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August 23, 2008 #3,331 Editor-Barry Block, DPM, JD

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IL Podiatrist Enjoys Variety of His Job

Marc Leonard, a doctor of podiatric medicine, is a board-qualified podiatrist who has made the goal of healthy feet his life work. A little more than a year ago, Leonard took over the Comprehensive Foot and Ankle Clinics of Streator, 506 E. Main St., from Dr. Egly. Leonard now has clinics in Streator, Braidwood and Dwight. When not working in one of those three clinics, Leonard works at his main office, Midstate Podiatry Associates in Bloomington, three days a week.

Dr. Marc Leonard

"During undergraduate work, I had a course that exposed students to a variety of professions," Leonard told The Times. "The podiatrist was local and it seemed like a good living. It didn't seem like it would entail a lot of calls or emergencies. But just to make sure I would like it, I volunteered at a local clinic. Well, it's been nine years since I graduated and I love what I do, particularly the people I see and work with. I've discovered that everyone has a unique personality and I enjoy the variety of my job."

Source: The Times (IL) [8/19/08]

CA Podiatrist’s Company Provided Orthotics to Olympic Athletes

Before Beijing, the U.S. Olympic Committee enlisted the help of Quasar Inc., a Tustin medical device company, to evaluate the foot alignment of hundreds of U.S. Olympic athletes and provide the company’s patented orthotic shoe inserts for many of them.

The company worked with the Olympic men’s volleyball team, the weight-lifting team, and many of the track athletes, said Quasar founder Craig Lowe, who is a podiatrist. “Athletes are always pushing the limits of their skeletal system,” he said. “We can maximize the ergonomic function of the foot, which affects all the load-bearing joints: ankle, knee, hip…”

Quasar’s technology reduces the foot evaluation time from 90 minutes to 90 seconds and cuts the cost of corrective shoe inserts from a starting price of $600 to $150, Lowe said. “Most professional athletes wear orthotics, but this makes the technology affordable for gardeners and workers who stand on their feet all day and children,” he said.

Source: Orange County Register [8/21/08]

Internet Grows Rapidly as Health Info Resource: Study

People are increasingly relying on the Internet to seek information about personal health concerns, according to a national study released by the Center for Studying Health System Change. In 2007, 56% of American adults, or more than 122 million people, sought health information from a source other than their doctor, up from 38% or 72 million people in 2001, the study found.

The proportion of Americans using the Internet as an information source, however, grew the most rapidly compared with other sources, doubling from 16% in 2001 to 32% in 2007. This trend was facilitated by substantial growth in overall Web access and exponential growth in residential broadband Internet access during this time period, the center concluded.

“Consumers’ use of the Internet for health information is now on par with their use of the more traditional, long-standing sources of books, magazines and newspapers (33%), and friends or relatives (31%), which also increased significantly since 2001,” the study said. The proportion of seniors using the Internet to get health information increased from 7% in 2001 to 18% in 2007. Yet, the elderly still trail younger Americans by a substantial margin in seeking health information, especially in using Internet information sources, according to the study.

Source: Jennifer Lubell, Modern Healthcare [8/21/08]

Give Your Attitude a Boost

Here are some things you can do to step up your attitude:

• Take 100% responsibility for yourself. If you are unhappy with where you are, and what you are doing, you can choose to leave.
• Choose your attitude. Bring enthusiam to work. As long as you choose to be at work, have some fun.
• Set an example by modeling a positive attitude. At all times, do your best and be your best at everything. It's amazing how a positive attitude and enthusiam are contagious.
• Hang with winners, not whiners. Distance yourself from negative people or gossips. Others will associate you with their negativity.
• Believe in yourself. Trust that you have the talent and ability to make things happen.

Source: Adapted from Step up to Success: 5 Realties of Our Work World by Marjorie Brody, CSP, PCC, CPAE.

Query: Standard of Care for Soft Tissue Masses

I am curious if it is considered standard of care to do a pre-op MRI and have intra-op frozen sections on every single soft tissue mass excised? To me that seems excessive, and I did not see this done routinely in my residency training which included cases with several specialties, including orthopedists and general surgeons. It is clearly not routine in podiatry from my training experiences. I agree that if there is high suspicion for malignancy, this is the way to go.

Also, if the frozen section turns out to be malignant, what is the best way to ensure adequate resection of the tumor margins during the initial surgery?

Judd Davis, DPM, Colorado Springs, CO

Query: Staff Vacation Time

In our practice our staff members that have been with us for over four years get 20 paid days off per year. This is combined vacation/sick and bereavement days. I am curious as to what is done in other practices and if what we do is excessive or about right. Any input is appreciated.

Scott Werter, DPM, Myrtle Beach, SC

Query: Rheumatoid Arthritis Surgery Coding

I have a patient with rheumatoid arthritis who has a severe hallux abductovalgus deformity and toe contractures. I performed the following:

Procedure 1: 1st metatarsal-phalangeal joint fusion
Procedures 2-5: Metatarsal head removals 2-5
Procedures 6-7: Hammertoe repair 2-3
Procedures 8-11: Removal of 1 cm. portion of the extensor tendon at the metatarsal-phalangeal joint level of 2-5.

How would the above be coded?

William Myers, DPM, Conway, SC

Response: Here's how I would recommend coding the procedures you have outlined:

Procedure 1 - 1st MPJ fusion - CPT 28750
Procedure 2-5 - Metatarsal head resections 2,3,4 - CPT 28112 x3
Met head resection 5 - CPT 28113
Procedure 6 - Hammertoe repair 2,3 - CPT 28282 x2
Procedure 8-11 - Extensor tendon resection - Would not code; this would be a component of CPT 28112.

Howard Zlotoff, DPM, Camp Hill, PA

Codingline subscription information can be found here

RE: Low-Grade Fibrosarcoma (Doug Mason, DPM)
From: Multiple Respondents

This patient needs to be referred to a tertiary care center that deals with musculoskeletal malignancies. Patients do much better in the long run if referred properly.

Mark S. Tracy, DPM, Port Charlotte, FL, goldenpheasant2001@yahoo.com

This should be referred to an orthopedic oncologist, if one is available in the vicinity or at the least an oncologist to evaluate and recommend treatment. This should be done as soon as possible.

Robert Bondi, DPM, Lee’s Summit, MO, Robert.Bondi@Foot-Docs.com

Anytime a pathologist reads a specimen as "sarcoma," a timely referral to an oncologist is warranted, even if you think you removed the entire lesion. A second evaluation by a doctor who treats potentially malignant tumors is a great idea, both medically and legally, low-grade or otherwise. Furthermore, that patient should be followed periodically to look for recurrence, or even metastasis. That should be done by the primary care doctor, the podiatrist, and the oncologist.

Todd Lamster, DPM, Phoenix, AZ, tlamster@gmail.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

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 - 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 for this practice, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

MINNESOTA - IMMEDIATE OPENING

Well-established practice with 8 offices in the Minneapolis metro area seeking a highly motivated PSR 24/36 trained podiatrist for a full time or part time associate position. ABPS certified, qualified or eligible preferred. Excellent income potential with benefits including health insurance, malpractice insurance, relocation expense, association dues, license fees, hospital dues, continuing education expense. Possible buy-in or buy-out in future. Heavy emphasis on surgery and sports medicine with minimal RFC. Please e-mail CV to footandankledoc22@hotmail.com

PRACTICE FOR SALE - MINNESOTA

Minnesota-2 well established prime office locations for sale in the Minneapolis suburbs. Great income potential with large MD referral base .Can purchase one or both offices together. 175k gross/ each office. Owner will help with transition. Please e-mail minnesotadpm@live.com

ALL PRO 2010 X-RAY PROCESSOR FOR SALE

2 years old, excellent condition, monthly maintenance/cleaning done by NJ X-Ray. Includes processor, leveling base, chemical draining hoses, water hose, two 10x12 x-ray cassettes and 1 box of brand new x-ray film. Instruction manual and extra washers/parts also included. Asking price $2,200 + shipping costs. Please email nefootandankle@optonline.net for all inquiries.

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

PODIATRIST NEEDED - NEW YORK

Podiatrist (DPM) needed for busy multi-specialty practice located in Great Neck, NY 11021 Must be experienced in all phases of podiatric medicine. Must have all licenses and certifications. Fax 516-829-9674 Nancy

PRACTICE OPPORTUNITY – DENVER, CO

Denver, Colorado. Metro Denver practice opportunity. Details: Email: g_gill@comcast.net

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

PRACTICE FOR SALE MN: PRIME LAKES AREA

WEEKLY SPECIAL - One week of ads (5x) for $89 One month of ads (20x) for $340 .

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