The Voice of Podiatrists

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August 06, 2008 #3,316 Editor-Barry Block, DPM, JD

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Many Parents Unaware of Importance of Foot Health: Taubman

Whether it is a complaint about foot or leg pain or an ingrown toenail, parents are not motivated to take their child to a professional for treatment, according to survey results released during April's Foot Health Awareness Month. Many health-conscious parents don't have high standards of foot health when it comes to their children's feet.

Dr. Ross Taubman

"This new information proves that many parents still aren't aware of two important things - prompt examination of a child's foot ailments and having the examination performed by a podiatrist," said APMA President Dr. Ross Taubman. "Remember, foot pain is not normal. It is very important that parents understand the vital role a podiatrist has in diagnosing and treating all kinds of pediatric foot conditions," he said.

Doctors at the APMA say they believe that one of the reasons parents may not be attentive enough to their children's foot care is a lack of understanding of many key foot ailments. Only 49 percent of parents surveyed would take their child to a podiatrist's office for ingrown toenails, which is common among children, and if left untreated, can lead to significant pain and loss of normal activity.

Source: Debra Braggs, Press-Register [7/29/08]

NJ Podiatrist Reaches Out to Community with Lectures and Screenings

Affiliated Foot and Ankle Center is having a great impact on the community that surrounds them. "People do not think about foot and ankle pain until it interferes with their quality of life," says Dr. Jessica Addeo, who recently spoke with over 60 residents of The Silvermead Community in Freehold about preventative steps that can be taken to protect themselves from foot and ankle ailments, and following the presentation, she provided free foot and ankle screenings.

Dr. Jessica Addeo

The event included a lecture and visual presentation, and those in attendance were interactive with the physician to address their questions and concerns.

Source: Howell Times [8/2/08]

CMS: Approved Billing Privileges for Two Fictitious Suppliers

CMS in the past year has approved Medicare billing privileges for two fictitious medical equipment suppliers that the Government Accountability Office established to test the ability of the agency to prevent fraud and has placed millions of dollars at risk, according to a GAO report obtained by the Associated Press, the AP/San Francisco Chronicle reports. According to the report, the two fictitious suppliers, based in Maryland and Virginia, had no clients or inventory and provided CMS with incomplete information and false documents that offered limited evidence of their legitimacy.

The report stated, "If real fraudsters had been in charge of the fictitious companies, they would have been clear to bill Medicare from the Virginia office for potentially millions of dollars worth of nonexistent supplies." In addition, the report stated that efforts by CMS to address the issue "will only be successful if those tasked with ensuring compliance exercise due diligence when conducting screenings and inspections."

Senate Homeland Security and Governmental Affairs Investigations Subcommittee ranking member Norm Coleman (R-MN), who requested the report, said, "This sting operation proves that there are gaps in the system and that scam artists can exploit -- and are exploiting -- those gaps." CMS officials said that they agreed with the results of the report but added that the agency recently implemented new standards that require medical equipment suppliers to obtain certification before they can receive billing privileges. In addition, CMS has begun to require that suppliers retain documents from physicians and restrict the use of cell phones and pagers as primary business numbers for suppliers.

Source: AP/San Francisco Chronicle via American Health Line [8/4/08]

No Offense, But....

Never speak what's on your mind if you feel the need to preface your comments with the words " I don't mean to offend anyone..." Warning others that you are about to say say something risky does not immunize you from the words' impact. The warning does not let you off the hook. If you think that your words might offend, rework your comments or save them for a more appropriate time.

Source: Adapted from: "Lessons from the Humor Police" by Joni Johnston

Query: Botox for Flexible Hallux Malleus

I have a patient with hereditary peripheral neuropathy who has been treated for several months for an ulceration at the distal aspect of his hallux. He has significant intrinsic muscular atrophy and a flexible hallux malleus. We have treated this with local wound care/debridement and off-loaded the area with various healing shoes, walkers and orthoses and the ulcer has nearly healed several times. Each time he resumes activity, the skin breaks down and the ulcer returns. I have talked with him several times about doing an IPJ fusion, but he is reluctant to undergo surgery. His neurologist inquired about Botox injections to relax the hallux contracture. Does anyone have experience using this type of treatment? His neurologist would do the injections, but he wants to know anatomically where to inject to get the desired effect.

Brian T. Maurer, DPM , Avon & Frisco, CO

Query: Ace American Insurance

We currently use ProAssurance malpractice insurance for our practice and have been very pleased with the insurance to date, with the exception of the virtually guaranteed annual premium increases despite never having had a claim against us filed. Like any practice trying to save costs, we received a quote from Podiatry Plus professional liability insurance an Ace American Insurance Co. Surprisingly, this quote was essentially half the premium that we currently pay. Is this "too good to be true"? Is Ace a reputable provider with a track record of consistent quality coverage? My office manager did some research and found that Ace American is rated "A+" by A.M. Best which is an indicator of financial strength. But personally, I don't know what the heck A.M. Best is either. Of course, we'd love to save 50% on our premiums, but we'd also like to have the peace of mind knowing we were covered should we need the protection.

Andrew Perry, DPM, Lafayette, IN

Query: Multiple Injections, Different Sites, Same Day

I recently was denied payment for a second injection given to a patient on the same day. The two injections, although given on the same foot, had different diagnoses. I billed CPT 20550-RT and CPT 20550-RT-59.

Should I have just billed 2 units for CPT 20550-RT? And what if the second injection was on the other foot? Are the "RT" and "LT" modifiers the only descriptives? Please let me know what you do.

Michele Kraft, DPM, Santa Cruz, NM

Response: In my opinion, you may have not billed these injection procedures correctly. What you did not say in your post was why you were giving those two injections.

TrailBlazer, your new J4 MAC Medicare carrier, adopted the Noridian "Injection" LCD when it took over New Mexico from Pinnacle. For some procedures you will need to file the unlisted surgical service on feet, CPT 28899. Then you will need to list on the CMS 1500 form in block #19 or its electronic equivalent what you are injecting. For other procedures and diagnoses, you will be using 20550 or 20551 depending on the diagnosis and site of the injection(s).

Review the TrailBlazer Injection LCD at Trailblazerhealth.com to be sure you are following the new rules exactly. If you have any questions, contact your CAC representative. She is well-versed on these new policies.

Paul Kinberg, DPM, Dallas, TX

Codingline subscription information can be found here

RE: The Dis-connect Of Professional Courtesy from Professional Ethics
From: Robert D. Teitelbaum, DPM

There are two local incidents here in Naples that illustrate this point:

1) A new practitioner, without any type of notice or warning, moves into a space that is fifty feet from another, established, practitioner's practice. Albeit, the area is an office-type complex and not straight retail---but……

Editor’s note: To read the full text of this letter go to: http://www.podiatrym.com/letters2.cfm?id=21128&start=1

RE: Take Everything Off But Your Socks (Juliet Burk, DPM)
From: Elliot Udell, DPM

I'm not surprised that the orthopedist misdiagnosed a simple keratoma for something else and you properly diagnosed and treated the patient's foot condition.

When managed care first came out, all of the companies required that the primary care doctors examine and treat their patients' pedal problems before sending them to us . The insurance companies penalized internists and family practitioners if they made too many referrals to specialists.

When the patients finally arrived at my office after having their feet treated by primary care MD's, I was appalled at the lack of knowledge displayed by these doctors. They diagnosed corns as dermatophytosis and visa versa. Ingrown toe nails were diagnoses as gangrene, etc. I wondered at times if these doctors had ever seen a human foot in their entire clinical careers.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

IMMEDIATE POSITION AVAILABLE TN/GA

We're in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in Southeast Tennessee/North Georgia. Must have Tennessee or Georgia license. Please reply via email to ikraus@sprynet.com

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE POSITION – CALIFORNIA

Coast to Coast Mobile Podiatry Group Seeks Podiatrist with Nursing Home contracts! Join our group and let us handle the back-breaking task of billing and managing your patients. This will equal great compensation for you. Please email us back at coasttocoastpodiatry@yahoo.com

PRACTICE FOR SALE - BEVERLY HILLS, CA

After 48 years in practice, it's time to retire. My current practice is 1 1/2 to 2 days per week and generates a six-figure gross. An excellent choice as a srart-up or for semi-retirement in beautiful Beverly Hills. MUST HAVE BACKGROUND IN BIOMECHANICS AND SURGERY. Will stay to train and introduce. Price negotiable. Call Bill Orien at 310-271-1944.

ASSOCIATE POSITION WITH OPPORTUNITY FOR PARTNERSHIP

Group practice located on NY-PA border with excellent growth in the area’s industrial, retail, and college campuses. Surgical privileges in medical centers in NY and PA. This position will involve rotating through multiple office locations, and wound care centers. Local insurance reimbursement involves mostly private pay PPO models. We are looking for an ABPS Board Qualified podiatrist to join our team. Candidates would need to obtain licenses in NY and PA, and become ABPS certified to maintain hospital privileges. Base salary starting at $85,000 plus bonus plan incentive, vacation, and health/mp insurances. Forward CV to prefprovider@hotmail.com

ASSOCIATE POSITION – GEORGIA

Atlanta area need a full-time or part-time associate for a 25 years old well-established practice, well-rounded surgery and routine, please email your CV to superrang@bellsouth.net

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

ASSOCIATE POSITION OPPORTUNITY IN MULTI SPECIALITY GROUP PRACTICE - ILLINOIS

Christie Clinic is a large Multi-Specialty Group practice located in Champaign, Illinois. We are seeking a PSR-36 ABPS Board Certified or Board Eligible podiatrist to join a well established Podiatry department. Must be competent in all phases of podiatric care, Surgical and Conservative. This position will involve rotating through multiple office locations with surgical privileges available at two medical centers and two outpatient surgery centers. Very competitive salary, bonus plan, vacation, and health/mp insurances. Forward CV to wpierce@chrisiteclinic.com

ASSOCIATE POSITION - BOSTON, MA

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-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

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