The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 15, 2009 #3,623 Publisher-Barry Block, DPM, JD

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FL Podiatrist Receives Fulbright Specialists Award

Leonard A. Levy, DPM, MPH, Associate Dean for Education, Planning and Research, Professor of Family Medicine/Professor of Public Health at Nova Southeastern University College of Osteopathic Medicine (NSU_COM) has been selected for a Fulbright Specialists project in the Slovak Republic at the Comenius University Bratislava Medical School for the month of October according to the United States Department of State and the J. William Fulbright Foreign Scholarship Board. He is the first podiatric physician to receive this award.

Dr. Leonard A. Levy

Dr. Levy will participate in developing collaborative relationships with the medical school in Bratislava and the medical, public health and biomedical informatics programs at NSU-COM. He will also provide instruction in all-hazards preparedness as well as in the broad field of medical education as well as podiatric medicine.

Retired NV Podiatrist Concerned About Obama Healthcare Plan

The debate over healthcare is far from over across the country, but a new report shows health insurance premiums for families in Nevada are rising three times as fast as earnings. Local residents spoke out at a free health fair at the M Resort. The people inside were focused on prevention of serious illnesses, but it was the debate about President Barack Obama's healthcare plan that took center stage. No one that Eyewitness News talked to supported it.

Dr. Lawrence Rubin

"I am not a youngster, as you can see. Like many other senior citizens, I am concerned that our needs, which are greater health-wise than most, are going to be evaluated with less importance than the needs of a younger person," said retired podiatrist Dr. Lawrence Rubin.

Dr. Rubin retired from podiatry some time ago. Now he volunteers for a non-profit called LEAP. The group promotes foot check-ups to prevent serious complications in diabetics. He, along with dozens of other health professionals, screened anyone who wanted a check-up for free at the M Resort.

Source: Eyewitness News (CBS-TV) [8/13/09]

Query: Dermatitis Post-Acupuncture

I have a 52 yo male patient who decided to go to an acupuncturist for diagnosed plantar fasciitis. He has received two treatments in which the needle was set in the mid-arch of his plantar foot.

Post-Acupuncture Dermatitis

He developed this skin condition and has tried lotions without success. He has no history of erythema or infection, just increased hypertrophic skin, non-painful on palpation for a 4-week duration. Any thoughts?

J. Michael Bluhm, DPM, San Antonio, TX

Query: Waiting Room Solutions EMR Software?

I have just been detailed by an Internet-based EMR/practice management company called Waiting Room Solutions. This is a CCHIT-certified outfit. It is primarily MD-based at present, but podiatry could easily be adjusted to orthopedic templates. Does anybody have any experience with this company? What other companies can you recommend?

Wes Daniel, DPM, Gainesville, GA

Query: Coding Bone Cyst & Fracture Treatment

Today, I excised a bone cyst from a left fifth metatarsal that had resulted in a pathologic fracture of the metatarsal at that site. The repair included windowing of the bone cortex, curettage of the material, and packing with a synthetic bone grafting material. The window was replaced, the fractured portion stabilized (without internal fixation). Soft tissue was closed over the area followed by skin closure.

I believe that the coding options include open repair of a metatarsal fracture (CPT 28485) and/or curettage of a bone cyst (CPT 28107-59).  Are these codes correct? How does the procedure coding affect the global post-operative period?

Howard J. Bonenberger, DPM, Nashua, NH

Response: It's my opinion that the correct coding for this procedure would be using the CPT 28104 (excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus).

The fracture was not reduced, fixated, or grafted. Therefore, the bone cyst repair was the procedure actually performed. I would feel differently if there was additional work done that was unique to the fracture.

Howard Zlotoff, DPM, Camp Hill, PA

Codingline subscription information can be found at:
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RE: Bleomycin Protocol (John M. Scholl, DPM)
From: Ira Meyers, DPM

For Bleomycin, the usual dosage is 1 unit per 1 squared cm. I usually block the area first with lidocaine usually with epi. The injection of Bleomycin should be given almost parallel to the lesion (it's not a quick injection). It's not uncommon for there to be some discomfort a few days later as the lesion necroses. I've had pretty good results for recalcitrant verruca.

Ira Meyers, DPM, Huntingdon Valley, PA, idmrun@aol.com
 

RE: Tarsal Tunnel Syndrome? (Tip Sullivan, DPM)
From: Howard J. Bonenberger, DPM

I agree with Dr. Sullivan that the diagnosis of TTS is largely a clinical one. One "functional" test I have heard of but have no personal experience with is application of a tourniquet (BP cuff) over the calf with inflation above diastolic but below systolic pressure. Have the patient walk for a few minutes in the office. This promotes engorgement of the veins in the tarsal tunnel and may reproduce the symptoms.

As for surgical decompression, be very certain to release all of the branches including Baxter's nerve. I have seen many patients who present for care after failed TTS surgery performed elsewhere (often by an orthopod), and the incision is about 3 cm in length and never goes near any of the terminal branches (Probably the worst I saw was a lady with a painful incisional scar that ran up and over her medial malleolus at a 45 degree angle never going anywhere near the tarsal tunnel). If you are not experienced or comfortable performing this surgery ask an experienced colleague to assist, or be the primary surgeon as you assist. 

Perhaps a reader can comment on the BP cuff test and their experience with this.     

Howard J. Bonenberger, DPM, Nashua, NH, howardbon@aol.com

RE: Referral Fees Under Stark Law (Name Withheld)
From: Vince Marino, DPM

I still to this day find it truly amazing that Stark Laws prevent referral fees to be paid to physicians, yet attorneys are routinely paid upwards of 30% of any settlement they receive to the referring attorney. For instance, a worker’s compensation attorney might refer a client to a personal injury attorney or to a medical malpractice attorney for further action. If that other attorney collects any monetary rewards for damages or for any other issue, they are “obligated” to pay the worker’s compensation attorney who referred the client 30% of the money he collects as his fees. This is common practice in California. Of course, the legislators who wrote the law are ATTORNEYS! When is the medical profession going to stand up and speak out about this “one-way street”?

Vince Marino, DPM, San Francisco, CA, drmarino@marinofootandankle.com

RE: Obama's Amputation Remarks
From: Multiple Respondents

I am gratified that the problem of foot amputations in DM is being discussed and take no umbrage at all.   

Dwight L. Bates, DPM, Dallas, TX, dlbates04@yahoo.com

From a podiatrist’s perspective, I think it is pretty clear that Obama has put his foot into his mouth one time too often. He seems to have a propensity of not thinking through his callous comments.

Ivar E. Roth DPM,MPH, Newport Beach, CA, ifabs@earthlink.net

So far, I have had three phone calls from friends who want to be adopted. Why? Because according to Obama, I make $30,000.00 to 50,000.00 an amputation. What are our patients going to think? I love his comments as well about the family doctor helping the patient control their diabetes. What does he think we've been doing for the past umpteenth years? My wife is a diabetes educator and she is still fuming. It's a shame he didn't say anything about the patient who misses appointments on a regular basis, never goes to the doctor until they are deathly sick, eats junk all the time, or my favorite, the patient who continues to smoke after being told by all his doctors that he must stop. I encourage you to read the bill and get the facts. 

Neil A Burrell, DPM, Beaumont, TX, nburrell@gt.rr.com

Editor's Note: We have received a large number of responses on this topic. We have published these additional responses in the order they were received. at: http://www.podiatrym.com/letters2.cfm?id=28129&start=1

ASSOCIATE POSITION – SOUTH CENTRAL FLORIDA

Multiple offices, in Jupiter, Ft Pierce. Looking for associate who is surgically trained PSR24, willing to travel between offices. Competitive Salary base plus percentage. Position available immediately. Send CV and questions to alfootdoctor@yahoo.com

ASSOCIATE POSITION - MARYLAND

Full time, hard-working, happy and personable Foot Surgeon needed for busy and growing practice in Frederick and Hagerstown Maryland. PM&S-36 or more required. We have a well-rounded, high tech practice with all types of pathology encountered in our two offices and in two local hospitals as well as our on-site accredited and certified ASC. Very competitive compensation. Please send your CV to drmichaels@rfainstitute.com

ASSOCIATE POSITION - FLORIDA

Busy practice in East Central Florida in search of full-time podiatrist to perform routine foot care in office and nursing home. Competitive salary and full benefits available. Reply to jrdpm@bellsouth.net

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 - MARYLAND (MONTGOMERY COUNTY)

Multi-office, well-established practice with surgical centers, digital x-rays, in-office vascular testing, ultrasound, EMR with voice recognition charting, and many other perks looking for personable, well-trained, motivated individual. Patient base available for immediate in-office productivity. If you are new or ready to change locations, contact us ASAP to discuss opportunities. Send resume and cover letter to mddpmassociate@comcast.net

WANTED: PRACTICE TO PURCHASE IN BERGEN COUNTY NJ

DPM interested in purchasing a practice in NNJ. If you are considering selling/retiring/slowing down etc let's talk and come to a mutually beneficial arrangement. Open to all situations/options. Contact: AdvancedFtCare@aol.com  for quick deal.

ASSOCIATE POSITION - MARYLAND

Harford County, Bel Air, est. 1991, seeking PSR24/36, strong ethics, friendly demeanor. Associate or partnership opportunity for the right applicant. We provide onsite ambulatory surgical center, patient base, strong referral resources, billing, scheduling, and many technologies. Visit our website. e-mail your CV to drhoward@hlsfootcare.com.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

FOR SALE: MICROVASC UNIT

Excellent Condition, Never Used, New 14K, BEST OFFER. All-Pro 2010 X-Ray processor, used, great condition, Includes cassettes BEST OFFER
NYCPodiatry@gmail.com

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.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

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.

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.

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

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

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