The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 03, 2008 #3,338 Editor-Barry Block, DPM, JD

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IN Podiatrists Report Success with Alcohol Injections for Neuromas

The relatively painless procedure of giving an injection of alcohol in the foot has been "out for a few years," according to Dr. Michael Nirenberg, podiatrist for Crown Point's Friendly Foot Care, but like anything else new in medicine, he starts slowly by testing the waters to see how people do with it. Nirenberg has been giving the shot for several years but has seen a growth in its use because of its good results. A new podiatrist at Friendly Foot Care, Dr. Michael G. Lacey, has performed the procedure for the last seven years in Chicago. The doctors stress that the injection is not for everybody.

Dr. Michael Nirenberg

"Some people may still need a small surgical procedure," Nirenberg said. "Others don't need a shot or surgery, but may require a custom-made arch support. But for those who do -- it's better than surgery." Patients typically receive four to seven injections over a period of four to six weeks. Those treated don't have to stop their activities or miss a day of work. Patients also need not rest or soak their feet afterwards, they can drive straight home and go for a jog.

The shot itself, which "kills" the neuroma, only takes a few seconds. "We'll use a diagnostic ultrasound to confirm where the neuroma is at, but a lot of times we don't need it," Nirenberg said. He said most insurance companies cover the injection because they recognize the benefit of having a person get a shot as opposed to surgery.

Source: Robert Earnshaw, Northwest Indiana Times [9/1/08]

ID Podiatrist Runs Successful State Fair Eatery

Mama and Papa Leo’s, located across the midway from the commercial buildings at the Eastern Idaho State Fair, has been bringing family specialties to fairgoers since 1992. Kert Howard, a podiatrist from Pocatello, is 20 percent of the family-owned business. Howard said family members started the stand which serves pizza, sandwiches and apple dumplings as a way to fund yearly family vacations. To date, Mama and Papa Leo’s has sent about 35 members of the family to Disneyland twice, San Diego, and the Oregon coast.

Dr. Kert Howard

The counter is staffed by a host of cousins, sisters-in-law and grandchildren.“Just about everybody has worked here at some point,” Howard said. Howard said food vendors at the fair pay a percentage of their sales to buy a spot on the midway. Mama and Papa Leo’s has been in its current location for the past eight years.

Howard and his wife Louise have been married 34 years and have six children and 11 grandchildren. When he’s not in the office or preparing for the Eastern Idaho State Fair, Howard said he enjoys waterskiing. The fair is always an exciting time for Howard and his family and the food booth keeps them busy.

Source: Idaho State Journal [9/1/08]

Healthcare Groups Oppose 5010 and ICD-10 Timelines

CMS's newly proposed timeline for the implementation of ICD-10 diagnosis codes and 5010 transaction standards is facing fierce opposition from many groups in the healthcare industry. America's Health Insurance Plans (AHIP), the American Medical Association (AMA), the Blue Cross and Blue Shield Association (BCBSA) and the Medical Group Management Association (MGMA) are just a few of the more than 40 national health industry organizations that have come together to call the proposed timeline "unworkable."

The organizations also contend that, to comply with HIPAA, the 5010 transaction standards need to be fully implemented before switching to ICD-10 codes. They estimate that it will take at least three years to implement ICD-10 codes once the 5010 standard is completed. The current medical code set, ICD-9, has been used for nearly three decades. And while MGMA and BCBSA agree with the need to implement the new codes, they say CMS's planned compliance date of Oct. 1, 2011, for ICD-10 and April 1, 2010, for 5010 is not enough time. ICD (i.e., International Classification of Diseases) codes are developed by the World Health Organization, but countries are able to modify the code sets to meet their particular needs.

Source: Health Plan Week [9/1/08]

Negotiate Your Way to Success

You will sidestep many potential conflicts if you keep this guideline in mind: Separate the issue from your opinion about it. If you remember that, you will enter into negotiations with a calm and reasonable manner that will contribute to a successful outcome.

Key: When you express an opinion rather than a fact, acknowledge that by beginning with a phrase like “I think… “In my opinion…” People are more likely to listen to your views if you present them calmly and in a reasonable manner.

Source: Adapted from Dealing With Other People Powerehomebiz.com

Query: Digital Answering Machine

Does anyone know of an inexpensive digital answering machine (1 or 2-line) that has the ability to record 4 different outgoing messages. Each message would be used at different times. e.g.. lunch, after hours, weekends (different message for covering doctor, as we have a 2-DPM practice).

Barrett E. Sachs, DPM, Plantation, FL

Query: E/M Service Levels & Multiple Complaints

If a patient presents with multiple problems, and the work-up and treatment of EACH problem individually justifies a CPT 99212 level, does the cumulative work-up and treatment of all of the problems "bump up" the E/M service level to a CPT 99213?

Arden Smith, DPM, Great Neck, NY

Response: There is no automatic bump up. Every visit is unique, and the level of E/M service must always justified by the chart note. E/M service determination allows for multiple conditions, separate examinations, and intensity of medical decision-making.

CMS has updated their guide for evaluation and management services in July, 2008. You can download a free copy by clicking here.

This guide will help you determine which level E/M code to bill.

Mark Schilansky, DPM, Catskill, NY

Codingline subscription information can be found here

RE: Medicare Open Door Forum on DME Wednesday September 3, 2008
From: Paul Kesselman, DPM

CMS will be holding a free telephone Open Door Forum on the DME Accreditation issue for physicians. An announcement is expected on how CMS plans to re-process applications which were initially rejected due to a lack of facility accreditation. CMS is also expected to announce a decision on the requirements for facility accreditation for physicians (including podiatrists) and other licensed health care providers.

This is free and all are urged to listen in and phone in your comments.

Phone-in information: Dial: 1-800-837-1935 & Reference Conference ID: 61231070 Time: 2-3:30 Eastern Daylight Time September 3, 2008

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: Obligation to Treat Medicaid Patient (Name Withheld)
From: Jeffrey Kass, DPM

Since the posting was from "name withheld", we don't know the state in which the doctor practices. In New York, podiatrists were removed from the Medicaid system many years back. (Medicaid as a secondary can be paid at 20% of the 20% rate.)

I think children under 18 can still be seen. Due to this fact, it is not the insurance which won't pay well, it is that you won't get paid at all. If someone calls my office with Medicaid, I respond by telling them no private podiatrist accepts Medicaid as a primary insurance and I inform them their insurance is accepted by hospital clinics.

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

RE: Dangers of Speaking to Government Investigators
From: Michael M. Rosenblatt, DPM

In an article from Ohio State University (PM News 9/1/08] , a recommendation was made:" ... to help make the investigative process more efficient for both sides by explaining what records are relevant and dissuading officials from seizing records that aren't..."

I don't think this advice applies to individual doctors or small clinics. A large university or group practice setting is vastly different from smaller venues. The issue is blame-finding. Executives for a large university or hospital will not (typically) be arrested or charged with Medicare or Medicaid fraud. In almost all situations, if blame is found in large venues, monetary fines and potential (temporary) loss of accreditation might occur. But Government usually limits those damages and punishments because of public health considerations.

Not so the private doctor or small clinic. As soon as you start speaking to investigators, there is a real danger of "spilling" your comments into areas where you should not be disclosing. If more than one investigator or auditor is present, their express purpose is to potentially testify to the nature of your verbal disclosures.

These people are not your friends. They may smile and be cordial. But they get rewarded for collecting money from you, and if necessary seeing you go down in flames. They are the personification of your worst nightmare. The less you say, the better. You have to co-operate with them, but you do not have to disclose to them verbally. Simply tell them that you will "provide written answers to their written questions."


Michael M. Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net

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