The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

September 08, 2007 #3,035 Editor-Barry Block, DPM, JD

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Congratulations to Neil Schleffler, DPM of Baltimore, MD, our weekly survey contest winner, who has won a copy of Bones and Cartliage by Brian K Hall (Value$104) .

Oral-B Professional Care 9100

This week's prize is an Oral-B Professional Care 9100 Triumph by Braun (Value $89). To enter the contest, complete the survey at www.podiatrym.com and send us question #45, along with your name and address. Be sure to vote in the survey for the 2008 inductees in the PM Podiatry Hall of Fame. All entries are eligible for the grand prize of a one-week Windjammer Caribbean Cruise.

Kids Feet Can Outgrow Shoes Fast: NY Podiatrist

Podiatrist Dr. David High says kids’ feet can grow a size or two in a matter of weeks, so don't rely on old sizes as a guide. Have their feet measured. He says, "When they grow you can see pants become too short, but you don't see that in their shoes, and kids often won't say anything when their shoes are too small."

Dr. David High

You should take a pair of tights or the socks kids will routinely wear during the fitting so you know for sure how the shoe or sneaker will fit. Also, old shoes can tell how your child wears shoes, so bring them along as well. Don't buy shoes too big hoping your child will grow in to them. That can lead to falls and a lack of support.

Too often children wind up with foot problems unnecessarily. Dr. High says, "We have kids come in with problems and the parents are embarrassed when the shoes are not fitting and that's the problem."

Source: WHEC-TV (Rochester, NY) [9/4/07]

Obesity Can Lead to Foot Amputations: TUSPM Podiatrist

Does carrying excess weight have any serious consequences for our feet? I was stunned to discover that there are more than 100,000 lower-limb amputations annually in the U.S. and more than half of them might have been prevented. Many overweight people literally squeeze the blood out of their feet, causing tissue death because not enough blood is getting to the area, explained Howard Palamarchuck, a podiatrist at Temple University.

Dr. Howard Palamarchuck

Tissue death leaves you unable to feel your feet, and that's where the danger lies, said Palamarchuk. "You could step on a tack and not know it's there." He once removed a child's toy that was embedded in a patient's foot. Foot insensitivity leaves your foot vulnerable to cuts and blisters that could lead to ulcers. An undiagnosed ulcerated foot may get infected, a condition sometimes requiring amputation.

"Walking exerts one-and-a-half times your body weight [onto your feet], and running places about four times that amount of pressure from your toes to your neck," Palamarchuk said.

Source: Kimberly Garrison, Philadelphia Daily News (PA) [9/6/07]

Medicaid Payments are Low and Varies by State

A doctor in New Jersey who sees a Medicaid patient for 15 minutes gets paid $20.60. The fee in Pennsylvania is $27. Doing the same work for a Medicare patient pays $60 or more. It would be no surprise then if area doctors shunned Medicaid patients in favor of those covered by Medicare.

That is what worries Public Citizen, a consumer-advocacy group. In a report released yesterday, it compared fees paid to primary-care physicians by Medicaid and Medicare. Medicaid rates are set by states and vary widely, while federal Medicare rates are more similar.

New Jersey and Pennsylvania landed in the bottom five states for Medicaid payments. In a comparison of 11 procedures, New Jersey's Medicaid payments were less than a third of Medicare's and Pennsylvania's were 42 percent less.

"There are a number of consequences," said Annette Ramirez de Arellano, a Public Citizen researcher who cowrote the study. "One is that a lot of practitioners decide it's not worth their while to see Medicaid patients." Others, she said, limit their Medicaid patients.

Source: Stacey Burling, Philadelphia Inquirer, {9/6/07]

Query: Implant Removal

I will be removing a BioPro great toe implant (possible O/M).This is the one with the stem that is serrated to prevent it from coming out.

Biopro Implant

The company had some suggestions about how to remove it, but no literature. I was wondering if anyone has done this and has some suggestions?

Bruce Lebowit, DPM, Baltimore, MD

Query: Punch Biopsy of Nail Bed

I did a nail avulsion, followed by a punch biopsy of the nail bed. How is this coded?

Barry Wertheimer, DPM, Torrance, CA

Response: It depends if the nail avulsion was incidental to the biopsy. If you had to do the avulsion to get to the nail bed, then I would bill the biopsy of the nail unit as CPT 11755.

Paul Kinberg, DPM, Dallas, TX

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

RE: Accommodative Device Ulcer on Malleolus (Elliot Udell, DPM)
From: Multiple Respondents

I have seen this etiology often, and especially with wheelchair-bound patients. Solution is a soft-lined boot followed by a "T-Bar" boot on the base of the heel (perpendicular to the heel). This is available from Alimed and works great:

T-Bar Boot

David Weiss, DPM, Richmond, VA, podmed3@msn.com

I have used in my Foot and Ankle Comfort Footwear Centers a product from Pedifix. A short low profile sock with gel built in the malleolus area. Gelsmart is the manufacturer and Pedifix carries it.

Steven Goldstein, Sole Dimensions, steveng555@aol.com

A good Multi-Podus splint will have an "outrigger", a bar that flips out from the back of the device that will prevent the foot from rolling in that direction. This will prevent your patient from applying pressure to the malleolus.

Neil M. Scheffler, DPM, Baltimore, MD, FeetOne@aol.com

You can order a PRAFO to apply to the foot and leg. It is usually fleece lined and has and aluminum heel protector that keeps the heel off of the bed. I have used it successfully for relieving pressure off of the heel ankle and the foot. It is usually well tolerated.
Robert Bondi, DPM, Lee’s Summit, MO, Robert.Bondi@Foot-Docs.com
I've had good luck keeping the pressure off of a lateral malleolus to heal an ulcer using a Waffle boot. This boot is lightweight and basically a balloon that shields bony prominences. Since I don't use many of them, I usually refer the patient to www.ehob.com to order it directly. Compliance has been very good, generally speaking, since it's easy to take on and off. It's also very light and easy to sleep in.

Andrew Schneider, DPM, Houston, TX, AJSDPM@aol.com

IN-NETWORK PODIATRIST WANTED – MANHATTAN

Busy Manhattan Office (2 locations) needs IN-NETWORK PODIATRIST, Can start immediately-Do not reply unless you are in with all plans Plz respond to gelus07@yahoo.com

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City. Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

INDEPENDENT CONTRACTOR WANTED - KANSAS CITY, MO

Immediate opening for podiatrist as independent contractor. Flexible schedule. All phases of podiatry. Knowledgeable and dedicated support staff. Must be compassionate and personable physician with good podiatric skills. Wonderful place to live and work. Please email CV and letter of interest to: Dr.Fine@FineFootCareCenter.com

PODIATRY ASSOCIATE WANTED – YONKERS, NY - ASAP

P/T-3 days per week for busy Yonkers and White Plains location-
Surgical training a plus, but not mandatory. Please fax resume to 9149939031 or call 914 325-9198 for more details.

ASSOCIATE POSITION SANTA FE, NEW MEXICO

Immediate opening for PSR 24/36 individual in three office practice. We are looking for an ethical, hard working, well trained Podiatrist. Partnership available. Please Fax CV to sfpodiatry@aol.com

Privileges at Certified Surgical Facility With MRI- NY & LI

Certified operating rooms which qualify under the new NY Patient Protection Law (which will require accreditation for in-office procedures) are available in Manhattan East 60th Street and Plainview, LI. Rent or Lease Extremity MRI. Turn-key operation no investment needed. Call 516 433-4447 for information or e-mail podo2345@aol.com

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-773-292-4800. Fax 773-342-4201 -E-Mail sschneider@homephysicians.com -- www.homephysicians.com

ASSOCIATE POSITION – LOUISVILLE, KY

Immediate opening for multi-office podiatric practice specializing in general podiatry, high volume orthotics, surgery, and advanced wound care. Looking for a motivated, surgically trained podiatrist. Partnership opportunity. Competitive starting salary, benefits, and pension. Please submit: CV, letter of intent and references to: jbroyles23@yahoo.com

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