The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 08, 2009 #3,617 Publisher-Barry Block, DPM, JD

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July 18-25, 2010

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MD Podiatrist's Procedure Restores Normalcy to Teen

Summer is halfway over, but Ayarna Kittrell, 14, of Aspen Hill will be wearing sandals as often as she can. Ayarna was born with brachymetatarsia, a hereditary disease that causes a grossly deformed appearing foot, said Dr. Chris Majewski, who performed Ayarna's surgery at Holy Cross Hospital in Silver Spring, MD.

Dr. Chris Majewski

Ayarna's toe next to the baby toe was shorter than her other toes, and there was a bump on top of her foot. The three-month process — with the first surgery May 7 and the final July 30 — will make Ayarna's foot look normal, Majewski said. Majewski of Rockville inserted a titanium device on the exterior of Ayarna's foot that required her, or her mother, Iva Kittrell, 51, to turn a knob on the device.

Majewski said without insurance, the surgery could cost $7,000 to $10,000. It's better for patients to wait to have the surgery when they get into their teens, Majewski said. "A lot of times, it's better to wait until the growth plates are a little more closed," Majewski said. "If a patient is younger, the growth plates haven't had a chance to mature."

Source: Andre L. Taylor Gazette.net [8/5/09]
 

OCPM Welcomes 132 Incoming Students at Whitecoat Ceremony

OCPM welcomed 132 incoming students this past week for orientation. The students are from all over the United States, as well as Canada, Kenya, and Cameroon. During the past week, the first year students had a very busy schedule, including a faculty mentoring luncheon, and a Professionalism Workshop with Dr. Edweana Robinson, followed by the White Coat ceremony that took place on Sunday, August 2, 2009.

OCPM Entering Students at White Coat Ceremony

The White Coat ceremony is held to recognize each student's entrance into the medical field. Once all the first year students were given their white coat, Dr. Vincent J. Hetherington, Vice President and Dean of Academic Affairs at OCPM, gave the students a standing ovation. This ovation led to the entire auditorium filled with over 400 friends and family members of the students also rising to recognize this great moment in their professional lives.

Retired PA Podiatrist is Basketball Commissioner of Popular League

On a recent night of the Rankin-Anderson summer basketball league, players and coaches and fans went out of their way to say hello to a man named Dave Scheiner. Everybody called him Dr. Foot. Scheiner is a retired podiatrist and the man behind the most popular league in a city where basketball is like a religion. The league is his continuing contribution to the city game he has stood at the center of for 30 years. Ask people about Scheiner, however, and the response will be blank stares.

Dr. Dave Scheiner

“Nobody knows my real name, actually,” he said recently, laughing. “Some of these guys don’t even know I’m a foot doctor. They think that’s really my name, like I’m a medical doctor and my last name is Foot.”

Scheiner, 58, became the commissioner of the Rankin-Anderson League soon after it started in 2002 with five teams. Today, it has 16 teams and draws players from the N.B.A. and overseas as well as schoolyard legends young and old.

Source: Ryan Goldberg, The New York Times [8/6/09]

Query: Bleomycin/Candin Wart Treatment Codes

Would the use of codes, CPT 17110 (destruction benign lesions, up to 14 lesions) or CPT 17111 (destruction benign lesions, 15 or more lesions) be the correct way to code to treatment of warts by injection of Bleomycin or candin? Or must the codes, CPT 11900 (injection, intralesional; up to and including 7 lesions) and CPT 11901 (injection, intralesional; more than 7 lesions) be the correct way to code treatment of warts by injection of Bleomycin or candin?

Also is anyone aware of a "J" code for candin?

Matthew Lappenga, DPM, Holland, MI

Response: CPT 17110 (or CPT 17111) specifies destruction of benign lesion. One of the example methods is chemosurgery. Bleomycin is a chemo treatment agent that can also destroy warts. CPT 17110 (or CPT 17111) is the appropriate code series to bill Bleomycin used to destroy warts. Be sure to bill for the Bleomycin supply (J9040; documenting the Bleomycin sulfate, the dosage used, the specific warts injected, etc.).

As for candin wart treatment, there is no specific code for such treatment of warts. Previous posts have suggested CPT 11900 (intralesional injection; 1-7) and benign lesion destruction. Candin is not a typical destructive agent. It is "designed" to set up an immune response which secondarily eliminates the wart. As such, I would not recommend CPT 17110 (CPT 17111). CPT 11900 is an intralesional injection. If you are actually injecting candin into a wart, then CPT 11900 (or CPT 11901) appears to be the code to bill. If you are not injecting candin, but implanting it some other way, then you will need to bill it as an unlisted procedure, skin, mucous membrane and subcutaneous tissue, CPT 17999.

Be aware that many payers will, if they know what you are doing (candin wart treatment) consider it investigational/experimental, and deny reimbursement. Be ready to 1) always preauthorize the procedure and 2) submit your medical records, letter of explanation, and peer-to-peer published studies validating the efficacy, safety, and standard of care performance of candin wart treatment.

As far as the "J" code, there is no "J" code for candin. I would recommend you bill J3490 (unclassified drug), and include a copy of your medical records and letter of explanation.

Tony Poggio, DPM, Alameda, CA

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RE: Patient with Recurring Infections Dorsal to the Left and Right Fourth Interspace (Elliot Udell, DPM)
From: Greg Aposperis, DPM

Does the patient work with horses or other farm animals? P. Mirabilis is common in horses' hoofs.

Greg Aposperis, DPM, Santa Barbara, CA,  santabarbarafootclinic@yahoo.com

RE: HMO Cancellations Tied to Hospitals (Jeffrey Kass, DPM)
From: Neal Frankel, DPM

There are two reasons why, if an HMO drops a particular hospital, you are not allowed to participate. The first has to do with how the hospital is contracted. If the hospital is capitated and you are paid from that capitiation (even if you are paid fee-for-service), then if the HMO drops that hospital, they would receive no funds to pay you.

The second reason is even if the HMO pays fee-for-service to that particular hospital and the HMO drops them, if you get a patient that you would normally take to that hospital, the HMO would have to pay a higher non-contracted, out-of-network rate that would be far more than what they would be contracted for if the hospital was participating. This is probably the reason the hospital is being dropped, because they won't accept the lower rate. Maybe, you should look at what you are being paid by this HMO; perhaps you are not being paid fairly either.

Neal Frankel, DPM, Chicago, IL, drnrf@aol.com
 

RE: American People Don’t Want Rationed Healthcare
From: Jon Purdy, DPM, Scott Whitman,  DPM

Editor's note: These notes can be read at:

http://www.podiatrym.com/letters2.cfm?id=27967&start=1

ASSOCIATE POSITION - MARYLAND

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - SUBURBAN DETROIT AREA

Home care doctor needed immediately for growing home care practice in the suburban areas of Detroit. Must have own vehicle and good driving record. Excellent opportunity for the right individual! email cv to: metrohomefootcare@gmail.com

PRACTICE FOR SALE-VIRGINIA (SOUTHEAST)

Very busy office near Williamsburg. Currently, a satellite office 2 days a week. Great opportunity to make office full-time. Grosses approx. 130,000/year. The office has everything needed to start practicing. All included. Must sell. If interested, e-mail totalfootcareva@hotmail.com

PRACTICE OPPORTUNITY - CINCINNATI, OH

Well-established practice located in medical/professional building minutes from hospital. Many referrals, three satellite clinics and two assisted living facilities to keep you busy. Associate leaving due to family emergency-need to either find an associate or sell ASAP. Contact bjadpm@hotmail.com for more details.

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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

ASSOCIATE POSITION - NEW JERSEY

Established successful practice in Central New Jersey seeking PT/FT Associate. PSR 24/36. Please forward CV to rpg145@gmail.com or fax 908 753-0199.

ASSOCIATE POSITION - ILLINOIS

Excellent opportunity for qualified candidates in Northern Illinois/Western suburbs of Chicago. Growing two office practice searching for an associate to grow into a partnership. Full-time position, PM&S-36 board certified or qualified physician in forefoot and rear foot surgery. Multiple hospital and surgery center affiliations. e-mail DrTina@DrTinaOnline.com

ASSOCIATE POSITION – CHICAGO

South Side Chicago practice seeks podiatrist. Practice focuses on general podiatry, surgery, biomechanics, and diabetic foot care. Candidate should be surgically trained, certified/ working toward certification by ABPS. Surgery in office and hospital with residents. Base salary w/bonus incentives, paid malpractice insurance, benefits. Contact. ChicagoDoctor2009@yahoo..com or 773-632-7042

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 – PACIFIC NORTHWEST

Russian-speaking podiatrist needed. Looking for well-rounded, recently out of residency, podiatrist. Would you like to raise your family in our beautiful Pacific Northwest? We are well-established and fast growing multi-office practice with all aspects of podiatry. Attractive compensation, malpractice and medical insurance provided. Call 206-661-9644.

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Excellent Opportunity, Full-Time or Part-Time, in busy and expanding podiatry practice. Offices located in Los Angeles and San Bernardino Counties. Fantastic Compensation. No Nursing Homes! Looking for at least one DPM now and one in July 2010. Spanish is helpful. Please send an e-mail to scpods@yahoo.com

ASSOCIATE POSITION - WASHINGTON — WEST PUGET SOUND

Well-established, two-doctor practice in all phases of treatment looking to replace associate who is leaving the area. Looking for energetic, affable, surgically-trained DPM to take over associate position leading to partnership. Satellite office and adjacent multi-disciplinary ASC available for use and possible partnership. Silverdale rated 92nd in best 100 locations in Money/CNN 2009 poll. See link . Contact and résumé at pwa@kitsappodiatry.com

PRACTICE FOR SALE - ALABAMA, GULF COAST 

Established 26 year old practice. Owner desires to sell and relocate. Operated 25 hours per week. Mixture of surgery and general podiatry. MD referrals. Surgery center and hospitals in close proximity. Highly profitable. Priced to sell. Will lease office to buyer. Call Mike Crosby at 888-776-2430 or email mcrosby@providerresources.com

ASSOCIATE POSITION - BOSTON, MA 

Associate wanted, Full-time or part-time, for busy long time, well established, and well-rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net 

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