinactin, Desenex and Lamasil cream are options; prescription drugs are the choice if those fail. The problem, Alway said, is re-infection. “People treat their feet, but they forget about their shoes. If they don’t treat those, it will re-infect.” “Good foot hygiene is the best defense,” Alway said.

Source: Carol Harrison, The Eureka Reporter (CA) [7/15/07]

NJ Couple Chose Podiatric Career From Prior Positive Experiences

A recent Gallup survey, 73 percent of people answered that their feet hurt occasionally and 62 percent consider that to be normal. Amy Gesualdi and Anthony Fiorilli Jr. would like nothing more than to change this way of thinking. Both are doctors of podiatric medicine and started their practice, Monmouth Family Foot and Ankle, LLC, two years ago in Howell, NJ. Here, the husband and wife team specialize in all facets of foot, ankle and lower leg care, including reconstructive surgery and medical modalities.

Drs. Amy Gesualdi and Anthony Fiorilli Jr.

Gesualdi and Fiorilli met in podiatry school and although they shared the same passion for their chosen field, had different reasons for pursuing their profession. "My mother suggested that I go into podiatry," Gesualdi explains. "My grandfather was a diabetic and she used to bring him to the podiatrist to have his nails done and to check his feet periodically. She thought that it would be a good profession for a female. When I looked into it, it appealed to me that I could be in the office and also do surgery as well."

Fiorilli chose the field due to his own experience. "I had my own foot and ankle problems growing up with sports," he notes. "I had a relationship with a podiatrist and was able to become pain free with conservative therapy in the form of orthotics. I also liked this profession because I wanted to specialize in surgery."

Source: Donna Frances Madej, Jackson Times [7/13/07]

CA Podiatrist Indicted on Drug Conspiracy Charge

A Riverside (CA) podiatrist is among five people indicted in North Carolina on charges related to a $15 million scheme that provided powerful prescription drugs to thousands of customers nationwide.

Dr. Christopher Otiko

The indictment alleges that between 2002 and 2006, 38-year-old Christopher Otiko and the others conspired to use false prescriptions to distribute powerful and addictive prescription painkillers and anxiety medications.

The government says the so-called prescriptions were actually drug orders with a photocopied doctor's signature, and were issued after a telephone conversation with the customer. Otiko is charged with one count of conspiracy.

Source: Associated Press [7/20/07]

Medical Errors Mean Stress, Anxiety For Docs

Increased anxiety and loss of sleep, job satisfaction and professional reputation were reported by physicians who committed medical errors, and many physicians who experienced a “near miss” suffered emotional and job-related stress as well, according to a report in the August issue of The Joint Commission Journal on Quality and Patient Safety.

Of the 3,171 physicians in the U.S. and Canada that researchers surveyed between July 2003 and June 2004, 57% said they had been involved with a serious error, 36% with a minor error and 7% with a near miss. The more serious the error, the more the physicians felt anxiety about future errors and the more they experienced loss of confidence, job satisfaction and sleep, the report said.

Although 82% of the physicians said they were interested in receiving counseling after a serious error, 90% said they did not think their hospital or organization adequately supported them or helped them cope with error-related stress. There were other barriers to getting counseling as well, with 43% saying that it was hard to take time off from work, 35% saying that they didn’t believe it would be helpful, and another 35% saying they were concerned the counseling session wouldn’t be kept confidential.

Source: Andis Robeznieks, Modern Healthcare [7/19/07]

Query: Casting Code & Description

In the recent publication of AAPPM, there was an article that reminded us that with the orthotics, not to forget to bill the codes, CPT 29799 (casting) and A4580 (plaster material).

Our office has used them a couple of times, but United Healthcare needs to know the proper description, and where the code, CPT 29799 comes from. If you know where online we can find the exact phrase, please let me know.

Vicki Hicks, Office of Daniel Brown, DPM, Herrin, IL

Response: CPT 29799 is defined as "unlisted procedure, casting or strapping."

You would need to elaborate to the payer in question exactly the type of cast you would be applying. In this case, a slipper impression cast is applied (temporarily) to be able to create a model of foot at the orthotic lab.

More than likely, United will deny the CPT 29799 and the HCPCS codes for the material, claiming they are global to the L30xx foot orthotic code. I would then ask United to provide you with a written copy of their policy document (similar to a Medicare LCD) on orthotic coverage. Carefully review this document. Should there be any discrepancy in how they processed your claim, you would have cause for appeal.

Paul Kesselman, DPM, Woodside, NY

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RE: Definition of “On The Job Injury” (Barry Block, DPM, JD)
From: Robert Scott Steinberg, DPM

Besides what Dr. Block outlined, a person who actually injured themselves while “on-the-job” knows that he/she has to report it. If it takes them a few days to remember to do that, then how much of an injury can they really have?

I see a number of employees of the United States Postal Service. Their employee, as well as their union, makes sure they know the rules on reporting on-the-job injuries. The mere fact that working on their feet is uncomfortable, is not what I would call an on-the-job injury. Coming into work the day after the supposed injury and then reporting it does not prove the injury didn't happen at home.

If the patient does not come in with a form from their employer, then be cautious, because they might be "shopping" for a physician they can fool.

Robert Scott Steinberg, DPM, Schaumburg, IL, doc@footsportsdoc.com

RE: Argentinean Orthopedists Report on MIS Bunionectomies (Richard Rettig, DPM)
From: Neil Barney, DPM, David Zuckerman, DPM

Thank you for having the courage to post an article on MIS procedures. It is unfortunate that it has taken so long for a publication to post such a reference and that the article has to come from a foreign concern and from the orthopedists. Perhaps the reference to a K-wire makes the article seem more legitimate. Some of the best if not THE best MIS surgeons are right here in the U.S. in the Academy of Ambulatory Foot and Ankle Surgery. I have been using these techniques for 27 years and know they work. Many of the procedures have been available for 40 yrs and more.

It is still hard to believe that these MIS surgeries are not taught widespread in the U.S. schools of Podiatric medicine. It is my sorry belief that until the "powers that be" "discover" that the European orthopedic community has been performing these techniques for years with success (many of these doctors having been taught by colleagues in the AAFAS) that they will embrace and incorporate the surgeries as new, exciting and the wave of the surgical future. Many other specialties are using MIS and understand the benefits to their patients.

Neil Barney, DPM, Brewster, MA, nbarney@mail.capecod.com

I read with interest this article on MIS bunionectomy. This wasn't the first article that has been reported on MIS procedures by MD's in Orthopedics' Today. What truly is amazing is that our own APMA journals have articles covering MIS procedures, such as hammertoe correction, MIS bunionectomy, and plantar fascia releases, etc. Where are the references to these pioneering articles in our podiatry journals.

If my memory serves me correctly, it was the Academy of Ambulatory Foot and Ankle Surgeons that was the first organization that devoted itself to the advancement of MIS procedures. Regardless of your opinion of these procedures, podiatry should get the credit, and our journals should be referenced.

David Zuckerman, DPM, Woodbury, NJ, Footcare@comcast.net

ASSOCIATE POSITION SANTA FE, NEW MEXICO

Immediate opening for PSR 24/36 individual in three office practice. We are looking for an ethical, hard working, well trained Podiatrist. Partnership available. Please Fax CV to sfpodiatry@aol.com

ASSOCIATE POSITION – MISSOURI

One of our long term associates needs to relocate due to family reasons. Step into full schedule. Five locations in growing population area without HMO's. Partnership available. Missouridpm@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

ASSOCIATE POSITION – YONKERS, NEW YORK

15 year old, well-established, modern practice located in Westchester County, looking for associate, P/T or F/T, motivated 24/36 trained or ABPS-Certified or eligible to start immediately. Looking for motivated individual, able to practice all facets of podiatry practiced. Fax CV to (845-225-4097)

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

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

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. 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 – BOSTON, MA

20 year old, well established, modern practice with 2 locations just out of Boston, looking for associate, P/T or F/T, motivated 24/36 trained or ABPS-Certified or eligible to start immediately. Strong surgically-based practice. Looking for motivated individual, able to practice all facets of podiatry practiced. Electronic scanning for orthotics and voice activated EMR already in office. Fax CV to (617) 567-0822

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