The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

September 23, 2009 #3,656 Publisher-Barry Block, DPM, JD

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Women Need to Follow 3-Hour Rule With Heels: TX Podiatrist

Whether it's stilettos, block heels or wedges, podiatrist Dr. Tyson  Green says feet pay the price. "With high heels, you put more pressure on the forefoot area and the ball of the foot, so a lot of people will get what we call metatarsalgia or pain underneath the ball of the foot," said Green. When your toes are in this position, up all day like that, you put a lot more pressure on the ball of your foot, and that's why you'll have a lot more pain," said Green.

Dr. Tyson Green

Green advises women to go by the "three-hour rule" - if you'll be on your feet for more than three hours, choose lower heels with plenty of room in the toe-box area.

Source: Jean Enersen, King 5 News [9/21/09
 

CMS to Stop Payment on Claims for Services Ordered by Non-Enrolled Providers    

CMS is cracking down on claims for services that are ordered or referred by physicians who don’t participate in Medicare, even if the services themselves are Medicare-approved.

Starting October 2009, Medicare will have a new claims edit to prevent payment for services (e.g., consultations, MRIs) that are ordered by physicians and non-physician practitioners (NPPs) who aren’t enrolled in Medicare, according to Medicare Transmittal 510 (Change Request 6417).

According to Medicare Transmittal 510, physicians and NPPs must have an NPI to bill Medicare. But having an NPI doesn’t mean you can bill Medicare. HIPAA established NPIs to uniquely identify healthcare providers in standard transactions. In many academic medical centers, residents receive NPIs because they write orders for patient care. An NPI merely lets providers enroll in Medicare, which is necessary for billing purposes. To actually bill Medicare for Part B services, physicians and NPPs must complete CMS enrollment Form 855I (or 855R if joining a group practice).

Source: Nina Youngstrom, Report on Medicare Compliance

Learned Behavior

Do your patients show up too early or too late and expect to be taken on the spot? Do they avoid paying their co-pay or deductible? Is it okay (in their minds) when they just don’t show? If policies are not being followed, it could be due to a weak system. Once you allow their behavior to override your policy, they’ll think it’s okay to continue doing it. Next time, take control. Be firm, but be polite and let them know that breaking the rules is no longer acceptable.

Source: Lynn Homisak, PRT, SOS Healthcare Management Solutions, LLC - 1-866-832-6767 - www.soshms.com

Editor's Note: PM News is proud to present excerpts from Meet the Masters. Full versions of these interviews will appear in Podiatry Management Magazine.

Bret Ribotsky: What is your favorite surgical procedure?

Stanley Kalish: As surgeons, we like to say no operation is our favorite operation because when it comes to the disease and the patient, we always should favor the patient and not the disease. We cannot get so myopically focused on the technique and the cookbook nature of an operation to realize that we are doing it on a patient. So, whatever we can, we try not to do surgery. With that in mind, my favorite operation is a Charcot reconstruction.

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is PM Hall of Fame podiatrist, Harry Goldsmith, DPM,  founder of Codingline.com You can register for this event  by clicking here.

Query: Rupture of Plantar Fascia ICD-9 Coding

Due to the vagaries of ICD-9 coding, I recognize that the following clinical presentations all share the same diagnosis code, ICD-9 728.71:  Plantar fasciitis, Plantar fibromatosis, Plantar fascial strain.

So, if a patient presented with acute rupture of the plantar fascia (with hemorrhage, neuropraxia, etc.), do I also code it as ICD-9 728.71? If not, what is the appropriate ICD-9 code for a rupture of the plantar fascia?

Rick Horsman, DPM , Olympia, WA

Response: While it doesn't say fascia, specifically, sprains and strains include: avulsion, hemarthrosis, laceration, rupture, sprain, strain, tear of joint capsule, ligament, muscle, or tendon.

So, if you don't like ICD-9 728.71 (that includes traumatic plantar fasciitis), I would suggest ICD-9 845.19 (sprain and strains of foot, other).

Paul Kinberg, DPM, Dallas, TX

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

RE: Alarming TENS Complication (Frank DiPalma, DPM)
From: Jon Segal, DC

I assure you that both of the instances cited by Dr. DiPalma are purely coincidental in nature. If proper instructions are followed in the use of a TENS unit, there will be absolutely no side-effects as a result of its use.  Having said that, it is not customary for a patient to use a TENS unit for an uninterrupted 24-hour period. It should be limited to a use of 60 minutes per session with a minimum rest time of 60 minutes before using again.

In regard to the alarm, there is no continued electrical conductivity that occurs after a patient turns off the unit, so it would be impossible for that to be the cause of the alarm. TENS units, even if worn into a store, would not transmit an electrical response capable of setting off an alarm. It is most likely a magnetic label that is not clearly identifiable that may be embedded into a piece of clothing that would be the cause of the alarm. Most store alarms are activated by magnetic frequencies, as opposed to electrical frequencies. I have worn a TENS unit in thousands of stores, and even through airport security without ever activating an alarm.

Jon Segal, DC, Boynton Beach, FL, drsegal@serenityhealthsystems.net

RE: The Barry University Yucatán Children's Project
From: G. Dock Dockery, DPM
 
I am asking for your help.

This is one of the most important humanitarian fundraisers you can support. For the past 13 years, more than 6,000 underprivileged crippled children in the Yucatán Peninsula of Mexico have received medical treatment, including life-altering surgeries, as a result of Barry University's Yucatán Crippled Children Project. In addition, more than 75 physicians and 50 residents have volunteered over 30,000 hours to the project, which will complete its 13th year of operation at a celebration and pediatric seminar held in Merida, Mexico Nov.19-21, 2009.

The Yucatán Project is....

Editor's Note: Dr. Dockery's extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=28983&start=1
 

RE: 2010 Medicare Cut? (Mark Levine, DPM)
From: Barry Block, DPM, JD

It should be noted that both the House and proposed Senate health reform bills would stop the 21.5% cut for 2010 and the House bill would eliminate the SGR formula that is causing the annual cuts. This has been reported numerous times in the APMA eNews, APMA News, and APMA Alerts, as well as in PM News.

Barry Block, DPM, JD, Forest Hills, NY bblock@podiatrym.com

RE: Reviewing EOBs (Hal Ornstein, DPM)
From: Steven H. Goldstein, DPM

Over my 30 years of practice, there was a policy that was always adhered to in my office. All EOB's were to be personally reviewed by me. No matter how good your staff may be, there are decisions that were needed to be made by me. Whether something was paid correctly or not, whether to adjust something, or to re-bill the insurance company for something they processed incorrectly. I found this to be especially true when an EOB for multiple surgical procedures was involved. The insurance company may deny a procedure that you are entitled to receive reimbursement for. Thousands of dollars can be lost by not reviewing your EOB's. I agree with Dr. Ornstein 100% here.
 
Steven H. Goldstein, DPM, Royal Palm Beach, FL, stevefootdr1@yahoo.com

RE: Obama’s Healthcare Plan (Pat Caputo, DPM)
From: Richard Gosnay, DPM, Narmo L. Ortiz, Jr., DPM

Medicare most certainly is not anything like a Ponzi scheme. Saying so because people pay into it and receive benefits from it at different times is like claiming that a 747 is a chicken because it has wings.
 
Rather than wasting time debating such nonsense as death panels, Ponzi schemes, and Hawaiian birth certificates, I suggest we all heed the wise advice of Dr. Levine. A huge reduction in our reimbursements is only a few months away. And this is not some talking point from a talk-radio program. This is real. And it will be catastrophic.
 
Richard Gosnay, DPM, Danbury, CT, glabroushead@gmail.com

Great comments by Drs. Boylan and Bennett. When we get Congress to give ALL Americans the same healthcare benefits that they (Congress) enjoy (which I'm sure most of them will not be able to afford on their own), then we can talk about healthcare reform.
 
It does not matter what political party you belong to, I highly recommend that you read Glenn Beck's new book, Common Sense, and you will realize what is really wrong with the actual system as a whole.
 
Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com
 

EQUIPMENT FOR SALE - AMFIT ORTHOTIC MANUFACTURING MACHINE

Includes digitizer, fabricating mill, new updates have been added and enough supplies to pay for the machine in the long run. At $200 per pair = about $28,000. Selling FOR $25,000, O.B.O, F.O.B. americanfoot@email.com or 405-733-2783.

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Looking for board certified/board eligible ABPS associate to join a multi doctor practice with 2 offices. May lead to eventual buy-in and purchase. Must have minimum 2-year residency and comfortable with rearfoot procedures and diabetic care, ER call. Must be dependable, honest, ethical individual. Send cover letter and CV to familyfootcenter@earthlink.net

ASSOCIATE POSITION (SURGICAL) – CONNECTICUT

Connecticut Surgical Group is seeking a Board-Certified podiatrist to add to our Surgical Podiatry division based in Central Connecticut. This podiatrist will provide all aspects of Podiatric care with a focus on wound and surgical care to a well-established patient base. We require PSR-36 training and board certification or eligibility, excellent surgical and wound care skills, a strong focus on providing compassionate care to our patients, and the ability to work as part of a team in a group practice setting. To apply please visit our website . EOE

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

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 a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

ASSOCIATE POSITIONS - INDIANA/OHIO

PrimeSource Healthcare is a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created an immediate need for traveling, independent contractors of podiatry services in Indiana/Ohio. Earn between $175k and $225k per year. E-mail CV to kwright@pshcs.com. Visit us at pshcs.com.

ASSOCIATE POSITION - CHICAGO AREA

Well-established, state of the art medical-surgical podiatry practice seeking well-trained motivated individual to work full-time with future partnership possible. Will start with full schedule. PSR-24 a minimum. Email resume to Howard4624@gmail.com

ASSOCIATE POSITION – NYC

Expanding Joint Commission Accredited Surgical and state of art medical podiatry practice seeks part-time ABPS Qualified/Certified podiatric surgeon on two weekdays in Flushing, Queens and on Saturday's in Midtown, Manhattan. Email CV and cover letter to EcksteinDPM@AOL.com

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

LOCUM TENENS POSITION – PHOENIX, AZ

Locum Tenens position available in West Valley Phoenix office beginning September 15th. Salary negotiable. One to two days a week in a friendly and casual office. Please direct all inquiries to drlaurel@cox.net

EQUIPMENT FOR SALE - ORTHOTIC FABRICATION SYSTEM

Amfit Orthotic Insole Fabrication System with Footfax SL Contact digitizer- For Sale Machine, Laptop, rolling bag, small inventory of shoes, insoles, all cords, parts and hardware Asking $8k. OBO! Please contact Jeff at Jhunt@psbank.net for further information, pictures.

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION – CENTRAL FLORIDA

Growing practice east coast of central Florida looking for full or part-time associate willing to buy into practice. PSR 24/36 Please contact: pfk4@yahoo.com.

PM News Classified Ads Reach over 11,500 DPM's and Students

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