The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

August 27, 2011 #4,244 Publisher-Barry Block, DPM, JD

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Congratulations to Robert Anavian, DPM of of Torrance, CA, winner of a   two-night stay at the Kensington Park Hotel in San Francisco (Value - $456.00).  We encourage you to participate in this important survey at www.podiatrym.com/survey Completing this anonymous survey provides us with valuable data, which we will publish in the February 2012 issue of Podiatry Management. It also makes you eligible to win thousands of dollars of valuable prizes. Enter by sending Question #43 (no answer is necessary) to bblock@podiatrym.com along with your name and address.

Pala Mesa Resort

This week's prize is a night night stay at the Pala Mesa Resort, including 2 rounds of golf (value $640.00).

This is also your opportunity to vote for the next DPM and Non-DPM inductees into the PM Podiatry Hall of Fame.

Minimalist Shoes Mostly Hype: IA Podiatrist

People are racing to buy a new type of running shoe, which is marketed to improve your balance, agility, and reduce the risk of injury, but do they actually do that? A barefoot running shoe is like a glove for your foot.The shoe's very minimalistic, and has a slot for each toe. The idea is to run more naturally. But foot doctors are wary of this new trend. 

Dr. Randall Bergen

"I really think it's just more of a little hype than it is anything else. I have not seen tremendous results with any of my patients that have used these shoes," said Dr. Randall Bergen, a Sioux City podiatrist. Bergen says for some people, the shoes might work, but he would still recommend a regular athletic shoe.

Source: Aaron Adelson, KCAU-TV [8/26/11]

CLEAR and Collaborators Obtain Grant from Forest Lab

Researchers at the Center for Lower Extremity Ambulatory Research (CLEAR) at the Scholl College of Podiatric Medicine, with the collaboration of researchers from Rehabilitation Institute of Chicago (lead-site) and Rush University, obtained a grant from the Forest Lab. This study aims to test the efficacy of Milnacipran in treating knee osteoarthritis (KOA) via a multi-dimensional outcomes package, ranging from subjective psychometrics (e.g. pain and mood) to fully objective bio-metrics (home tele-monitoring). 

Dr. Bijan Najafi

“The goal is to develop, test, and validate a novel, pragmatic paradigm of highly responsive outcomes compatible with successful phase III and IV trials, emphasizing improved function as it correlates with pain relief,” said Dr. Bijan Najafi, Associate Professor of Applied Biomechanics and site-PI (Primary Investigator) at CLEAR. “Many prior pain studies relied almost exclusively on patient self-report and/or observations made in the clinic,” said Najafi.

NY Podiatrist to Hold Free Care Day

Podiatrist Dr. Mary Carlson will be giving away free podiatric care in an effort to help the community in these difficult economic times. The Free Podiatric Care Day is designed to treat anyone for free who cannot otherwise afford to visit a podiatrist for his/her foot or ankle problem. 

Dr. Mary Carlson

The free treatments will be given by Dr. Carlson from 10 a.m. to 4 p.m. Patients will be seen on a first-come first-served basis. Dr. Carlson will do anything short of surgery to help patients become pain-free.

Source: Mineola American [8/26/11]

Query: Autoclaves
From: Elliot Udell, DPM
 
Any ideas on buying a new autoclave? I am considering the Midmark M11. Does anyone have this? Are you happy with it?  Does it last without breakdown too frequently? Any suggestions on this unit and any other unit available would be greatly appreciated.
 
Elliot Udell, DPM, Hicksville, NY

Query:  E/M Codes and CPT 11750

Can you bill for both a new patient visit and a nail excision? It is now considered part of the procedure by Medicare in our area, but this seems wrong. The doctor needs to complete a full history to determine if the patient is, for example, a diabetic, has neuropathy, and many other things before deciding how to proceed with the surgery.

There is no exclusion in the coding books for a new patient visit and the surgical procedure. Ideas?

Paul Somers, DPM, Nashville, TN

Response: We bill in Tennessee, and are paid by Medicare for the new patient visit and the nail procedure by using the "-25" modifier on the office visit. We also append the toe modifier in case the patient comes back for another similar procedure on a different toe within the global period. In those cases, we are able to justify the second procedure using the "-79" modifier.

Medicare will also pay for an established visit and a nail excision if you can justify the extra E/M in your notes. This also requires a "-25" modifier on the E/M code.

Katherine Sharp, Woodbury, TN

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

RE: Chronic Bruising of Foot (Dawn Foster, DPM)
From: Dock Dockery, DPM, Bryan C. Markinson, DPM

Regarding the patient with unexplained pain, redness, swelling, etc. Once the standard evaluations have been performed and continue to be negative, it might be worth considering 'self-inflicted' injury as an etiology.

I never like to jump to this conclusion too early, but over the years I have seen several forms of somatoform disorders such as Münchausen Syndrome, psychocutaneous disorders, self-inflicted injuries, and conversion reaction.

Most of these patients are seeking attention (or drugs) and open discussion and direct confrontation may be necessary to expose the problem.

Dock Dockery, DPM, Edmonds, WA, gdockdockery@aol.com

Consider the possibility of factitial injury (self-induced by patient). This is a syndrome where patients produce injury or symptoms because of a subconscious need for attention and/or some derived benefit of going through medical testing.
 
Typical features are lesions occurring only where they can reach, irregular shapes to lesions, pain out of character to the presentation, familiarity with x-rays and scans, requests for certain treatments or medications, etc.
 
Bryan C. Markinson, DPM, NY, NY, Bryan.Markinson@mountsinai.org

RE: CROW Walkers (Jay Kerner, DPM)        
From: David L. Nielson, DPM 
 
Langer is the company we use. An STS fiberglass boot is fitted just below the knee. Mark areas with pen such as bony prominences. Allow the patient to bear weight while the cast dries. The foot should be placed 90 degrees to leg. Take measurements of the ankle and the calf without the fiberglass. Draw an outline of the foot on paper and submit it to the lab.

David L. Nielson, DPM, Roanoke, VA, pampantla@hotmail.com

RE: Digital X-Ray Company That Supports Podiatry (Alan L. Bass, DPM)
From: Jeffrey Kass, DPM

I am not familiar with the A2D2 company that Dr. Bass speaks of, but no software support or upgrade fees are indeed a tremendous savings. This is the first time that I have heard of a company offering such a service. I would make sure you have that in writing.

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

RE: Effects of Laser Treatment for Nails Only Temporary: DC Podiatrist (Hartley Miltchin, DPM)
From: Bryan C. Markinson, DPM

After reading Dr. Miltchin's post, I felt compelled to respond to some of his outrageous, unproven claims, and how the innapropriateness of this type of testimonial makes our profession easy to be taken advantage of by industry. I believe that Dr. Miltchin is sincere, and given the opportunity to re-think his statements. I hope he will modify them. First of all, he states he "believes that the risks of oral medication FAR outweigh the benefits." REALLY?

The only part of his post for which there is existing data is reduced to his "belief." After tens of millions of uses of...

Editor's note: Dr. Markinson's extended-length letter can be read here.

RE: Medicare Proposes No Podiatric Coverage For Pneumatic Compression Therapy (Allen Jacobs, DPM)
From: Jeffrey Kass, DPM, Mathew M. John, DPM

I echo the sentiments of Dr. Jacobs. The domino effect of something like this can be devastating.
 
Jeffrey Kass, DPM Forest Hills, NY jeffckass@aol.com

I agree completely with Dr. Jacobs' remarks.  A dangerous precedent is being set if this type of proposal goes forth. It always seems easier to fight to keep something we already have than to fight later to obtain it. I believe this action is a step backwards. I also urge our leaders in the national organizations to work to address this issue.
 
Mathew M. John, DPM, Marietta, GA, footdoc@afcenters.com

RE: Toning Shoe Injury Lawyers (Kevin Kirby, DPM)
From: George Jacobson, DPM

Dr. Meltzer asks, "What profession do you think these lawyers are going to call upon as expert witnesses to testify in their cases?"  The Avia toning shoes that tout their avi-walker system advertise an APMA Seal of Approval, and the accompanying DVD which mentions the same.
 
George Jacobson, DPM, Hollywood, FL

EQUIPMENT FOR SALE – PRE-OWNED DIGITAL X-RAY SYSTEMS

Currently in use Reina-20/20 Extreme CR scanner (OEM iCRco) systems for sale. System includes CR scanner, 4 cassettes/imaging plates, and image acquisition software. Perfect for the low-medium volume practice or satellite office. E-mail Melanie Murdock for details and pricing.melanie.murdock@2020imaging.net

EQUIPMENT FOR SALE - CLASS FOUR LASER

I have a class four pain laser for sale. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net

PRACTICE FOR SALE - BOSTON AREA

8 miles north of Boston with sublease available in a modern medical building. Presently working 3 days/week, grossing $300,00 annually with easy potential for full-time. All office and podiatric equipment, instruments, digital x ray, furniture, etc. are included. Turn-key operation. Please e mailfootdoc71@aol.com or call 781 279-2332.

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. Preferably a Spanish-speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITION – IOWA CITY AREA

Established podiatric clinic looking for an associate to join our team, 4 offices located around the greater Seattle, WA area. Great base salary, benefits and friendly work environment. Please send resume toseattlefootdoctor@yahoo.com

ASSOCIATE NEEDED - SO. CAL

Position open for podiatry associate in Southern California. Applicant must be highly motivated and available for long term employment. This practice is extremely busy and requires a hard work ethic and desire to practice in a group practice environment. Excellent salary and benefit package offered. Please e-mail resume to footcare4all@aol.com

ASSOCIATE POSITION - NE GEORGIA

Immediate opening in established practice for PSR-36 or experienced doctor who is ABPS qualified or certified. Hosp./ASC privileges available. Excellent opportunity for partnership or purchase of practice. Contact dpm1942@hushmail.com

ASSOCIATE POSITION - HUDSON VALLEY REGION, NY

Unique opportunity for the right person! We are a high-volume, diversified, multi-office practice utilizing state-of-the-art modalities. Ample growth opportunities for a personable and highly-motivated DPM. Please forward CV to: healthyfeet4ever@yahoo.com

ASSOCIATE POSITION - MANHATTAN

Busy upper east side podiatry practice seeking In-Network Podiatrist. Please email CV toinstitutebeaute@aol.com "Attn: Podiatrist" in the subject line.

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

SPACE AVAILABLE- NYC & LI

SUB LEASING TIME on MRI (NYC)

.31 tesla extremity MRI in state-of-the-art midtown Manhattan office location. Lease time on magnet in compliance with the Stark laws. This magnet is the only one that will be accepted by Medicare and all other insurance as of 2012. Why not bill out for your own MRI's??? Email today dri@myfcny.com.

PM News Classified Ads Reach over 12,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,500 DPM's. Write tobblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

PRACTICE FOR SALE - BOSTON AREA

8 miles north of Boston with sublease available in a modern medical building. Presently working 3 days/week, grossing $300,00 annually with easy potential for full-time. All office and podiatric equipment, instruments, digital x ray, furniture, etc. are included. Turn-key operation. Please e mailfootdoc71@aol.com or call 781 279-2332.

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. Preferably a Spanish-speaking podiatrist. Contact me at Podocare@aol.com

ASSOCIATE POSITION – IOWA CITY AREA

Established podiatric clinic looking for an associate to join our team, 4 offices located around the greater Seattle, WA area. Great base salary, benefits and friendly work environment. Please send resume toseattlefootdoctor@yahoo.com

ASSOCIATE NEEDED - SO. CAL

Position open for podiatry associate in Southern California. Applicant must be highly motivated and available for long term employment. This practice is extremely busy and requires a hard work ethic and desire to practice in a group practice environment. Excellent salary and benefit package offered. Please e-mail resume to footcare4all@aol.com

ASSOCIATE POSITION - NE GEORGIA

Immediate opening in established practice for PSR-36 or experienced doctor who is ABPS qualified or certified. Hosp./ASC privileges available. Excellent opportunity for partnership or purchase of practice. Contact dpm1942@hushmail.com

ASSOCIATE POSITION - HUDSON VALLEY REGION, NY

Unique opportunity for the right person! We are a high-volume, diversified, multi-office practice utilizing state-of-the-art modalities. Ample growth opportunities for a personable and highly-motivated DPM. Please forward CV to: healthyfeet4ever@yahoo.com

ASSOCIATE POSITION - MANHATTAN

Busy upper east side podiatry practice seeking In-Network Podiatrist. Please email CV toinstitutebeaute@aol.com "Attn: Podiatrist" in the subject line.

SPACE AVAILABLE- NYC & LI

SUB LEASING TIME on MRI (NYC)

.31 tesla extremity MRI in state-of-the-art midtown Manhattan office location. Lease time on magnet in compliance with the Stark laws. This magnet is the only one that will be accepted by Medicare and all other insurance as of 2012. Why not bill out for your own MRI's??? Email today dri@myfcny.com.

EQUIPMENT FOR SALE - CLASS FOUR LASER

I have a class four pain laser for sale. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net

PM News Classified Ads Reach over 12,500 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,500 DPM's. Write tobblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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