The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 04, 2008 #3,365 Editor-Barry Block, DPM, JD

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IL Podiatrist is First to Lecture at IFFAS Brazil Meeting

Dr. Lowell Weil, Jr., a partner in the Weil Foot & Ankle Institute, recently became the first podiatric surgeon ever to be an invited speaker and a panel moderator at the prestigious Triennial Foot & Ankle meeting of the International Federation of Foot & Ankle Societies (IFFAS).

Dr. Lowell Weil, Jr. at IFFAS

This meeting held in September 2008 in Sauippe, Brazil was attended by 850 orthopedic foot & ankle specialists from all over the world.

Weil Jr. Lectured on "A unique method for repair of the plantar plate in conjunction with the Weil Osteotomy through a dorsal approach" and "Medium term results of the Calcaneal Scarf Osteotomy for the treatment of flexible flatfoot."

Bakotic is Partner in New Podiatric Pathology Lab

Bako Podiatric Pathology Services has announced that they will begin operations with Oct. 13th as the targeted "go-live" date. Bako, co-founded by Bradley Bakotic, DPM, DO will be a dedicated anatomic pathology lab dedicated to serving the podiatric profession. "From a professional perspective, I have never been more excited,” said Bakotic. “This move allows us to take our service and support to an entirely new level."

Dr. Bradley Bakotic

Dr. Bakotic began his career as a podiatric pathologist in 2001 as the nation's only podiatrist with board-certification in skin pathology, and formal training in oncologic surgical pathology. He has founded outreach programs, focusing on podiatric physicians, within both a large general pathology group and a major corporation. As a principle partner in Bako, this is his first initiative that will be wholly customized to the needs and welfare of podiatric clientele and their patients.

Medicare Won’t Pay Hospitals for "Conditions That Could Reasonably Have Been Prevented"

Medicare no longer will pay hospitals for the treatment of certain "conditions that could reasonably have been prevented" under a rule that takes effect this month. Under the rule, hospitals cannot charge Medicare beneficiaries directly for treatment of those conditions. The rule likely will affect hundreds of thousands of the 12.5 million hospital stays for which Medicare pays annually.

The rule likely will not result in a major reduction in Medicare costs, but will serve as a example of efforts by the Bush administration to reform the system used to reimburse healthcare providers in the U.S. Critics maintain that the current system pays providers based on the quantity, rather than quality, of services provided to patients. According to economists, the rule might lead to changes that shift the focus of the system to prevention and chronic disease management and discourage the use of unnecessary treatments.

Source: American Health Line [10/1/08]

Take These Steps to Catch a Thief – Part 1

Something - money, equipment, or supplies - is missing, and while you have a hunch, you are not certain who the culprit is. Before you start making accusations you may come to regret, slow down.

Suppose you have reason to suspect a certain staffer. Before you start a conversation, make sure that you are prepared to hear a denial. Can you accept the possible damage to your working relationship? If you’re not prepared for that outcome, it’s not worth having the conversation.

If, however, you’re committed to the conversation, say something like: “I have a concern that I hesitate to bring up. But I know if I don’t, it will interfere with our relationship. Can we talk about it?” When you received permission to proceed, share your facts carefully and without passing judgment. (continued tomorrow)

Source: Adapted from To Confront a Thief

Query: Amfit CAD/CAM

I am considering the purchase of the Amfit CAD/CAM mill carving station with the foam scanner to have better control over my diabetic inserts, for my DM shoes. Has anyone purchased this system? And, if so, are you happy? If not, are there any other systems that are better, or that could be recommended?

Q. Solomon, DPM, Marble Falls, TX

Query: 2 Partial Matrixectomies 1 Toe Coding

I am researching the coding of matrixectomies for my podiatry group. Upon review, I am leaning toward billing CPT 11750-22 when our physicians perform two separate matrixectomies on the same digit.

Per CPT, "when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier -22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (i.e., increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required)."

Based on this definition, a medial and lateral matrixectomy on the same toe should meet modifier "-22" definition as it is twice the work, takes twice the time, and has twice the risk for adverse reaction. I have tried billing two separate matrixectomy codes for two separate matrixectomies on one digit to commercial payers without success - even after appeal. It appears that using a single matrixectomy code with a "-22" modifier might be more effective for receiving the correct reimbursement for the service rendered.

Terri Phillips, CPC, Tulsa, OK

Response: Although it may be considerable more work, I would disagree with your recommendation under current coding standards. A nail is a nail, with no right/left sides anatomically. The nail matrix is the bed where the nail is actually produced by the human body, no matter how narrow or how wide.

I cannot think of any anatomical part where there would be a distinction to the size of the body part that would define additional payment other than an oversized panniculus during abdominal surgery - and, quite frankly, most physicians are denied additional payment for that 'extra work.' Until there is a modifier that identifies right/left sides of *singular* anatomy parts, (eyeballs, fingers/toes/nails, kidneys, etc) - we use current coding standards.

Karen Hurley, CMM, CPC-I, Waldorf, MD

Codingline subscription information can be found here

RE: HAV, Hammertoes, and Met Adductus (Joseph S Borreggine, DPM)
From: Tip Sullivan, DPM

On the AP view, this only appears to be a “skew foot” i.e., compensated metatarsus adductus. This is not simply a forefoot limited met adductus foot (look at the mid foot-cuboid). Of course, a WB lateral view is needed to determine the real deformity, but my point is that this patient may require addressing the deformity at the level of the deformity which is not simple metatarsal osteotomies and toe work. If you do not do a lot of these, you might consider asking someone to assist or just send the patient out.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@msfootcenter.net

Editor’s note: The correct city/state for Dr. S Jeffrey Siegel, who posted yesterday, is Philadelphia, PA.

RE: Creaking Midmark Chair (Philbert Kuo, DPM)
From: Brooke Weaver, Richard Silverstein, DPM

We recently had to have our Midmark chairs serviced for “squeaking” problems. The hydraulics in the chairs had become worn from lifting heavier patients. The part is not very expensive but the repair is very labor-intensive and the repairman needed about 2 hours to fix each chair. Our chairs ranged in age from 3-10 years of age. We decided to go ahead and do all of them (9 in total) because we would have a hard time having a room out of service for patients. The repairman was able to accommodate our schedule and work on a Saturday. The company was an authorized Midmark repair service.

Brooke Weaver, Central Kansas Podiatry Associates, Brooke@ksfootdoc.com

I have a Midmark chair that made a very loud noise when returning to the original upright position. The gas cylinders and capacitor after 2 years went bad and they (Midmark) replaced it for free. You need to get in touch with Midmark and explain that a chair after 8 years should not be performing like that. My chair was not under any warranty.

Richard Silverstein, DPM, Baltimore, MD, ERsilver1@aol.com

RE: OIG Releases Work Plan 2009
From: Paul Kesselman, DPM Woodside NY

The Office of Inspector General released its work plan describing those areas it plans to investigate this coming year. Some areas which may be of some concern to podiatrists include:

1) Medicare Secondary Payer: Medicare payments made while a patient is covered by another third-party payer who should be primary.
2) Physical therapy payments made to patients covered under a Home Health Agency (HHA).
3) Over utilization of HHA referrals by physicians.
4) Payments to suppliers for DME services which are subject to Skilled Nursing Facility (SNF) consolidated billing.
5) Place of service errors
6) Payments for E&M Services made during a post op global period.
7) Incident to physician services.
8) High use of ultrasound services
9) Physician reassignment of benefits
10) Excessive use of the GY (not covered by Medicare) Modifier.
11) DME payments for patients receiving home health agency services.
12) DME payments for claims with modifiers.
13) DME Claims for patients in SNF’s.
14) Duplicate Payments for DME for providers with multiple NPI’s.
15) Providers billing more services than is feasible to provide in one day.

The entire OIG Work Plan for 2009 may be found at: tinyurl.com/4t3qrx

Paul Kesselman DPM, Woodside, N.Y. pkesselman@pol.net

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, fax to 410-486-2049, call r. Herbert Rosen 410-580-0255

ASSOCIATE POSITION - NORTHWEST IOWA

Great opportunity for hard-working, ethical podiatrist to join Midwest multi-physician, podiatric group with multiple locations. A well-established, successful, growing practice with strong hospital affiliations seeking FT and PT surgically trained physician. Applicant should be well-trained in all aspects of surgical care, completed a 24-36 month residency, & at least board eligible. Diverse practice offering high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume to: 712-258-9977

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

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

PRACTICE FOR SALE -CORAL GABLES FLORIDA

Well-known practice for over 20 years. Excellent location on Coral Way with heavy traffic, great visibility and plenty of parking. Busy, fully-equipped, full- time office with established patients. Grossing over 300K with tremendous growth potential. Office is currently open and ready to take over immediately. For additional information contact QVAN@aol.com or 305-975-5516.

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership 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

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

ASSOCIATE POSITION – CONNECTICUT

Full or part-time position available for a podiatrist licensed in CT. This practice encompasses wide variety of patients including Diabetic wound care and general podiatric care. Must be willing to cover all aspects of the practice including nursing homes and house calls. Please e-mail CV to RPMDPM@aol.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

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