August 21, 2006 #2,668 Editor-Barry Block, DPM, JD

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Brigido, Kesselman Take Part in NASDAQ Opening Bell Ceremony

Steve Brigido, DPM and Paul Kesselman, DPM had the honor of being part of the opening bell ceremony at NASDAQ this week, along with tennis great Jimmy Connors. This was in celebration of Wright Medical's 5-year anniversary on the exchange.

Dr. Paul Kesselman (3rd from Left)

Jimmy Connors, who had been unable to play tennis for the last five years due to a severely degenerative hip, recently received a Wright hip implant, which has allowed him to return to the tennis court within six weeks of his surgery.

Podiatrist Celebrates 105th Birthday

Bernando LaPallo has discovered the fountain of youth. He’ll tell you his secrets to his longevity, but he doubts you’ll follow it. The Mesa, AZ man is turning 105 today, but you’d never in a million years guess he’s that old. In fact, he could pass for someone half his age. “I feel great,” he said. “I’m never sick.” LaPallo credits his longevity on his diet, his faith in God and keeping active.

Dr. Bernando LaPallo

He was born in Brazil in 1901 and moved to the United States when he was 5 years old. He lived in New York for 90 years and moved to the Valley three years ago. He’s been a chef, a podiatrist, a licensed massage and physical therapist, and a herbalist. He still drives, has his original teeth and doesn’t wear a hearing aid.

Source: Hayley Ringle, East Valley Tribune, [8/17/06]

MPMS Presents Awards at 100th Anniversary Celebration

As part of the recent Massachusetts Podiatric Medical Society (MPMS) 100th Anniversary Celebration MPMS president, Dr. James Ioli, gave Dr. Norman Wortzman, Awards Chair and a Past President of MPMS, the honor of making presentations to several award recipients at Boston’s Fairmont Copley Plaza Hotel, including:

Dr. John George – Distinguished Service Award – MPMS’s highest award
Dr. Joseph Addante – Distinguished Service Award
Dr. Jerry Brant – Meritorious Service Award
Dr. Bob O’Keefe, – Meritorious Service Award
Dr. Max Schertzer – Congratulations on 60 years in practice.
Dr. Peter Paicos, Sr. - Congratulations on 60 years in practice.
Dr. Peter Paicos, Jr. – Retiring MPMS president’s award

Dignitaries and Honorees at MPMS 100th Anniversary Celebration

Pictured left to right are: Dr. Joseph Addante, Gary Adams, Dr. Max Schertzer, Dr. Peter Paicos, Sr., Dr. Peter Paicos, Jr., Dr. David Schofield, Dr. John George and Dr. Norman Wortzman.

New Regs Create Safe Harbors for E-Prescribing and EHR

CMS and the HHS Office of the Inspector General (OIG) have released final regulations for anti-kickback statute "safe harbors" and Stark self-referral exceptions for electronic prescribing and electronic health records (EHRs). The coordinated move shows that the government is eager to get the country wired for health information technology (HIT), experts say.

Recipients Must Pay 15% of Costs

The exception under the Stark law for donations of EHR technology will protect the "provision of software or information technology and training services that are necessary and used predominantly to create, maintain, transmit or receive the electronic health records of the donor's or physician's patients," HHS explains in an Aug. 1 prepared statement.

In parallel final rules, CMS and OIG say that entities can donate technology and training services for e-prescribing and EHRs to physicians without triggering the anti-kickback statute or Stark law. The immunity is needed so that hospitals and physicians can invest together in the expensive technology needed to move forward in both areas, stakeholders note.

Source: Report on Medicare Compliance [8/14/06].

Query: C/N Tarsal Coalition

I have a young healthy athletic male with aspirations of college baseball scholarship. He has an abducted forefoot with digital deformities that hurt bilateral-i.e., bunions. Interestingly he only has some occasional midfoot/rearfoot pain with sports activities. On exam, he did not have the typical pronated STJ in static stance. There was an early heel-off and no motion in the STJ. He has a previous history of multiple inversions. I suspected a coalition and an MRI demonstrated a significant Cal/Nav coalition typical at the calcaneal beak. To say the least is options are not good:

--Play ball (in accommodative orthoses) until it hurts so bad he is forced to stop then triple arthrodesis
--Try a coalition resection along with forefoot reconstruction—my experience with those is about 60% complete success and 40% less than complete success.
--Just do the forefoot reconstruction and leave the coalition alone

I would appreciate any feedback regarding this situation and/or pearls on how to improve results with coalition resections.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

Query: Two Modifiers on E/M Codes

Is it ever appropriate to use both a -24 and a -25 modifier on an E/M code? For example-an E/M service for a patient in the global period of an amputation on the right foot, with debridement of a new ulcer on the left foot in addition to a work up of a tinea infection?

Arden Smith,DPM, Maspeth NY

Response: Your example of where these two modifiers would be used together is a good one.

In terms of the order of placing them, I'm not sure which way would be best, as it will likely depend on the order that the edits appaear in the payer's claims adjudication software. Assuming that a global period modifier edit would appear before a modifier specific to the combination of the codes on the claim itself, I would put -24 first, followed by the -25.

I would suspect however, that the service would either be denied or would be pended for records regardless of the order of modifiers.

As a result, make sure the staff knows that if a bundling denial of some type is received that you expect that they'll process an appeal (be sure that your progress and procedure notes clearly outline the separateness of these services).

Joan Gilhooly, MBA, CPC, CHCC, Deer Park, IL

Codingline subscription information can be found at http://www.codingline.com/subscribe.htm

RE: United Healthcare No Longer Covers ESWT for Any Condition - as "Not Proven"
From: Ken Malkin DPM

It has finally happened. Podiatry finally has its own Lasix eye surgery. Let's embrace the fact the ESWT may soon be not covered by all payers and we can know have our patient's pay cash for this service. The business model for this technology will need to change and if it considered a non covered insurance service the possibilities for joint ventures are enormous.

Heel pain is the number one orthopedic complaint for our offices and the fact that this service is not being covered is truly a blessing in disguise. Make it work!

Ken Malkin, DPM, Caldwell, NJ, drmedicare@aol.com

RE: Hard to Find 800 Numbers
From: Arthur Gudeon, DPM

Bookmark this URL; it’s a list of hard to find 800 numbers. This is a directory for practically all companies, etc., and how to get a real person on the phone.

http://www.hardtofind800numbers.com

Arthur Gudeon, DPM, Rego Park, NY,afootdoc@ix.netcom.com

ASSOCIATE POSITION - NEW JERSEY

Seeking associate for practice in Ocean County area. Seeking a hardworking, ethical, energetic and well trained (PSR 24/36) individual. MUST be willing to do all aspects of podiatry! Competitive salary and benefits package. E-mail CV to NJFEET@aol.com

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

HOUSE CALL PRACTICE OPPORTUNITY- CHICAGO / NORTHWEST INDIANA

Chicago-Home Physicians specializes in house calls to the elderly homebound. Full and part-time positions available in Chicago/Northwest IN. Competitive Compensation, including malpractice. Contact Scott Schneider. Phone-773-292-4800. Fax-773-486-3548. E-mail sschneider@homephysicians.com www.homephysicians.com SEEKING

SEEKING ASSOCIATE POSITION - NEW YORK

Hardworking, ethical and well trained PSR-24 trained podiatrist seeking a part-time associate position in Westchester county or surrounding areas. Please contact (206) 919-2832 or bbrick2@yahoo.com

EQUIPMENT FOR SALE - PODIATRIC CHAIR

Midmark 416 podiatry exam chair. Lincoln Park Chicago, IL. Great chair. I moved office and no longer need it. Must sell. Blue color (will e-mail photo on request). 773-871-3338

HOUSE CALL PRACTICE FOR SALE – SOUTHERN CALIFORNIA

House Call practice for sale which includes approx. 400 patients and continued referrals. Perfect for solo practitioner. Extremely easy and profitable practice to run. Yearly gross of over $200K. Current DPM is retiring. Financials will also be provided. Please contact ccipinc@ccipinc.net

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