The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

September 29, 2007 #3,053 Editor-Barry Block, DPM, JD

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NV Podiatrist Opens Pedicure Salon Adjacent to Practice

The nature of diabetes can prevent wounds from healing quickly. If bacteria gets into a cut, a dangerous infection can follow. Las Vegas podiatrist Jodi Politz says cuts and blisters aren't all she's seen from patients who have been to pedicurists that use improperly sterilized or shared equipment.

Dr. Jodi Politz

She explained, "I've seen everything from infected in-grown toenails, athlete's foot, warts. I've seen cuts from the curette blades from cutting off the hard skin from corns and calluses or cracks in their hills.

Dr. Politz recently opened a pedicure salon adjacent to her practice. She believes pedicures are beneficial in helping diabetics maintain healthy feet. After all, neglected feet that are dry and scaly can also be problematic. But there are milder forms of buffing and filing for the diabetic. And if the pedicurist doesn't ask, they need to be told by the client about their condition.

Source: Paula Francis, KLAS-TV CBS 8 (NV) [92/27/07]

Retired Army Podiatrist Carries on Service to Country

After 21 years of active service, Douglas R. Beirne, DPM, Lt. Col (Ret) proudly continues to serve his country. For the last 16 years, he has served as a contracted podiatrist at the Brooke Army Medical Center in San Antonio, TX. Beirne, a 1970 graduate of The California College of Podiatric Medicine was the first Army podiatrist to be residency-trained in a program run by Lawrence Harkless, DPM. “The Army even paid for my board certification”, said Beirne.

Dr. Douglas R. Beirne, Lt. Col (Ret)

“The opportunities in the Army as a podiatrist are limitless,” explains Bierne. “One can train in such courses as advanced life support, trauma, and even mountaineering. You can even learn to skydive, if you so desire. All the medical equipment we use is state-of-the-art, including digital x-ray machines, computer-assisted rehabilitation environments, and electronic medical records. We work side-by-side with orthopedists, neurologists, and other specialists.”

Owners of NJ Firm Charged with Bilking Podiatrists

A Pennsylvania couple that ran a Red Bank investment firm was arrested this morning and charged with stealing more than $500,000 from podiatrists who were their clients. Jeffrey Lafferty, 39, and Vincella Ross, 38, were charged in a five-count indictment handed up in Trenton yesterday by a state grand jury, Attorney General Anne Milgram said. They are charged with conspiracy, money laundering, securities fraud and other counts.

Jeffrey Lafferty

The couple ran Lafferty & Partners LLC, which specialized in providing wealth management for podiatrists and was affiliated with a member organization for podiatrists, authorities said. Lafferty and Ross allegedly spent the money investors gave them on a home in Green Lane, PA, and for expenses including airline tickets, hotel rooms and mortgage payments, authorities said.

Lafferty was permanently barred from the securities industry in 2004 after the New York Stock Exchange determined he stole client funds while working at a brokerage firm, authorities said.

Source: Greg Saitz, Newark Star Ledger [9/27/07]

Query: Request for Unwarranted Disability Certification

If a patient has had surgery or trauma I have an idea how long they can't do their particular job. How do I handle "my heel is really sore, take me out of work"?

Doug Dickson, DPM, Syracuse, NY

Editor’s Comment: PM News does not provide legal advice. As a podiatric physician, you are charged with responsibility of exercising your clinical judgment and rendering appropriate advice and treatment to your patients. When a patient requests a note requiring that you certify that he can’t work when your clinical findings don’t justify such a determination, you need to convey your prognosis accurately. Tell the patient, “I wish I could help you, but my clinical findings cannot support that statement and I would be committing fraud if I misrepresented your condition.

Query: Arthroereisis vs. Arthrodesis

There is a procedure that our docs do for which there is no code assigned in CPT. It is an arthroereisis. We bill the procedure using the unlisted code, CPT 28899. We have had two of these denied by insurance companies as experimental. Would it be appropriate to bill CPT 28725-52 for any future arthroereisis? And, if yes, would it be appropriate to rebill the two already denied as corrected claims and use the CPT 28725-52?

If the answer is "no" to using CPT 28725-52, would we then tell the patient they are going to be responsible for the surgery, which of course they most likely can't afford, and they won't get an operation they need because we are simply not going to continue doing free surgeries?

Cheryl Christensen, Everett, WA

Response: CPT 28899 (unlisted procedure, foot) is the only regular CPT code to use for subtalar arthroereisis. It is not correct to submit CPT 28725 (subtalar arthrodesis) for the procedure, even if a "-52" modifier (reduced services) is appended.

Some private insurers have written polices that deny subtalar arthroereisis as a non-covered experimental procedure. For example, it is denied by Regency, the Blue Cross carrier for Idaho, Utah, Oregon and Washington, and Wellmark Blue Cross and Blue Shield See:

http://www.regence.com/trgmedpol/surgery/sur144.html

http://www.wellmark.com/e_business/provider/medical_policies/policies/Subtalar_Arthroereisis.htm

I suggest that you get written confirmation of coverage from the payer before performing a subtalar arthroereisis. If you cannot get written authorization/coverage approval, advise the patient, in writing, that the service may very well be non-covered, and, if they would like to proceed, they agree to pay your fee (this can use a form similar to Medicare’s advance beneficiary notice).

Mark Schilansky, DPM, Catskill, NY

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RE: Podiatric Biomechanics: Was Schuster Right After All? (John McNerney, DPM)
From: J. David Skliar, DPM

In the September issue of Podiatry Management Dr. McNerney paid tribute to the late Dr. Schuster. Unfortunately, a number of his comments are not accurate.

I taught biomechanics at the NYCPM with Dr. Schuster from 1962 through 1978 We analyzed the work of Dr. Merton Root, which I was then teaching (along with Dr. Justin Wernick) at the New York School, and compared it with Schuster’s concepts of lower extremity function. Although it was later stated that “a debate raged, pitting the East Coast (Schuster) verses The West Coast (Root) philosophies in the field of podiatric biomechanics” no such event ever occurred between Drs. Schuster and Root.

Dr. Root arrived at his conclusions mostly from academic sources; Dr. Schuster’s conclusions were mostly derived from clinical sources. Their differing approaches, however, yielded almost identical concepts in regard to classification and mechanisms of lower extremity problems.

The only aspect of diversion is in the casting technique for the required orthotic. The Root suspension technique yields the forefoot-rear foot relationship. The Schuster semi weight bearing technique yields the forefoot-rear foot relationship and the leg influence. No additional posting is required in the Schuster technique for extrinsic influences.
Of great significance is his direct method of determining the required correction for any and all areas of influence rather than calculating through multiple steps in the Root examination protocol. The end result of both examination techniques yields the same orthotic corrections. This was originally detailed in the article referenced by Dr. McNerney, “Origins and Implications of Frontal Imbalances of the Leg and Foot”, in the “Yearbook of Podiatric Medicine and Surgery, 54-67, 1981”.I have a modified copy of this masterful article that I used for teaching purposes. I can e-mail this to anyone interested as well as the benefits of Schuster’s casting and orthotic materials choices.

J. David Skliar, DPM, Spring Hill, FL, dskliar305@bellsouth.net

RE: Answering a Subpoena (David Gutierrez, DPM)
From: Richard Boone, Esq.

In addition to the cogent comments of the Learned Editor, you should be aware that you still have some potential personal exposure to suit in matters like this. This could happen in either of two ways:

First, the manufacturer of the cream could try to obtain testimony sufficient to permit it to implead you as a third-party defendant, asserting that you are also responsible for the patient's injuries and therefore should be liable to contribute to any judgment obtained by the patient. In lawyer-speak, that's a "third-party action for contribution or ndemnification." The bottom line of such an action, if it succeeded, would be a judgment against you, probably in favor of the manufacturer.

Second, the deposition might yield testimony which would permit the manufacturer to try to place ALL of the blame for the patient's injuries upon you. If the statute of limitations hasn't expired, this could force the plaintiff to add you as an additional defendant. This is a VERY common tactic in these situations and the plaintiff's lawyer wants to represent you at the deposition so that he can control you and, hopefully, prevent this from occurring. [That's another reason not to let the plaintiff's attorney advise you at the deposition.]

In these situations we usually recommend that you inform your malpractice carrier immediately and request them to provide you with counsel for the deposition. Most reputable carriers are happy to do this and will hire an attorney for you at no cost to you. This usually does not count as a claim against you for underwriting purposes unless, and until, an actual claim is filed against you in court.

The bottom line, as the Learned Editor notes, is that you should ALWAYS go to these depositions represented by your own attorney.

Richard W. Boone, Sr., Health Care Attorney, Fairfax, VA, RWBoone@aol.com

ASSOCIATE POSITION – VIRGINIA

Must have Virginia license. Requires 24 to 36 month Residency. Permanent position with potential buy in. Includes all phases of Practice excluding nursing homes. Competitive Salary and Benefit package. Please send Resume including salary requirements and availability date to needpodjob@yahoo.com

ASSOCIATE POSITION – CENTRAL FLORIDA, ORLANDO AREA

Exceptional opportunity for qualified candidates. Associate position available in a rapid growing, well established multi-office practice. Applicant must be bilingual in English and Spanish, well trained (PSR-24 or more). Compensation includes excellent salary plus incentives and benefits. Please e-Mail CV, letters of reference to CF_resume@hotmail.com

PODIATRIST WANTED – RIVERHEAD, NY

Podiatrist needed in Riverhead, NY for an Article 28 Diagnostic and Treatment Facility with unlimited growth potential. Multidisciplinary site with much cross referral. Great opportunity. Call 631-981-1333. lakechiropllc@optonline.net

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 -- www.homephysicians.com

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@comcast.net or fax to 410-486-2049 or call Dr. Herbert Rosen at 410-580-0255

ASSOCIATE POSITION – MANHATTAN / QUEENS

Associate wanted for busy and growing Manhattan/Queens office. Full-time, PSR-24 minimum, straight 30% income with possibility of partnership in 1-3 offices. Call 917 880-6639 or e-mail hansfeet@aol.com

ASSOCIATE POSITION – CINCINNATI, OH

This is your once in a lifetime opportunity to join one of the largest, most successful practices in the United States. Start immediately with a six-figure income. If you are motivated, and knowledgeable in practice management, your income is unlimited. Please fax resume to: 513-577-7261

P/T ASSOCIATE POSITION - QUEENS, NY

10 yr old practice seeks motivated, surgically-trained individual . Fax CV with hours available to (718) 458-0053.

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

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