The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 07, 2008 #3,367 Editor-Barry Block, DPM, JD

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We've just mailed the October 2008 Podiatry Management. This special 228-page issue contains our annual review of footwear and is filled with a variety of interesting, informative, and useful articles. You'll also find our usual assortment of features, including our columns, and two (2) CPME-approved CMEs.

October 2008

Louis M. Newman, DPM

Dr. Louis M. Newman passed away on October 1, 2008 in Philadelphia. He was a retired Professor of Surgery at the Pennsylvania College of Podiatric Medicine (now Temple University School of Podiatric Medicine) and a long-time delegate to APMA from Pennsylvania and the House of Delegates.

Newman was a founder of the original American Board of Podiatric Surgery (ABPS). He was a 1935 graduate of Temple University and a pioneer of podiatric surgery in the Philadelphia area who remained active in the profession until his retirement.

PM News policy is to request that memorial donations be made to the APMA Education Foundation Student Scholarship Program, 9312 Old Georgetown Rd. Bethesda, MD 20814.

Source: Arthur Helfand, DPM

CA Podiatrist Honored By Elks Lodge

Robert "Bob" Schulze was recently honored by the Redlands Elks and friends for his 43 years of service to Redlands Elks Lodge 583. More than 100 people attended the dinner.

Dr. Robert Schulze (R) with wife and son. Larry Eberly (L)

At the dinner, Larry Eberly, exalted ruler of the Redlands Elks Lodge, presented Schulze a plaque commemorating his service as a trustee, esquire and treasurer. Elks members Alan Dangermond and Dick Bartlett spoke about Schulze's accomplishments. Also attending were his wife, Ann, and son Robert Schulze Jr. Schulze has served the Redlands community as a podiatrist, and he and his wife have lived in Redlands for more than 50 years

Medicare Pay-For-Reporting Effort Draws Fire from Frustrated Doctors

Medicare's flagship Physician Quality Reporting Initiative has left in its wake a sea of annoyed physicians who say the pay-for-reporting program is being poorly managed by an unresponsive administration.

In July, more than a year after nearly 100,000 doctors started reporting quality measures to Medicare for the first time, the Centers for Medicare & Medicaid Services started sending out the first of more than 55,000 bonus checks to those who reported enough measures to qualify in 2007. In August, CMS began allowing participants access to confidential reports to let them know if they achieved the reporting threshold for the measures they chose -- or by how much they fell short. So far, the reviews from doctors on both processes have been largely dismal.

For starters, nearly half of the physicians who tried for a 1.5% bonus failed to get one, prompting doctors who never received the anticipated check to download their reports and find out why. But many who tried to access the documents were defeated by stringent security measures, and some gave up before they could see their performance. Those who did, found the data useless in telling them how to improve quality.

Source: David Glendinning, AMNews [10/6/08]

An Ideal Icebreaker

Start conversations that build relationships when you ask a simple question: "What is the most challenging thing about what you do?"

Source: Adapted from Present Like a Pro by Cyndi Maxey and Kevin O'Connor

Query: Chronic Nail Pathology

This is a healthy 40 year old female who has had nail pathology for 10 years. It began on her hands after using a "nail hardener" which may or may not be related to the pathology. It then started on all her toes. She is a vegetarian and admits to many allergies, including animals, metals and many products contained in cosmetics, shampoos, etc., all supported by skin patch testing. Two prior cultures were done. One was negative, the other showed "growth of Candida albicans identified by germ tube test."

Chronic Nail Pathology

Her dermatologist tried topical anti-fungals and anti-Candida drugs with no results. This was followed by 4 months of Sporonox with no results. Lamisil was not tried. Thyroid, liver and adrenal function were normal. Although RBC indices were normal, serum iron, ferritin and TIBC indicated mild deficiency. All rheumatoid studies were normal. What is interesting is that the condition will disappear after the application and then removal of darker shades of nail polish, followed by gradual recurrence over 3 to 4 days. I would greatly appreciate any input.

Gary Gugliada, DPM, Staten Island, NY

Query: Ultrasound Machines

I am a new practitioner who has some experience with ultrasound and am currently looking to get an US machine for my office. There are many models and sellers out there, but which are be considered among the best options for podiatry, as far as price and quality goes?

J. Velazquez, DPM, Flowery Branch, GA

RE: Discoloration of Skin 17 years Post-op (Josef Geldwert, DPM)
From: K. Anderson, DPM

I second the notion to do a biopsy. The discoloration may suggest dermatofibrosarcoma, an extremely rare soft tissue lesion to show up in the foot, but one that may follow a "trauma." They are very slow growing, usually present with an underlying mass, and rarely invade deep to bone. It is not possible to tell in the submitted photograph whether there is any mass present. If so, and the discoloration is somewhat blue, get a second opinion from a dermatopathologist before cutting into it. It requires a 3cm peripheral margin if it is indeed a dermatofibrosarcoma, which means wide excision, pathologic ID and skin graft. Radiation therapy is of little documented use for these lesions.

K. Anderson, DPM, La Jolla, CA, drkarendpm@aol.com

RE: Matrixectomy Billing Rules (Karen Hurley)
From: Lloyd S. Smith, DPM, Lowell Weil, Sr., DPM

CPT 11750 has been RUC reviewed and valued in recent years. As such, the values for the code are well accepted and frequently referenced when other codes, including all CPT codes, are reviewed. The value for the code is determined by a vignette that only discusses one border being mentioned. However, and this point is central to this debate, RUC allows and understands that more than 1 border could be done and has provided an allowance in this code for that possibility.

CPT 11750 should only be billed one time whether 1 or 2 borders are done. You should note that I am the appointed RUC member by APMA and am the only podiatrist to ever have a formal RUC vote.

APMA might want to submit a code proposal to CPT to add a code but if that occurred, the value we currently get for 11750 would decrease.

Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

The "sterilization" of the fibular and tibial side of a nail border should be treated no differently than performing a proximal interphalangeal arthroplasty for a hammertoe and a concurrent distal interphalangeal arthroplasty for a mallet toe on the SAME DIGIT. There are NO statements in CPT to preclude this method of coding and they certainly fall within the definition of Modifier -59. The key words in the -59 definition, different procedure, different site, separate incision all are present when sterilizing a border on an incurvated nail.

From a surgical standpoint, I would think that all podiatric physicians who perform this procedure would agree that there is more work, time, and potential complications by doing two borders rather than one border.

On the other hand, I can understand why a professional coder may treat this differently which only goes to prove that coding rules should be established by a combination of input from practicing surgeons who do the work, professional coders, and evidenced- based medicine indicating the efficacy, risks and complications of various procedures.

‘59’ Distinct Procedural Service: Modifier 59 is used to identify procedures or services, other than E/M services, that are not normally reported together but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available and the use of modifier 59 best explains the circumstances should modifier 59 be used. (paraphrased from AMA CPT coding rules 2008)

Lowell Weil, Sr., DPM, Des Plaines, IL, lswsr@aol.com

RE: OIG Releases 2009 Work Plan (Paul Kesselman, DPM)
From: Marc Katz, DPM

Notice that ultrasound was included as a red flag. This is the OIG telling us subtly, keep up the abuse and we will pull the code or limit the use of ultrasound by podiatry. Let’s not stick our heads in mud. We saw what happened to ESWT, alcohol injections, etc. I have colleagues that do ultrasound on most patients! Also they repeat the US multiple times for only one reason! And to top it off, they do not write a report or put adequate findings in the report. They will admit that they have no clue what they are seeing on the US. As Earl Pitts says, "Wake UP America." Let’s not be foolish and greedy. Learn from the past, please.

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

RE: Creaking Midmark Chair (Philbert Kuo, DPM)
From: J. Ressler, DPM

I have a Midmark 417 chair and experience what I believe to be the same sound. To be accurate, it is a creaking and grinding sound. Recently, when having another chair repaired, I had the tech look at my Midmark. He said it sounded like the gear housing. Although they did not make the repair, I was told that taking the tilt gear housing apart and lubricating it would solve the problem. He did not feel this sound would lead to a serious failure.

J. Ressler, DPM, Lauderhill, FL, RedWingCrzy@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

PODIATRISTS NEEDED – DALLAS/ FT WORTH – TEXAS AREA

Texas Home Footcare Associates, a podiatry exclusive company specializing in house calls and visits to facilities for the elderly, is looking to hire podiatrists. We are located in the Dallas area. Full and part-time positions are available. Immediate Openings Available. Must have a Current Texas license. Competitive Compensation Package. If interested fax curriculum vitae to 972 931-4819 or e-mail gjmdpm@tx.rr.com. For further information, call 972-380-8028.

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 - 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

SSOCIATE 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

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