The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

August 25, 2012 #4,568 Publisher-Barry Block, DPM, JD

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NY Podiatrist Discusses Dangers of Salon Pedicures

Dr. Tejas R. Pandya of Capital District Podiatry sees the negative effects of problem pedicures regularly in his practice. “If the salon isn’t sanitary, people may need antibiotics, possible hospitalization or surgery,” Pandya says. “You can get fungus in your toenails. You can have ingrown toenails that need to be treated. You can get a staph infection. You can get warts if they’re not sanitary places.”

Dr. Tejas R. Pandya

His first tip is to put off a pedicure if you have any kind of open sore. “Nail dust can get into the wound,” he says. “It’s back to sanitation. You don’t really know if the instruments have been autoclaved.” For that reason, Pandya recommends taking your own implements: “You clean them and can be 100 percent certain they’re sanitary.”

Source: Wendy Page, Healthy Life Magazine [8/22/12]

Osteoarthritis Can be Controlled Early With Proper Shoes: CA Podiatrist

Is your big toe stiff? You could have osteoarthritis. See a doctor as soon as you suspect a problem, says Bob Baravarian, DPM, co-director of the University Foot and Ankle Institute in Los Angeles and chief of foot and ankle surgery at Santa Monica/UCLA and Orthopedic Hospital.

Dr. Bob Baravarian

At this point, he says, you may be able to control the OA with shoes that are long enough and have a deep enough toe box to keep your big toe from rubbing against the side of the shoe. A rigid sole should also help, as it prevents your big toe from bending and twisting.

Source: Catherine Winters, Prevention

APMA President Discusses Teens and Foot Health

Many parents agonize over making just the right choice for their baby’s first pair of shoes. In one important way, however, picking infant shoes is easier than choosing for an older child: babies have nothing to say about what style or brand you put on their feet. Teens, however, have strong opinions about fashion – opinions that extend all the way to their toes. That could be why six out of 10 teens today experience foot pain, and two out of every 10 who suffer from foot pain experience it because they’re wearing high heels or other uncomfortable footwear, according to a recent survey by the American Podiatric Medical Association (APMA).

Dr. Joseph Caporusso

“Foot health is incredibly important to a person’s overall health and well-being, especially in the teen years when feet are still growing,” says Dr. Joseph M. Caporusso, a podiatrist and president of APMA. “While our survey found that half of teens see feet as important to their overall health, many are still living with foot pain. It’s vital that we educate teens and their parents on how to properly care for their feet.”

Source: Univ of North Alabama Flor-Ala [8/23/12]

One-Year Delay on ICD-10 to October 2014 Finalized

The federal government has finalized a one-year delay in the compliance deadline for the nationwide conversion to ICD-10 code sets. The delay, first proposed in April, will move the compliance deadline to Oct. 1, 2014.  HHS said the extra time would allow healthcare organizations—small organizations in particular—adequate time to get ready for the changeover.

HHS included the change in a 208-page final rule establishing a unique health plan identifier for all insurers. In a news release on the CMS' website announcing the rule, HHS said the identifier—along with other administrative simplification regulations included in the healthcare reform law—will save the healthcare system an estimated $6 billion over the next decade.

Source: Maureen McKinney, Modern Healthcare.com [8/24/12]

New Thermometric “Stress Test” May be Used for Early Diagnosis of Acute Charcot

A multinational study demonstrated that temperature response to dosage of activity is different between subjects with acute Charcot neuroarthropathy (CN) and age matched non-CN with type 2 diabetes and peripheral neuropathy. Twenty-two eligible subjects were enrolled in this study. The plantar temperature response to walking for two pre-defined paths of 50 and 150 steps was examined. The results demonstrate that the proposed stress test allows differentiating CN with higher effect size than static plantar temperature assessment.

Dr. Bijan Najafi

"The observed differential thermal response to walking initiation between Charcot and non-Charcot feet warrants future investigation to provide further insight into the correlation between activity dosing and thermal response," said Dr. Bijan Najafi, lead author and associate professor  at the department of surgery, Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona. "It may also lead to valuable insight into identifying an 'inflammatory trigger' that may ultimately provide an early warning sign or increased sensitivity for subsequent unilateral or bilateral CN development or clinical expression of foot ulcer", he added. This study has been published at the Journal of Aging Research.

Query: Coding a Second Opinion

Can anyone tell me what the correct CPT code would be for a second opinion performed in our office? 

Joseph Fanara, DPM, Rockford, IL

Response: The CPT 9927x series of confirmatory consultation codes (for second and third opinions) were deleted from CPT in 2006.

You will need to use the appropriate outpatient E/M code (CPT 9920x) or E/M consultation code (CPT 9924x) depending on what type of service you provided, and who initiated the request for the service - the patient or another physician.

Paul Kinberg, DPM, Dallas, TX

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Recurring Forefoot Pain in a Cyclist (Mark Aldrich, DPM)
From: Brad Makimaa, DPM

As a triathlete, I have discussed this several times. Don't overtreat with orthotics. Take away all the excess pads and have him get a proper bike fit. Likely the fitter will adjust the position of the shoe clip. This alone should resolve the problem, but one should always go with a full bike fit for maximum comfort and performance.
 
Brad Makimaa, DPM, Key West, FL, drmak3@comcast.net

RE: Treating a Diabetic with an Inversion Sprain (Philip McKinney, DPM)
From: Jeffrey Kass, DPM

I believe the diabetic inversion case treatment was good medicine, and if someone wants to claim the doctor was overzealous - well, "better safe than sorry." Good job.

Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Terminating an Office Manager (Name Withheld)
From: Pete Harvey, DPM

In  Texas, if you dismiss any employee without prior discussion you will, at most, be charged in a wrongful dismissal suit and, at least, you will lose when she files a complaint with the Employment Commission. The EC will side with the employee and allow benefits for many months. That money must come from somewhere, so it is charged back to you and it will take several years of HIGH tax payments to pay it off.
 
In Texas, you must be sure your office manual has been read by all employees and that employment dismissal is spelled out. You must then document that the problem was discussed with the emloyee THREE separate times. Each time must be in writing and spell out what was discussed and then be signed by the employee. Then, if she files with the EC, you will prevail.
 
Most large companies have security to escort the ex to the door and it is done immediately. In my career, I have not gone that far, but twice I have dismissed the employee and then immediately changed the office locks. Check your state laws. It’s important.
 
Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

RE: Scope of Practice (Robert Bijak, DPM)
From: David Gurvis, DPM

In contrast to Dr. Bijack's opinion that we are not competent to talk to patients on weight loss, I feel that we are; at least as competent as most family docs, internal medicine docs, surgeons of any specialty. When my wife had colon problems, the GI doc told her to eat more fiber, and if she needed more help, he would refer her to a nutritionist. When I hovered around the pre-diabetic state, my internal medicine physician told me to lose about 10% of my body weight and be retested. He offered to send me to a dietitian if I wanted. I dare say I can do that as well. What does counseling entail? Telling patients that they need to lose weight or stop smoking? Offering a referral to a nutritionist or to a "stop smoking" clinic?

If it entails a full discussion of weight loss methods, talk of strategies to stop eating, a psychological evaluation of causes of over-eating, and caloric counting vs. fat counting and so on...then very few docs, DPM or MD/DO, are competent. Yes, Dr. Bijack, we are competent to talk with a patient about weight loss - not to discuss all the ins and outs of it, but to "discuss" it.
 
David Gurvis, DPM, Avon, INdeg1@comcast.net

RE: Two Tests For Posterior Tibial Dysfunction
From: Michael Turlik, DPM

In order to have confidence in performing diagnostic tests, clinicians need to have some idea of the pretest probability of the disease in their patient population and some idea of the precision of the test: sensitivity/specificity, predictive value, or likelihood ratio. Decisions on treatment and reimbursement in the 21st century will be increasingly based on data rather than expert opinion.

Michael Turlik, DPM, Cleveland, OH, mmturlik@aol.com

RE: UK Podiatrist Tells Kate Middleton to Fix Her Feet
From: Sam Bell, DPM

I am curious as to how the unsolicited, and without examination or permission, public airing of what Ms. Supple's opinion of Kate Middleton's feet was received by the people there. Was it scandalous, was there outrage or was it just a big yawn? Will it bring Ms. Supple more patients or will people say, "If I go to Ms. Supple, will my foot problems be in the morning paper?" Personally, I do not think it represented podiatry favorably.
 
Sam Bell, DPM, Schenectady, NY, dpmbell@aol.com

EQUIPMENT FOR SALE

Retiring from practice. Equipment For sale. Mini x-ray. One year old Ultrasound with MS arterial/venous X-ray plates. Great condition Ritter chairs. Drills, surgical tools. So much. Just ask, I probably have it: Footcare@comcast.net

EQUIPMENT FOR SALE - PINPOINTE LASER

PinPointe Laser for sale. All accessories included. In service since 2008. Service policy in place, fully transferable. $35,000. tatarb@verizon.net.

PRACTICE FOR SALE - NEW YORK

Located in New York, Capital District (Albany, Schenectady, Troy). Grossing 500k+ consistently with less than 10% surgery.
100% EHR Compliant and steady growth. Great opportunity for a doctor or doctors. Will help in the transition process, long-term lease is available. Please email serious inquiries to PodiatristDoctor@gmail.com

PRACTICE FOR SALE - NEW ROCHELLE, NY

Flexible terms. Stable location, medical co-op, 24 year practice with a stable established patient base. Great opportunity for a self motivated podiatrist wanting immediate income and future stability. Call 551-574-0776 for details.

PRACTICE FOR SALE - SOUTHWEST FL

multilocation multidoctor practice in beautiful Southwest Florida . Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to: practiceforsaleswfla@gmail.com.

PRACTICE FOR SALE - BALTIMORE, MARYLAND

Established 40+ year old well-rounded practice of both surgical and non-surgical care with special emphasis on sports medicine. Medicare and BS/private insurance base, no Medical assistance. Needs to transition to a confident well trained individual. Purchase can include building. Contact: podiatrypracticesale@gmail.com
 
SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

ASSOCIATE POSITION - CHARLOTTE, NC

Charlotte, NC practice with excellent reputation and patient base seeks to hire a podiatric surgeon. Looking for an associate with partnership potential to join our team serving 5 offices located in Charlotte metro area. Please send resume to Charpodiatry@gmail.com.

ASSOCIATE POSITION - OHIO
 
Ohio practice with excellent reputation and patient base seeks to hire a Podiatric Surgeon. The offices are state of the art including Digital X-Ray, EMR, Diagnostic ultrasound, Padnet Vascular Testing, CO-2 Lasers all aspects of DME. The base salary is $120,000 with a bonus structure and benefits also would like to have this individual buy into the practice eventually. Please send CV to: Ohiopodiatrist@aol.com

ASSOCIATE POSITION – NORTHERN CALIFORNIA/BAY AREA
 
We’re looking for someone entrepreneurial who can help grow our practice. Must have great people skills, clinical/surgical skills, and positive demeanor. California license required. Send your CV and cover letter to cvpodiatrist@gmail.com

ASSOCIATE POSITION - NEW YORK CITY & QUEENS

High Income Potential. One of the fastest growing podiatry practices in New York City and Queens seeks a hard-working podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Contact me at: podocare123@gmail.com

ASSOCIATE POSITION – NEW YORK

Great opportunity to share “state-of-the-art” offices and equipment in mid-town Manhattan and White Plains with Board Certified podiatrist. Out-of-network or participating providers welcome. Please call 212-704-4310 for additional information and fax your CV to 212-704-4311 or email to: ifanelli.hms@verizon.net.

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 12/24 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977

ASSOCIATE POSITION – SUFFOLK COUNTY, LI

Well-rounded podiatry practice. A business-oriented, mature board eligible/certified podiatrist who is not just looking for a job, but a secure future. Equity position possible. 2 hospitals available. No nursing homes. Competitive package. Please send CV to 631-581-0857.

ASSOCIATE POSITION - SACRAMENTO, CA

Associate position available immediately. Full or Part time. Opportunity for buy-in and full partnership. Full scope of practice with hospital and surgical privileges available. Please call 310.854.0203 or fax 916.732.2280.

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering part-time positions in Maryland. Our group, Podiatry Management Services, provides care in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your CV to: drhprosen@verizon.net or fax to 410-486-2049 or call Dr. Herbert Rosen at 410-580-0255

ASSOCIATE POSITION - MINNEAPOLIS/ST. PAUL

Contract podiatrist. Doctors By Your Side, a high quality team serving senior communities. Are flexible, work as little as 2 days monthly. Good compensation, expenses and all administrative capabilities (scheduling, billing and EMR) provided. To learn more, please send CV and availability to: john@doctorsbys.com or call 763-390-9276.

ASSOCIATE POSITION - NORTHERN, NJ

Part-time or-full time. This position can and will lead to purchase of practice if so desired. Well-equipped modern office. Digital x-ray, ultrasound, etc. Individual must be well-trained and be ABPS Qualified/Certified. Must be competent in general foot care and be able to do routine foot surgery without help. Call: 201-986-1900.

ASSOCIATE POSITION - WASHINGTON, DC

Prominent two office (3 practitioner) podiatric medical group seeking well rounded, personable individual with good medical and surgical skills. Must be 24/36 month trained, board qualified or certified foot and ankle surgeon. Salary with benefits package. Serious inquiries to ponyrunner66@gmail.com

ASSOCIATE POSITION - NASSAU COUNTY, NEW YORK

Exciting Opportunity! Associate position. Must be Board Qualified. Joining all Board Certified Doctors in foot surgery and reconstructive rear-foot and ankle surgery. Respond to: Podiatryoffice@doctor.com

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