The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

July 25, 2012 #4,523 Publisher-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2012- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

FL Podiatrist Discusses Consequences of Wearing Flip-Flops Full-time 

Jimmy Buffett famously crooned about the gash he opened up on his heel when he "blew out [his] flip-flop [and] stepped on a pop-top" while sauntering through Margaritaville. Area foot and ankle specialists say flip-flop injuries are a perennial problem in South Florida, and summer break's laid-back routine offers even more opportunities to step into some foot trouble.

Dr. Neil Strauss

"I do see a lot of flip-flop injuries. It's very regular," said Tamarac podiatrist Dr. Neil Strauss. "Fortunately for us, we live in an area with 12 months of sunny weather, so people wear flip-flops year-round," but the fallout is often not so fortunate. Among the most common results of a flip-flop slip-up: torn toenails, sprained ankles, bone fractures, stubbed toes, athlete's foot, and sores caused by bacteria build-up.

Source: Nicole Brochu, Orlando Sentinel [7/20/12]

IPMA Podiatrists Network with Endovascular Surgeons

Several volunteer podiatrists representing The Illinois Podiatric Medical Association (IPMA) exhibited this week at the Chicago Endovascular Conference the week of July 18-21. IPMA members staffed the association’s booth in the conference exhibit hall. 

Drs. Barry Brandes and Jondelle Jenkins

Association volunteers included  Drs. Barry Brandes, Jondelle Jenkins, Douglas Solway, Alice Cisneros, DPM, Hyim Baronofsky DPM, and Thomas Dwyer. IPMA members answered questions and networked, particularly with endovascular professionals. “It’s also part of IPMA’s effort to form collaborative venues with endovascular surgeons,” said IPMA executive director Michael Hriljac, DPM.

NJ Podiatrist Prepares for "Dancing With Gloucester County’s Stars"

Dr. Lori Lewis, a Woodbury podiatrist, is trusting that her own feet will hold up to the test as she practices feverishly, along with five fellow competitors, in preparation for the seventh edition of “Dancing With Gloucester County’s Stars.” After all, she works out in high heels, footwear that’s a tad unfamiliar to her.

Dr. Lori Lewis (Photo: Lori M. Nichols)

A 1978 Woodbury High School graduate, Dr. Lewis ranks as one of the leading track and field athletes in Gloucester County history. While in high school, she qualified for the U.S. Olympic sprint relay team before an injury — the knee — knocked her off the squad. And, for good measure, Lewis was a three-time All-American at the University of Florida.

Source: Bob Shryock, Gloucester County Times [7/23/12]

Calm Complainers

Calm complainers by first agreeing with something they say.

Example: “You’re right; your wait was too long.” Empathize with their position, apologize, and then move forward to resolve their problem.

Source: Adapted from “How to Resolve Complaints,” Arnold Sanow, Leader’s Beacon via Communication Briefings

Query: Severe Injury in 80 Year Old Diabetic 

This patient presented himself to my office with a swollen painful foot 48 hours after catching his foot on a drain and falling. The problem is that he is an 80 year old diabetic and an extremely poor surgical risk, both medically and circulatory.

Post-Traumatic X-Rays of Diabetic Foot

I have treated injuries to similar poor risk patients and found that after a period of immobilization, the x-rays might not look great, but the foot didn't hurt. I have never seen an injury like this in this type of patient. Any thoughts of a possible treatment plan would be appreciated.
 
Burton Katzen, DPM, Temple Hills, MD

Query: Office Newsletters

What companies are my colleagues using for monthly newsletters? What are the initial set-up costs? Have you found a good return on your investment? 

David Kahan, DPM, Sacramento, CA

Query: Diabetic Foot Care Modifier

When billing a paring of keratotic lesion(s) (CPT 11055-11056) together with debridement of nails (either CPT 11720 or CPT 11721), I use a "-59" modifier on the CPT 1172x code. Both paring and debridement codes are paid in full. My billing service feels that billing both codes will result in over-usage of the "-59" modifier, triggering an audit.

If I alternatively use a "-51" modifier on the nail debridement code, I get a denial for "improper modifier". I remember being told at a Florida seminar in years past to use the "-59" modifier. What is the proper way to bill CPT 1105x and CPT 1172x services?

Joel Levy, DPM, Tampa, FL

Response: Presuming you are correctly applying the "-59" modifier on your claims, your billing service is incorrect in thinking the modifier use will trigger an audit. In fact, if you are applying the modifier correctly, there would not be "over-usage" of the modifier. You can be audited for any reason whether your billing is right or wrong, or the payer randomly 'selects' you, or your claims raise red flags (e.g., over-utilization, being an outlier, upcoding, adding E/M services to every encounter a procedure is performed or in a global period, etc.).

Incorrect use of the "-59" (or any other) modifier could, for instance, trigger an audit. Proper use of the "-59" modifier is defined by CPT and (for Medicare at least) the CCI edits. In your example of billing for palliative foot care services, you correctly applied the "-59" modifier to CPT 11720 or CPT 11721 when billed with one of the paring of keratotic lesion codes, CPT 11055-11056). And Medicare correctly paid you (this obviously presumes the patient's risk status and your documentation meet Medicare requirements).

The "-51" modifier gets you nothing from Medicare. It is not a modifier that "unbundles" bundled code edits. Medicare typically ignores the "-51" modifier if appended to codes.

Harry Goldsmith, DPM, Cerritos, CA

Editor's note: Dr. Goldsmith 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: Non-Compliant Patient With Diabetic Ulcer (Brent Rubin, DPM)
From: Elliot Udell, DPM
 
Management of the non-compliant patient is a clinical problem that physicians from all specialties deal with. In a study by Choudhry, Avorn, et al. published in the December 1, 2011 New England Journal of Medicine, it was found that less than fifty percent of patients discharged from a hospital, after being treated for a myocardial infarction, complied with taking their medications prescribed to prevent a second cardiac episode. The reasons why patients choose to non-adhere to a physician's advice are far more complex than meets the eye.
 
In the case described, what are the reasons the patient gives for not listening to sound medical advice? Although, in and of itself, a bipolar disorder would not cause limb-threatening non-compliance, there might be other mental health issues at play. A talk with the patient's psychiatrist might be in order. Talking with the patient about why he does not listen and laying out the likely prognosis might also help. If this fails, talking with members of the patient's family, so long as the patient grants his permission, might work. Lastly, documentation of every incidence where the patient diverted from advice is absolutely critical, with one caveat. Only state the facts, for example, "the patient did not wear the surgical shoe." Always refrain from putting any negative label on the patient in the patient's chart.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Artificial Toenail Innovation/Successes (Eric Hart, DPM)
From: Mark L Bauman, DPM

I have been working on a permanent artificial nail implant, with pilot pre-clinical trials completed by a local colleague having been successful, and hope to begin clinical trials by next year.

Mark L Bauman, DPM, Voorhees, NJ, nailsone@comcast.net

RE: Artificial Toenail Innovation/Successes (Eric Hart, DPM)
From: Janet McCormick, MS

There is no such thing as a permanent "fake" nail and, of course, there should not be such a thing. At best, they are temporary and this should be inherent knowledge when considering applying one. The patient should be fully informed of this, the importance of home care and of follow-up care. The retention time of the artificial/prosthetic/fake nail is according to several factors:

1) The expertise of the person who applies the product has the most effect on retention.

2) The amount of nail plate - or lack there of - is important for retention. A small amount of nail plate, however - no matter the configuration - can retain...

Editor's note: Ms. McCormick's extended-length letter can be read here.

RE: Unknown Roadways Present Risks for Barefoot Runners: IL Podiatrist
From: Steven King, DPM

Dr. Beth Jarrett's comments that barefoot running is not meant or safe for everyone is correct. I would add that many foam-based shoes are not meant or safe for running as well.
 
It only takes 20 Newtons force to push a protruder through a standard running shoe using American Society of Testing Materials puncture standards. It has taken 6,000-8,000 Newtons force to puncture the orthotics systems currently being tested by the U.S. Department of Defense.

Steven King, DPM, Lahaina, HI, kingetics@gmail.com

PRACTICE FOR SALE – KANSAS SOUTHWEST

For sale multi-location practice in beautiful Southwest Kansas. Practice has 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Recently added new office space with digital x-ray. Only surgical podiatrist in 2 of 3 locations. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice, a great location and opportunity for the right doctor. mcrosby@picagroup.com

PRACTICE FOR SALE - SOUTHWEST FL

multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to practiceforsaleswfla@gmail.com.

ASSOCIATE POSITION - SEATTLE, WA AREA

Established podiatric clinic looking for an associate to join our team, 5 offices located around the greater Seattle, WA area. Great base salary, benefits and friendly work environment. Please send resume to: seattlefootdoctor@yahoo.com

ASSOCIATE POSITION - MANHATTAN

Well-established successful Park Avenue podiatry practice is recruiting skilled and well trained DPM with a minimum of 3 years of experience. Must be experienced in rear and forefoot reconstruction. Must be self- motivated, and great with patients. State-of-the-art practice facilities and technologies which include: in-office physical therapy, digital x-ray, diagnostic ultrasound, and electronic medical records. MRI, and private operating room. All interested candidate email CV to elautin@gmail.com

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 12/24 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

High Income Potential. One of the fastest growing podiatry practices in New York City and Queens seeks a hard-working podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Contact me at: Podocare@aol.com

ASSOCIATE POSITION - NASSAU COUNTY, NEW YORK

Exciting Opportunity! Associate position. Must be Board Qualified. Joining all Board Certified Doctors in foot surgery and reconstructive rear-foot and ankle surgery. Respond to: Podiatryoffice@doctor.com

ASSOCIATE POSITION TUCSON - SOUTHERN ARIZONA

Accepting applications for an associate position. Applicant must have completed surgical residency and be Board Qualified/Certified. Our practice involves multiple office locations and looking to expand. We offer all aspects of foot and ankle medical and surgical care. Hospital and Surgery Centers privileges. Competitive salary and benefits. Partnership opportunities available. email resume to: drdafac@gmail.com

ASSOCIATE POSITION - LOUISVILLE, KY

Immediate position for established practice in excellent location with option to buy. All phases of podiatry with good mix of patients. Two local residency programs with foot and ankle and trauma privileges. Office has EMR qualifying for meaningful use in the first year. PADnet vascular testing. Send resume to: samuel10530@yahoo.com.

ASSOCIATE POSITION - BIRMINGHAM, ALABAMA

Immediate opening. Strong established group practice. 30-40 office patients per day to start. Surgery available, but not required. Base salary, production bonus, benefit package, relocation assistance. Aggressive work ethic a must. Email resume and cover letter to:dwh101@bellsouth.com

HOUSE CALL PODIATRIST NEEDED - BRONX, NY

Immediate opportunity for a hardworking and motivated podiatrist to make house calls in the Bronx, part-time. Perfect opportunity for young practitioner just starting out, or experienced podiatrist looking to downsize from private practice. Make your own hours and schedule patients at your convenience. Excellent compensation. We will provide for you all that is required including instruments (if needed), and supplies, EMR charting, billing, and scheduling. 914.584.1434 Email information to: Podiodoc@gmail.com

ASSOCIATE POSITION - YONKERS, NEW YORK

Immediate part time associate position now available. Appx: 3 1/2 days per week with room to grow. Practice is a good balance of all aspects of podiatric foot care, including surgery. Perfect opportunity for new graduate, or experienced podiatrist. Looking for the right person to transition into vacancy that will be left by current associate leaving the area and you will have an immediate, full schedule of patients. Over 25 year well-established practice with large referral base, and both hospital and surgery center privileges available. Interested persons please forward CV and brief summary of surgical log to:Podiodoc@gmail.com914.584.1434

ASSOCIATE POSITION - BAKERSFIELD, CA

IMMEDIATE OPENING: Office and hospital-based podiatry group in Bakersfield, CA seeks highly trained surgical associate to join us. Prefer surgeon with trauma and Charcot reconstructive experience. Staff privileges with 5 local hospitals. Offering health insurance, CME allowance and competitive salary. Must be PSR 24/36 trained, ethical and thoughtful when treating patients. Please forward CV and letter of intent to modpm@aol.com.

ASSOCIATE POSITION - OHIO

Ohio practice with excellent reputation and patient base seeks to hire a Podiatric Surgeon. The offices are state of the art including Digital X-Ray, EMR, Diagnostic ultrasound, Padnet Vascular Testing, CO- 2 Lasers all aspects of DME. The base salary is $120,000 with a bonus structure and benefits also would like to have this individual buy into the practice eventually. Please send CV to: Ohiopodiatrist@aol.com

ASSOCIATE POSITION - NJ

Immediate opening for full-time or 2 part-time DPMs for diversified practice that features most all phases of podiatric medicine and surgery. Full-time candidate must be ABPS Board Certified in Foot Surgery or PSR 24/36 Bd Qualified in RRF. Competitive salary and bonus. Great working conditions and area. Realistic Partnership opportunity. Send resume to:MonmouthDPM@aol.com

EQUIPMENT FOR SALE - USED PODIATRIC LASERS

Great price, great outcome. Stop wasting money on expense lasers. Personally owned and used few hours in my office,. 10 and 30 watts lasers. Two handpieces in one. First one for plantar fasciitis, Achilles tendonitis, arthritis, pain, inflammation. 2nd handpiece for surgical ablation and fungus toenail conditions. Portable fast and very cost-effective. footcare@comcast.net

EQUIPMENT FOR SALE

Retiring from practice. Equipment For sale. Mini x-ray. One year old Ultrasound with MS arterial/venous X-ray plates. Great condition Ritter chairs. Drills, surgical tools. So much. Just ask, I probably have it: Footcare@comcast.net

EQUIPMENT WANTED - WHIRLPOOLS, CHAIRS

Whitehall Whirlpool Either model P-10S or P-15S. These are the stationary, not portable models. Must be in very good condition. Also, looking for a Midmark 417 or MTI 527 Podiatry chairs. Please contact me at redwingcrzy@aol.com or call 954 650-8637

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815PODO2345@AOL.COM

PM News Classified Ads Reach over 13,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 13,500 DPM's. Write to:bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $115 for a 50-word ad. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.