The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 13, 2008 #3,347 Editor-Barry Block, DPM, JD

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CA Podiatrist Discusses Etiology and Treatment of Plantar Fasciitis

Injuries to the plantar fascia and connected tissues are the most common foot ailment in athletes over 30. Many people, feeling the first stabs of heel pain from an injured fascia, switch to softer, looser athletic shoes, thinking that will corset the foot and correct the problem. It does the opposite. “Adding soft cushioning beneath your feet increases instability,” says Douglas Richie, a podiatrist in Seal Beach, CA, and a former president of the American Academy of Podiatric Sports Medicine. The unsupported foot rolls too much, and the tight tissues get pulled even tighter.

Dr. Douglas Richie, Jr.

If stretching doesn’t provide relief, more drastic measures might be required, including a brace like the one Green uses. Custom orthotics, which raise the heel and reduce pressure from a tight Achilles tendon, can also help, but they’re pricey (often $400 or more), and some research has indicated that they’re no better in the long term for treating plantar fasciitis than the gel inserts you can buy at any Walgreens. A reputable sports podiatrist can tell you if your degree of injury calls for custom orthotics.

Two additional treatments for intractable heel pain have shown promise: one uses a radio-frequency probe to break up scar tissue along the fascia, and another merely deadens the nerves in the heel. “Plantar fasciitis is almost always self-limiting,” Richie says, meaning that it forces you to stay off your foot until it heals. “This technique allows the patient to get through the pain until the condition finally resolves.”

Source: Gretchen Reynolds, New York Times [9/11/08]

OH Podiatrist Turns Hobby Into a Form of Artistry

John Smothers, owner of Catawba Woodworks, recently won the “Best in Show” award at the Medina Fine Arts Show. The blue ribbon hangs in his shop beside his West Catawba Road home. Nearby stand a few end tables, including the console table which won the award in Medina.

Dr. John Smothers in his home shop

Smothers, a retired podiatrist, said he's been a woodworker for several years. "I always have. I mean, even when I practiced, I always had this shop," He said. "I'm just handy and I like putting stuff together and now it's a creative thing." He's tried to keep from letting the new award go to his head. "I know what artists are. I'm not an artist," he said.

Source: Catharine Hadley, Port Clinton Herald News [9/10/08]

CMS Calls for Transition to ICD-10 Codes in 3 years

Physician organizations are concerned that a federal agency's proposal to implement an expanded set of diagnostic codes by Oct. 1, 2011, does not give doctors enough time to get up to speed. The deadline would occur only 18 months after national electronic transaction standards are upgraded to accept the new codes.

The Centers for Medicare & Medicaid Services, in an Aug. 22 proposed rule, called for physicians, hospitals and health plans to make the transition to the 10th revision of the International Classification of Diseases code sets standard. ICD-10 has roughly 65,000 diagnostic codes, about five times as many as ICD-9. For example:

ICD-9 CODE: 896.2: traumatic amputation of foot, complete or partial, bilateral

Comparable ICD-10 Codes: Specify one of the following:
s98.011: complete traumatic amputation of right foot at ankle level
s98.021: partial traumatic amputation of right foot at ankle level
and one of the following:
s98.012: complete traumatic amputation of left foot at ankle level
s98.022: partial traumatic amputation of left foot at ankle level

Before physicians, hospitals and others can use the new code sets, they must upgrade their electronic transaction systems to be compatible. CMS, in a separate proposed rule, set an adoption deadline of April 1, 2010, for these transaction standards.

Source: Doug Trapp, AMNews [9/8/08]

Hiring Tip

Rehire former employees whenever possible. This conveys to all employees that "This must really be a great place to work if these people want to come back."

Source: Lin Grensing writing in Office Systems

Query: CMS 10-year Record Retention Requirement

I have just been informed by one of my HMO contractors that new (2006) regulations from CMS require doctors to maintain their patient records (including all financial records, federal tax returns, contracts, etc.) for ten (10) years. 42 C.F.R. 422.504 is cited as the regulation. Has the readership been informed of this? How have the readers adjusted their records retention procedures to comply? And, finally, who at CMS augmented the previous 6+ year requirement? Does this seem necessary and sensible, or simply arbitrary? Thoughts?

Neil H Hecht, DPM, Sherman Oaks, CA

Editor’s comment: PM News does not provide legal advice. The exact language of the statute is:

"(d) Maintenance of records. The MA organization agrees to maintain for 10 years books, records, documents, and other evidence of accounting procedures and practices..."

(2) HHS, the Comptroller General, or their designees may audit, evaluate, or inspect any books, contracts, medical records, patient care documentation, and other records of the MA organization, related entity, contractor, subcontractor, or its transferee that pertain to any aspect of services performed, reconciliation of benefit liabilities, and determination of amounts payable under the contract, or as the Secretary may deem necessary to enforce the contract.

Query: Coding the Excision of a Sinus Tract

My physician performed a partial excision of 5th phalanx bone. He also excised a "sinus tract" in the 4th interspace.

I have the code for the excision of bone, but I have never heard of excising a sinus tract. The patient is not a diabetic. She had an infected corn that would not heal with local care. Can anyone help me with this?

Amy Ellis, Evansville, IN

Response: I would code the ostectomy of phalanx as CPT 28124 (ostectomy, partial, phalanx, toe).

If the excision of sinus tract was a component of the skin incision to expose the bone, it would not be billed separately. If, however, a separate incision was made for the removal of sinus tract skin-to-capsule, consider CPT 28092 (excision of lesion, tendon, capsule, toe) or CPT 28090 (excision of lesion, tendon, capsule, foot), depending on the specifics of the incised tract. I think this would be reasonable for the procedure you've described.

Howard Zlotoff, DPM, Camp Hill, PA

Codingline subscription information can be found here

RE: Arthroplasty of Proximal Phalanx (Sandy Schustek, DPM)
From: Multiple Respondents

Arthroplasty of the IPJ of the hallux creates instability of this joint. The resulting deformity is hyperextension of the IPJ which can readily create a neuropathic ulcer on the plantar surface.

Frederic C. Spector, DPM, Savannah, GA, spec18608@aol.com

Dr. Schustek said that he removed a hallux interphalangeal sesmoid 10 years ago. It looks to me that you have another one there on the film you submitted. I would try removing that before doing an arthroplasty.

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

It still looks like there is an accessory ossicle under the base of the distal phalanx. I would do an axial sesamoid view of the hallux before removing the head of the phalanx.

Neal Frankel, DPM, Chicago, IL, drnrf@aol.com

RE: Verapamil for Plantar Fascia Nodules (Jim Clark, DPM)
From: Multiple Respondents

PDL labs has a prepared topical verapimail patch. They have a patent on their delivery system. You have to order directly through them and they can give you information for the patient to try to submit for insurance but I do not know how successsful that is. Alternatively, I have used compounding pharmacist to make verapimil topical 40 mg/ml in PLO gel, apply bid-tid. You don't get the patented delivery system ,so theoretically you may be reducing efficacy.

I have personally had mixed success, but I like to use it prior to a radical fasciotomy.

Robert M. Przynosch, DPM, Asheville, NC, rprzynosch@hotmail.com

RE: False Testimony by Expert Witness (John Doolan, DPM)
From: Multiple Respondents

My own personal malpractice attorney years ago, when I asked this same question, said to let it go, 'cause getting into a mud wrestling match with a "pig" is pointless, you get dirty and the pig has fun!!!

William F. Keyes, DPM (retired), Carmel, IN, drbillpod@sbcglobal.net

I do not represent the Florida Board of Podiatric Medicine, but as a member for 2 terms, have had experience seeing this type of complaint against DPM's. Unfortunately, expert opinions are just that, opinion, and therefore cannot be proven to be lies or fraudulent. In the context of this forum, I agree that exposing this behavior may be a good step to shine a light on the shadows that persist in our profession.

Beth Pearce, DPM, St. Augustine, FL, drfootmagic@aol.com

Editor’s comment: We agree with Dr. Pearce that an expert has a right to an opinion, even if it is a wrong one. The issue arises as to the consequences of providing (under oath) contradictory testimony.

PARTNER WANTED - COLORADO

State-of-the-art practice with EMR and digital x-rays, in our physician-owned Medical Office Building and Surgical. Focus on Sports Medicine, pediatric and adult flatfoot, bunion surgery, and homeopathic care. Great opportunity for self starter. Please send CV and letter of introduction to: greg@stilwellfeet.com.

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for full-time podiatrist in a multi practice location in the Chicagoland and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent practice associate leading to partnership opportunity for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes.Top hospitals. Fax CV with references to 703-491-9994

PRACTICE FOR SALE – CALIFORNIA

Practice is available immediately for sale in sunny Capitola, CA. The office space is available for lease or month-to-month for $750/month. The practice has a loyal patient base which is mostly home visits and skilled nursing facilities in Santa Cruz county. The practice can be moved to another location or merged with an existing practice. Asking price $35,000.00. dtarsky@gmail.com

IMMEDIATE POSITION AVAILABLE TN/GA

We're in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in Southeast Tennessee/North Georgia. Must have Tennessee or Georgia license. Please reply via email to ikraus@sprynet.com

ASSOCIATE POSITION - CALIFORNIA

Looking for OUTSTANDING 3-year residency-trained Dr. July 2009. This is the first Concierge odiatry practice in the U.S. Applicant MUST have been in top 10% of their class, Have excellent residency training and personality to match, {the total package}. This practice is about excellence and service. Contact. Ivar E. Roth DPM/MPH, ifabs@earthlink.net 949-650-1147

MINNESOTA - IMMEDIATE OPENING

Well-established practice with 8 offices in the Minneapolis metro area seeking a highly motivated PSR 24/36 trained podiatrist for a full time or part time associate position. ABPS certified, qualified or eligible preferred. Excellent income potential with benefits including health insurance, malpractice insurance, relocation expense, association dues, license fees, hospital dues, continuing education expense. Possible buy-in or buy-out in future. Heavy emphasis on surgery and sports medicine with minimal RFC. Please e-mail CV to footandankledoc22@hotmail.com

PRACTICE FOR SALE - MINNESOTA

Minnesota-2 well established prime office locations for sale in the Minneapolis suburbs. Great income potential with large MD referral base .Can purchase one or both offices together. 175k gross/ each office. Owner will help with transition. Please e-mail minnesotadpm@live.com

ASSOCIATE POSITION – ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings available. If interested fax curriculum vitae to 312 225-9366 or e-mail feetwork@aol.com

ASSOCIATE POSITION – VIRGINIA

Well-established 2-office private practice in central Virginia, completely automated, modern, full scope of foot and ankle care. Position requires hindfoot/ankle reconstructive and trauma surgery experience. External fixation experience helpful. ABPS BQ/BC. Competitive base salary, incentive plan, malpractice, health insurance, retirement plan, vacation & other benefits. Partnership option available. Forward CV and letter of intent to: admin@vfasa.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-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

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