The Voice of Podiatrists

September 04, 2006 #2,680 Editor-Barry Block, DPM, JD

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Pedorthists are “Pharmacists of Shoes”: TX Podiatrists

Podiatrists and other doctors often refer patients to certified pedorthists. "These people might be called the 'pharmacists of shoes.' Most foot problems will be resolved with the correct shoe," said Dr. Dwight L. Bates, a podiatrist at the University of Texas Southwestern Medical School in Dallas.

"In 2006, there are going to be some changes in the certifying process for pedorthists where it will be tied into a two-year associate's degree," said Dr. Douglas P. Murdoch, director of podiatric medicine and the surgery residency program at Scott & White, which is affiliated with Texas A&M University System Health Science Center in Temple.

Source: Susan Kreimer, The Dallas Morning News

CLEAR and WTN Join Forces to Establish Wound Care Database

Scholl’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science and telemedicine pioneer Wound Technology Network (WTN) have joined forces to develop a novel system for tracking wound care across the country. The program, known as the Wound Outcomes and Utilization National Database Service (WOUNDS) provides real-time monitoring of patient-level and healthcare utilization-level outcomes for patients from coast to coast.

“We are enormously excited about the potential for this service,” noted David G. Armstrong, DPM, PhD, Professor of Surgery, Associate Dean and CLEAR’s Director. “We now have the ability to − in real time − query a database and find out who is healing, who isn’t, and how much that costs. This is going to provide information that will not only help industry and academia, but will definitely help direct the right therapies to the right patients at the right time.”

Query: Source for CO2 Laser

Does anyone know an affordable store/website for a portable/economical CO2 laser to use for warts/porokeratosis..

R. Benjamin Nikravesh, DPM, Los Angeles, CA

Query: Sclerosing Injection Protocol

What is the protocol for a patient that has already had a series of injections? She was pain free for 6 months and the symptoms have now returned. The patient refuses surgical intervention of any kind. Is it appropriate to perform the sclerosing injections again?

Teresa J. Burtoft, DPM North Andover, MA, tburtoft@comcast.net

Query: E/M Denials and the Unlisted Casting Code

Blue Cross Blue Shield and United HealthCare have been denying and/or requesting additional information when CPT 29799 (unlisted casting code) is used with an E/M service code. They deny the E/M code stating it is part of the unlisted code...and then request information for CPT 29799. Any suggestions for reimbursement on both procedure codes?

Todd Horak, DPM, Homewood, IL

Response: When a procedure is billed on the same day as an E/M service (generally, with exception of an initial patient encounter), the E/M service is considered to be part of that procedure...unless there is an attached modifier to indicate that the E/M service is "significant and separately identifiable" from that included in the procedure allowance. This would be true from any procedure code, including an unlisted code such as CPT 29799. You would need to apply a "-25" modifier to the E/M code. Most payers, prior to reimbursement consideration, would want you to submit an explanation (copy of the medical record should do) to clarify the unlisted code.

As an unlisted casting code, CPT 29799 can represent anything in that category. Therefore, it is not unreasonable for the carrier to want information to determine exactly what was performed to see if the service is 1) covered under the plan's guidelines, 2) medical necessary and reasonable, 3) included in any other submitted code, and 4) able to be determined to have a value that can be reimbursed.

You can speed up the process by submitting all that documentation with the claim whenever an unlisted code is billed and suggest a CPT code of similar complexity and its pricing to help the carrier price the service you rendered.

By the way, it would be rather premature on the part of either Blue Cross Blue Shield and United HealthCare to deny an unlisted code stating it was part of the E/M service allowance without actually having information detailing what the unlisted code truly represents. I would include a statement to that effect in my letter of appeal/explanation to those payers.

Tony Poggio, DPM, Alameda, CA

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

RE: Time For EMR? (James M. Petko, DPM)
From: David E. Gurvis, DPM

EMR will – in the future – hold many benefits for both physician and patient. In the future, your records will electronically follow you anywhere and everywhere, probably initially from an Internet-connected databank, and finally, on a chipped charge card-like device. I think that for the time being, however, EMR is not for solo practices.

There are many truly good products out there, but, they don’t talk to each other. Records in program A cannot interface or transfer to program B. If you see a patient who was last seen by another provider who has EMR, and you need records, you won’t get a CD to read, but instead, a print out. Worse yet, in my experience, each EMR, using its own company and end-user templates, will be more or less readable to you. An example is one of my local hospitals. The ER sends me a patient, along with the ER -EMR record. 8 pages long, nearly indecipherable.

Someone in the government thinks forcing EMR on us is a wonderful idea. As long as they don’t have to pay for it, that is. The most recent figures I have seen from the government, for through implementation of EMR and the associated “extra” privacy steps needed to implement this, is nearing $60,000 for a small group. Because of this, they have relaxed the Stark rules to allow a partial “gift” of a program from your local hospital to help defray the cost.

David E. Gurvis, DPM, Avon, IN, Deg1@comcast.net

RE: Time to Drop Out of Insurance Plans (Bob Kornfeld, DPM)
From: Neil H Hecht, DPM, Bob Kornfeld, DPM}

Both Dr. Kornfeld and Dr. Shavelson have some very important and timely suggestions in this regard. I urge my fellow podiatrists to carefully consider whether giving away services for less than fair value is appropriate.

Just thought I'd add some of my thoughts to this discussion. First, I have evaluated my 1099's from the various plans. Then I contacted the smallest payers (usually small HMO contracts) and began negotiations to either increase my fee schedule or resign from the panel. I have been successful in this about 50% of the time, especially when I discover that I am the ONLY podiatrist with whom they are contracted!!

As a bell weather, I regard 100% of Medicare to be the minimum that I will accept. After all, most of the private payers charge premiums far greater than Medicare, and try to pay less than current Medicare fees. Obviously, they can afford to increase their payments for professional services, but only if this is demanded. Unfortunately, if they refuse, I must call their "bluff" and reject the contract. Recently, I did so for United Health Care after 3 successive increasing offers still did not measure up to local area Medicare rates.

As an aside, revenues cannot be "made up" by volume if the cost of providing each service is at a loss. This seems to be the case with Medi-Cal in California (Medic-Aid). I have not accepted "straight Medi-Cal" since 1982 because of this fact, and I don't understand why any doctor would do this except on a charity basis.

Neil H Hecht, DPM, Sherman Oaks, CA, drhecht@sbcglobal.net

I am simply overwhelmed at the enormous amount of e-mail I received on this subject. It could be in the hundreds. I will respond to all of these e-mails, but it is going to take some time. There is, however, one thing I would like to make public because it speaks loudly for the situation many find themselves in. Of the hundreds of e-mails I received, I have yet to read one that speaks of a possible solution to the managed care fiasco or how we can unite the profession to "walk away" from managed care. Instead, every single e-mail asks me what other businesses I am involved in and how can I help them to do the same.. Something is dreadfully wrong with this picture!

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

INDEPENDENT CONTRACTOR POSITION AVAILABLE- GREATER ST. LOUIS MISSOURI AREA

Immediate full-time position available in the long term care field. One of the largest providers of long term care servicein the midwest. Corporate support with 10+ years in the business. Competitive compensation and assistant provided. Fax resumes to (636)281-1808.

ASSOCIATE POSITION -ARIZONA

Seeking an experienced podiatrist versed in all aspects of podiatry with current AZ License. The right person will join as a salary associate leading to partial ownership in a group practice. Podiatry practice is well established over 25 years, successful and a large volume in the Phoenix metro area. Position available immediately. Email CV and inquiries to: pprac4sl@cox.net

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

ASSOCIATE WANTED – SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice needs part-time podiatrists to assist in surgical cases and patient volume. Email response to podfootdocs@aol.com

PRACTICE FOR SALE – SOUTH FLORIDA

Miami-Dade and SW Ft. Lauderdale, well established surgical practice for sale. This one has everything. Surgery, Orthopedics, Pediatrics, Trauma, ER, General Podiatry. Participates in all local and national managed care plans. $850,000 but will discount depending on amount up front. Mature, serious inquires with business experience preferred. Email response to podfootdocs@aol.com

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

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