The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

August 06, 2011 #4,226 Publisher-Barry Block, DPM, JD

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IN Podiatrist Provides Back-to-School Shoe-Buying Advice  

Fall represents one of the peak times for children's shoe shopping. Parents need to keep in mind these tips from podiatrist Dr. Richard Stanley and the American Podiatric Medical Association as they peruse the shoe aisle for the young feet in the family: 

Dr. Richard Stanley

“The biggest mistake I see people make is buying a size instead of fit,” he said, adding that sizing may vary from brand to brand or even within a brand. So, make sure your child tries on both shoes, and that the shoes fit both feet. If one foot is larger than the other, as is frequently the case, make sure that the shoes fit both feet. If you have to use a shoehorn, it's probably too tight, Stanley said.

Source: Asheville Citizen-Times [7/25/11]

APMA Affiliates Toast Dr. Brad Bakotic in Boston

The new APMA affiliate clinical group, The Association of Extremity Nerve Surgeons (AENS) and the American Academy of Podiatric Practice Management (AAPPM) hosted a reception honoring Dr. Brad Bakotic of Bako Podiatric Pathology for his Hall of Fame Award received in Boston.

(L-R) Drs. Ben Weaver, Ollie Foster, Brad Bakotic, and Jon Purdy

GraMedica, maker of Hyprocure implants, sponsored the scotch tasting table - which was a huge success. Over 100 doctors attended and enjoyed the Boston "Raw" Bar & Lobster Rolls, as well as toasting Dr. Bakotic for his generous support of the profession, his research, and for advancing of lower extremity care.

Effectiveness of a Multi-faceted Podiatry Intervention to Prevent Falls in Older People with Disabling Foot Pain: Randomized Controlled Trial

A multi-faceted podiatry intervention reduced the rate of falls in community-dwelling older people with disabling foot pain. The components of the intervention are inexpensive and relatively simple to implement, suggesting that the program could be incorporated into routine podiatry practice or multidisciplinary falls prevention clinics.

Source: Spink MJ, et al. British Medical Journal, [08/04/11]

RAC Program Collects $233 Million

The CMS' Medicare fee-for-service recovery audit contractor program collected about $233.4 million in overpayments from March through June of this year, bringing the total of recouped overpayments since October 2009 to about $575.2 million. A permanent national program since last year, the RAC program uses four contractors—Diversified Collection Services, CGI, Connolly, and HealthDataInsights—to help identify fraud and abuse.

Meanwhile, the RAC program returned about $55.9 million in underpayments to providers for the third quarter, which is more than double the $23.7 million in underpayments it returned in the previous quarter. Since October 2009, the RAC program has returned about $109.6 million in underpayments.

Source: Jessica Zigmond, Modern Healthcare [8/3/11]

Query: Hallux Extensus in a 2 Year Old

I have a 2 year old infant patient who has hallux extensus (as does his mother), and whose toenails and distal hallux are irritated by hitting the tops of shoes. Besides trying tapings, (possibly with a sequential bent splint), any other ideas would be appreciated.

Arthur Gudeon, DPM, Rego Park, NY

Query: Certification for In-office Ultrasound

Has anyone been turned down for payment by an insurance company for not being certified in ultrasound?

Asher Rudowsky, DPM, Brooklyn, NY

Query: CPT 10061 Question

If CPT 10061 (incision and drainage of abscess, complicated or multiple) was performed on 3 different abscesses/sites (lateral, right/left hallux; medial left hallux), do I bill CPT 10061 (3 units)
or CPT 10061, CPT 10061-59 & CPT 10061-59?

The patient has Blue Cross Blue Shield.

Donald Falknor, DPM, Houston, TX

Response: Because CPT 10061 is defined as "incision and drainage of abscess, complicated or MULTIPLE, you would only bill the code once (which described all 3 procedures), and not with 3 units.

Craig M. Gastwirth, DPM, West Bloomfield, MI

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RE: Medial Malleolus Screw Removal (Gary Bjarnason, DPM)
From: Majid Seyedin, DPM

I would like to offer these suggestions;

1) Through previous op-reports/surgery documents, find out what kind of a screw it is so that you can have the right type of a screw driver on hand.

2) There is most likely bony callus build-up over the screw head which will make it difficult to feel or see it.

3) With the use of a fluoroscope and an 25 gauge needle, attempt to...

Editor's Note: Dr. Seyedin's extended-length letter can be read here.

RE: 93% Error Rate for Therapeutic Shoes  
From: Jeffrey A. Szczepanski, DPM

Any process that has a 93% failure rate (see DME e-mail below)  tells you there is something wrong with the process, not necessarily with the people involved.

"The National Government Services, Jurisdiction B Medical Review department continues to conduct a pre-payment targeted medical review for therapeutic shoes. This review includes a selection of multiple supplier submitted claims based on a targeted service(s) that are reviewed for medical necessity.

As of June 30, 2011, a total of 246 claims have been captured for review and developed for additional documentation.  All of these claims have been reviewed and processed.  Of these, 229 claims were denied (93.10% claim error rate)."

I stopped dispensing diabetic shoes last year, because of the flawed process. The patients are the only ones to lose out. It’s sad.

Jeffrey A. Szczepanski, DPM, Traverse City, MI,drjeff@greatlakesfoot.com

RE: Pulse Dosing Regimen for Sporanox (Bill Trabulsi, DPM
From: Jay D. Helman, DPM

The recommended dosing is two 100mg. tablets BID x 7 days. Repeat this regimen once per month for three consecutive months.

Jay D. Helman, DPM, Dobbs ferryy, NY, footdr80@hotmail.com

RE: EBM Studies for Class-Four Lasers? (Charles Perry, DPM)
From: Nelson Marquina, PhD

There are many research studies that have been published in journals, but before getting into details, we need to differentiate between the types of applications available with Class-4 laser devices. Class-4 laser devices must emit at least 0.5W of average power. They can be used as a (1) therapeutic laser (a.k.a. “cold” lasers) for phototherapy or photobiomodulation, (2) soft tissue surgery, (3) hard tissue surgery, or for (4) cosmetic medicine.

As you can imagine, studies on Class-4 lasers are rather broad, and the published research in each of these four areas is extensive. I will be more than glad to expand on the technical and scientific aspects of any of the four areas listed above. Since I am not a podiatrist, for clinical applications of Class-4 lasers, I rely on the advice...

Editor's Note: Dr. Marquina's extended-length letter can be read here.

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