The Voice of Podiatrists

Serving Over 14,601 Podiatrists Daily

September 14, 2013 #4,869 Publisher-Barry Block, DPM, JD

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Congratulations to William A Sachs, DPM of Shrewsbury, NJ, winner of a free registration for the American Academy of Podiatric Practice Management's (AAPPM) 2014 Midwinter Conference, February 27-March 2, 2014 at the Pittsburgh Airport Marriott, (Value $645). We encourage you to participate in this year's important annual survey at podiatrym.com/survey Completing this anonymous survey provides us with valuable data, which we will publish in the February 2014 issue of Podiatry Management. The survey will close on September 16th.

FL Podiatrist Discusses Treatment of Puncture Wounds of the Foot

Your preschooler follows the older kids excitedly as they build their tree fort—until she steps on a nail and shrieks. The nail doesn't look rusty. What should you do? "Even a nail that looks clean can carry tetanus," says Dr. Alan MacGill, a podiatrist in Boynton Beach, FL. Most kids have had vaccines and boosters, but a 3-year-old is almost due for the next one, "so get to urgent care or the ER to get it addressed."

Dr. Alan McGill

Two other concerns: A puncture brings in dirt, debris, perspiration, and maybe sock and shoe fragments that can cause infection. "Urgent care or the ER can flush out the wound better than you can, and they'll probably give her antibiotics as a precaution," MacGill says. Also, "the foot is a complex structure—with tendons, ligaments, bones, nerves—and it's hard to see how far the damage goes," he says. Better to have an expert assess it.

Source: USA Today [9/14/13]

MI Podiatrist Joins Staff of Botsford Hospital

George E. Gopoian, DPM, has joined the medical staff at Botsford Hospital in Farmington Hills. This podiatric surgeon has joined his father, George P. Gopoian, DPM. Dr. Gopoian graduated from Rosalind Franklin University of Medicine and Science - Dr. William M. Scholl College of Podiatric Medicine in North Chicago, IL. He then completed the three-year podiatric medicine and surgical residency at Botsford.

Dr. George E. Gopoian

In service to his community, Dr. Gopoian has performed free foot screenings, which included a thorough foot and ankle examination, assigning a risk assessment, and recommending a treatment plan, if needed. He is a member of the American Podiatric Medical Association, the Michigan Podiatric Medical Association, and the American College of Foot and Ankle Surgeons.

Source: Beth Montalvo, West Bloomfield Patch [9/13/13]

NY Podiatrist Wins Singing Competition 

On Friday, September 13, 2013, Robison Oil Corporation presented a check for $1,000 to Dr. Kathy Reilly Fallon for winning 1st Place in the Robison Idol Singing Competition.

Dr. Kathy Reilly Fallon with Robinson co-presidents David Singer (L) and Daniel Singer (R)

Dr. Reilly Fallon donated the prize to Heavenly Productions Foundation, a 501c-3 not-for-profit charity, which she founded. This money will be used to purchase 200 more backpacks for the charity's yearly backpack outreaches for children in need.

OH Podiatrist Named Best of Finlay

Podiatrist Dr. Trena Reed has been selected by the Findlay Award Program for the 2013 Best of Findlay Award in the podiatrist category. Reed's practice was honored for enhancing the image of small business through service to customers and the community.

Dr. Trena Reed

Dr. Reed is involved in various community projects. She served on a Program for Assertive Community Treatment designed for several Indian reservations. She is board certified by the American Board of Podiatric Surgery  and is affiliated with St. Regis Medical Center and Blanchard Hospital.

Source: The Findlay Courier [9/13/13]

My patient, a 42 year old female, presented with edema bilaterally, which began 3 months ago and does not change during the day or night. BP and Doppler assessment of circulation were normal. Her MD has done blood tests for: liver enzymes, kidney, thyroid etc., all were normal. Due to the edema, there is stiffness in joints: ankle, MPJs, etc. Recently a rash has started. She has worn support hose with limited success. She does not take medicines or have any known allergies.

Bilateral constant edema with rash

Any ideas that I could pass on to patient to ask her MD to perform (tests/further assessments)? I suspected Lyme disease, but it is rare in Toronto. There was no history of tick bites or the characteristic bullseye.

Query: Automated Reminder System for TRAKnet

"No-Shows" and late cancellations devastate a work schedule. I am looking for automated patient reminder systems that interface with TRAKnet. Please comment if you have experience with a company.
 
Larry Lloyd, DPM, Fishers, IN

Query: Piezogenic Pedal Papule Diagnosis 

What is the diagnosis code for piezogenic pedal papules?

Mark C Baxter, DPM, Kingsport, TN
 
Response: I'd recommend ICD-9 709.8 (other specified disorders of skin).

Joan Gilhooly, CPC, CHCC, Lebanon, OH

Codingline subscription information can be found here

APMA Members: Click here for your free Codingline Silver subscription

RE: Recurring Lesions
From: Don Peacock, DPM, Steven J. Kaniadakis, DPM
  
This case is thought-provoking and certainly challenging. In the photo, hypertrophic scarring exist at the previous surgical sites.  Additionally, the  left foot appears to have a giant cell tumor in the plantar aspect of the 3rd toe. Providing an x-ray would be helpful in accessing whether the proximal phalanx head is plantar-flexed or if this is scarring/giant cell.  

Treatment will require very fastidious attention to detail, paying homage to hurdles set by previous surgeries. My recommendation would be to perform a through and through minimally invasive osteotomy of the proximal phalanx to allow the toe to slightly float dorsally. Preceding the osteotomy, reduce the phalanx head/fusion site by percutaneous ostectomy. Then redo your flap and cross your fingers.

Don Peacock, DPM  Whiteville, NC, peacockdpm@gmail.com

Perform lesion-marked x-rays. Use a little tip of a paper clip and tape it over the lesion. It is likely these are transfer lesions from adjacent toes or metatarsals. Compare your clinical presentation to the radiographs before planning your surgery. This is especially the case in flatfoot conditions or reafoot to forefoot relationship is unequal in what appears to be a normal longitudinal arch. Remember, if underlying pathology is more cartilage, it not as obvious on your x-Rays. However, use your index of suspicion and fine analysis. Do not waste your patient's time with pads and things.

Steven J. Kaniadakis, DPM, St. Petersburg, FL stevenkdpm@yahoo.com

RE: CT Podiatrist Receives 3 Year Sentence and $134K Restitution (Michael Rosenblatt, DPM)
From: Paul Kesselman, DPM, Richard A. Simmons, DPM

Aside from DME audits, reviewing claims for total or partial nail avulsions really is a slam dunk for carriers. Dr. Rosenblatt is very much on target when he suggests that DPMs benefit insurance carrier auditors by not documenting proper procedure(s) when it comes to nail removals (CPT 11730).

The following documentation should be placed in the patient's chart:
1) A consent form - If the patient cannot sign this for whatever reason, that information should be placed in the chart;
2) Notation of the name and dose of injectable anesthetic (unless you document neuropathy);
3) Removal of a substantial portion of the nail (total border from distal to proximal, or the entire nail)
4) Written post-op instructions should be provided and signed by the patient (give your office patients a copy) or write these orders in the NH or hospital chart.
5) The use of digital photography, while not mandatory by most MCR LCDs and private insurance carriers, is highly recommended.
For some MCR carriers it is mandatory for lessor toenails 2-5.

Paul Kesselman, DPM, Woodside, NY , drkesselmandpm1@hotmail.com

In the excellent letter written by Dr. Rosenblatt concerning the billing for CPT 11730 part of the procedure that he stated was necessary for correct billing required that the surgeon to “Remove a section of nail that includes eponychium.”

In Florida, our LCD 29318 does not require removing any of the eponychium, but it does require “the entire length of the nail border to and under the eponychium." This is not a procedure that I perform with any great frequency (probably less than once every sixty days); however, I have never done this procedure where it involved such extensive removal of the matrix region as would be required with excision of the eponychium. Is the excision of the eponychium a new requirement by CMS?

Richard A. Simmons, DPM,  Rockledge, FL  RASDPM32955@gmail.com

RE: CT Podiatrist Receives 3 Year Sentence and $134K Restitution
From: Ira Baum, DPM

These articles are sickening. Most responses focus on two issues: 1. Fraud and 2. Aggressive (or overly aggressive) post-payment audits. Fraud hurts every podiatrists and is fuels the fire for overly aggressive post-payment audits. No one can condone that. Overly aggressive post-payment audits negatively affect the doctor-patient relationship, increase physician psyche on practicing defensive medicine, and cause a reaction from third-party payers (not only the federal government). The response adversely affects the provision of healthcare, and potentially dangerous outcomes for patients.  Regulations can be made that are impossible or impractical to follow. The enforcing, or not enforcing these types of regulations is a method of control and intimidation. 

Drilling down the issue to services in nursing homes or geriatric patients, Medicare guidelines are antiquated, unjust, and need revision.  It's simply unfair for those podiatrists who provide these needed service, and for the patients who need the care, but don't meet the regulatory requirements. Contact your legislative representatives and explain why these services are needed and why the regulations need to be more humane. Unfortunately, it is the only process that may lead to a resolution.
 
Ira Baum, DPM,  Miami, FL, ibaumdpm@bellsouth.net

RE: Nothing Can Keep "California Girls" Off the Beach (Keith Gurnick, DPM)
From: Martin V. Sloan, DPM

Whether following strapping, casting, or surgery on the extremity, Castguard works fantastically in keeping the extremity dry. It's available at CVS Pharmacy and other outlets. No more walking down the hall with a Baggie full of water after a shower.

Martin V. Sloan, DPM, Rockwall, TX, martinsloan@me.com

RE: The World's Most Comfortable Shoes?

Who says all high heels are bad for your feet! (Photo: John M. Craig)

Submitted by Dr. Howard Fox

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, Midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 12/24 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977.

ASSOCIATE POSITIONS - LOS ANGELES, CALIFORNIA

Looking for reliable, honest, and motivated podiatrists to join our group to assist with house calls to patient’s home residences and  group facilities. Candidate must be willing to drive throughout the San Fernando Valley and the greater Los Angeles area. Part/Full time, flexible hours, independence, great compensation! Please email resume to: homefootcare@hotmail.com

ASSOCIATE POSITION - UPSTATE NY 

Busy well, established multi-specialty practice in Upstate New York looking for an additional podiatric physician. Work with our three podiatric physicians that have a combined practice experience of over 100 years.  Very busy practice with a high volume of surgical cases. Working with three local hospitals. Foot, Rear Foot & Ankle Surgical procedures. Outstanding opportunity, Excellent salary and benefits. Advanced wound care. Broad based referrals. Opportunity for partnership. Electronic medical records. NYS Finger Lake Region. University atmosphere. Recreational, Social, Educational Opportunities. Please send CV to associateinfoot@yahoo.com or fax 607-723-1567.

ASSOCIATE POSITION - FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Base salary, percentage, benefits including 401K. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

PODIATRIST WANTED - MN

We are seeking highly motivated, experienced and enthusiastic associate’s to join our successful, well-established practice, we currently have 6 locations and plans to add more, throughout Minnesota. The practice incorporates surgery, wound care, sports medicine and general podiatry. This opportunity offers an excellent salary, bonus and % commission with benefits, also an opportunity to become an associate down the road. PPMR/PSR required. Email CV to: kpepple@midwestpodiatrycenters.com

ASSOCIATE POSITION - CT (GREENWICH, FAIRFIELD AND NORTH HAVEN)

 Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info www.greatfootcare.com. Send resume to Dr.Kassaris@yahoo.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Very busy, two location group practice seeking a full-time, self motivated and hard working podiatry associate. Competitive salary and benefits are offered. Please email CV to: footcare4all@aol.com

ASSOCIATE POSITION - CENTRAL FLORIDA

Associate position for busy practice in Central Florida. Competitive salary with complete benefit package available. Please send resume to cmedders@atlanticpodiatry.com

ASSOCIATE POSITION - MARYLAND/SUBURBAN DC

Busy 3 doctor practice seeking highly motivated, hard working associate. PSR 24/36 trained with opportunity for partnership.  Hospital privileges, ER call, in office ASC, etc. Will consider residents completing their program to begin work July 1, 2014 or sooner. E-mail CV to: mlmltm@aol.com

ASSOCIATE POSITION – SOUTHWEST, FL

R U a SuperStar? PM&S36 or PSR24. Comfort W Recon surgery. Hardworking w/o Ego. Excellent salary, benefits, chance at partnership. ABPS BC/BQ required RRA. Send CV, recommendations, and why you are a superstar. email: mny1029@gmail.com

ASSOCIATE POSITION - LONG BEACH, CA

Immediate opening available for a DPM with 2 or 3 year residency . Prefer some work experience, but with the right qualifications and can-do attitude, will consider newly out of residency. Full-time needed, must be willing to work hard and provide excellent care. We have a very fast paced, busy practice and lots of great patients. Please send your resume/c.v. and a brief note citing what you are looking for in your career to: Mil2RN@gmail.com.

ASSOCIATE POSITION - ARIZONA

Immediate opening for a full time podiatrist in a rapidly expanding multi-office practice in the suburbs of Phoenix, Arizona. Compensation is performance based with patients scheduled from day 1 but must be entrepreneurial and an ambitious individual who can provide excellent care and expand already existing patient base. Should be familiar and competent in podiatric surgery, biomechanics, trauma, PRP, wound care, and ultrasound diagnostics. Send CV to:  ArizonaFootAnkle@gmail.com

ASSOCIATE POSITION - PENNSYLVANIA

Associate Wanted for busy, multifaceted podiatry practice in Chester and Delaware counties, Pennsylvania. Seeking PSR-24/36 trained podiatrist for full/part time associate position. Two offices and hospital privileges. Send CV and letter to: 123bunion@gmail.com

ASSOCIATE POSITION - NYC METRO AREA

Must participate with HealthFirst, Affinity, Fidelis health plans (2 of 3 OK). Preferably on staff at Bronx or Manhattan hospitals or surgicenters. Excellent opportunity for quick partnership. email CV to: rrranch7@yahoo.com

ASSOCIATE POSITIONS - CHICAGO

Chicago practice has 2 part-time house calls positions available. You'll make at least $3,000 per months working your own hours. Full logistical support provided. Great moonlighting  opportunity for 2nd and 3rd year residents -IL license required; we'll provide malpractice insurance . Contact: dpms2@hotmail.com

ASSOCIATE POSITION - PLAINFIELD, IL

Associate wanted for established practice in the suburbs of Chicago, self motivated and patient oriented a must. We will provide you with a state of the art facility, experienced support staff, $100,000+ salary, 401K with match, bonus and flexible hours. Please forward cover letter and CV to: chrisbaileydpm@sbcglobal.net or fax 815-230-4925.

ASSOCIATE POSITION AVAILABLE - MANHATTAN

Excellent opportunity to join a Midtown Park Ave practice. Surgery only. You need to do forefoot surgery well. Must be ABPS board qualified or certified. CV to mailto: nealblitz@yahoo.com

PRACTICE FOR SALE - MIAMI, FL

Established Medicare base, no HMO's with tremendous room for growth. 30 year practice, current doctor relocating. Office renovated and fully equipped with digital x-ray. Ready for new practitioner or group to take over. Perfect satellite, 2nd office or great for new grad looking to start out. dpmoffice10@gmail.com

PRACTICE FOR SALE - CONNECTICUT

Well-established, 35-year-old reputable practice/condo with approx 2,500 Square ft. Grossing approximately $450,000. Outside Hartford area. All phases of podiatry. Contact:  drsch52@hotmail.com

EQUIPMENT FOR SALE - 2012 PINPOINTE FOOTLASER 

FDA-cleared treatment for toenail fungus. Used only 30 times. Doc closing practice. Paid 66K asking 47K or best offer. Buyer pays shipping from Arizona. Email rmfleck@cableone.net or call Robin at 928-443-0943 Thursday or Fridays 8-5.PST.

EQUIPMENT FOR SALE -  FOX DIODE 1064nm LASER FOR SALE

Like new, under warranty, excellent results for onychomycosis, verrucae, spider veins. Portable, many extras. $9800. 727-586-3668 or 727-321-3100.

EQUIPMENT FOR SALE - DIOWAVE 15 WATT, PORTABLE 980 LASER

This is a used multiple function laser, plantar fasciitis, Achilles tendonitis, joint pain. nerve pain, post surgical, warts, toenail  problems, two-year plus warranty, MSRP: $25,000. E mail Dr. Zuckerman at: footcare@comcast.net for questions and pricing.

PM News Classified Ads Reach over 14,500 DPMs and Students

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