The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

October 08, 2008 #3,368 Editor-Barry Block, DPM, JD

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David George is New President of ABPOPPM

The American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM) has announced the appointment of David H. George, DPM of Leonia, NJ, as president for the 2008-2009 term. The ABPOPPM offers a comprehensive board qualification and certification process in Podiatric Medicine and Orthopedics. Dr. George completed his medical education [Cum Laude] and residency at the New York College of Podiatric Medicine in 1973.

Dr. David George

Over the past 35 years, Dr. George has held many professional positions, including: Professor of Podiatric Medicine, Dean of Graduate Medical Education, [NYCPM], and Past President American Society of Podiatric Medicine, American College of Foot Orthopedists, American Association of Hospital Podiatrists, and Consultant to numerous Veterans Medical Centers. He is a former Director of Residency Education, VA HVHCS and was voted one of America’s Most Influential Podiatrists by Podiatry Management Magazine.

Currently, George is a full- time staff podiatrists at the Veterans Administration Hudson Valley Health Care System and serves as a Reviewer of Podiatric Residency Programs for the Council on Podiatric Medical Education, Oral Examiner Podiatric Medicine and Orthopedics [ABPOPPM], and Director of Educational Instructional Media for Podiatry Management Magazine.

Source: Bergen Record [10/2/08]

CMS Enhances Program Integrity Efforts to Fight Fraud & Abuse in Medicare

The Centers for Medicare & Medicaid Services (CMS) today announced aggressive new steps to find and prevent waste, fraud and abuse in Medicare. CMS is working closer with beneficiaries and providers; consolidating its fraud detection efforts; strengthening its oversight of medical equipment suppliers and home health agencies; and launching the national recovery audit contractor (RAC) program.

CMS will focus on companies and individuals whose billings for Medicare services are higher than the majority of providers and suppliers in the community. CMS is also shifting its traditional approach to fighting fraud by working directly with beneficiaries by ensuring they received the durable medical equipment or home health services for which Medicare was billed and that the items or services were medically necessary. Those additional steps include:

• Conducting more stringent reviews of new DMEPOS suppliers’ applications including background checks to ensure that a principal, owner or managing owner has not been suspended by Medicare;
• Making unannounced site visits to double check that suppliers and home health agencies are actually in business;
• Implementing extensive pre- and post-payment review of claims submitted by suppliers, home health agencies and ordering or referring physicians;
• Validating claims submitted by physicians who order a high number of certain items or services by sending follow-up letters to these physicians;
• Verifying the relationship between physicians who order a large volume of DMEPOS equipment or supplies or home health visits and the beneficiaries for whom they ordered these services;
• Identifying and visiting high risk beneficiaries to ensure they are appropriately receiving the items and services for which Medicare is being billed.

Source: CMS

Two Words That Persuade

Two key words will make you more persuasive. The Words: "if" and "then."

Whether you are trying to convince a patient to get orthotics or have that surgery, the message that works is "If you will take this action, then you'll get the reward."

The next time you're planning to persuade a patient, use these two words to get what you want.

Source: Overcoming Resistance by Gerald M. Jellison

Query: Nail Dust Inhalation

What are others using to protect themselves from nail dust inhalation? I use a vacuum plus a mask but I was wondering if the mask I use is efficient enough. According to one article that I read, "nail dust particle size can be as small as .1um", and yet most masks are rated according to their ability to filter/block particles of .5um or larger (N95).

"Even with the most effective dust extractors, the electric nail debridement process is not totally risk free because the extractors range from 25% - 92% effective in reducing airborne particles. While the large particles settle out to the floor, varying amounts of smaller particles remain suspended and inhaled or impacted on the practitioner and clinical environment. The particle sizes range from 0.1 to 100 um and 86% of these particles are less than 5 um in diameter and therefore capable of entry into the alveoli." Within the podiatry profession, there is four times the national prevalence of asthma.

Steve Bennett DPM, NYC, NY

Query: Medicare Diagnostic Ultrasound

When billing Medicare for diagnostic ultrasound studies, we have traditionally billed the service as CPT 76880 (ultrasound, extremity, nonvascular, real-time with image documentation) along with an "RT" or "LT" modifier to denote which foot was being imaged.

Recently, we have begun receiving rejections stating that "the claim/service lacks information which is needed for adjudication." Does any have suggestions as to what we need in the way of information to get the claims paid?

Bob Kornfeld, DPM, Lake Success, NY

Response: Previous to 2003, Empire Medicare Services required the "ZP" modifier for CPT 76880. The "ZP" modifier indicated that both the technical and professional components of a procedure were performed by a non-hospital based physician. The "LT" and/or "RT" modifier was also required.

Perhaps since NGS absorbed all the New York State Medicare carriers, it is now again requiring the "ZP" modifier. The LCD on non-vascular diagnostic ultrasound was also eliminated which would have provided some guidance.

I would suggest you contact NGS or the New York CAC rep (if you are an APMA member) for further instructions.

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found here

RE: Chronic Nail Pathology Gary Gugliada, DPM)
From: Bryan C. Markinson, DPM, Paul Stepanczuk, DPM

I always check proper shoe fit and proper shoe length. All too often this is a problem.

Paul Stepanczuk, DPM, Munster, IN pstepanczuk@juno.com

The patient’s photos appear to reveal that she has distal nail discoloration as well as distal onycholysis. This all may be a matter of keeping the nails shorter and wearing larger toe box footwear.

Nail polish-caused distal nail coloration changes or varying shades of beige to white, is also a possibility, depending on how long nail polish remains on, and not related to what it looks like immediately upon removal. Of course, the allergy history alone can explain it, and in her case, she may have to try hypo-allergenic footwear, which when Googled will reveal sources of same. Lastly, this may be the manifestation of mild acral psoriatic changes.

If the positive Candida cultures were real, she just may be in the group of non-responders, taking into account the multiple treatment failures.

Bryan C. Markinson, DPM, NY, NY Bryan.Markinson@mountsinai.org

RE: Louis M. Newman, DPM
From: Allen Mark Jacobs, DPM, Frederick Rothberg DPM

Louis Newman was a great and dedicated professor of surgery at PCPM. I recall him always treating students and residents with respect, and as future colleagues. He always would treat his assigned students to lunch, and always took the time to instruct in the OR and on rounds. As a student in the early 1970's, I witnessed the respect with which he was held, and which he brought to our profession at the then Rolling Hills Hospital in Philadelphia.

Dr. Newman was always a model and inspiration to me and others whom he trained. I am sorry to hear of his passing. He loved our profession, and many in the profession similarly loved Dr. Newman.

Allen Mark Jacobs, DPM, St. Louis, MO

I was saddened by the news that Dr. Newman had passed away. Early in my career and through the great kindness of Dr. Jack Rubinlicht, I had the great pleasure of working with him. He was a true pioneer of modern podiatric medicine. He helped train many of our profession's finest podiatrists at Old Rolling Hill Hospital. It has been a hard few years for alumni of Rolling Hill Hospital - first with the passing of Stanley Boc, and now with the passing of our founder. They will all be greatly missed.

Frederick Rothberg, DPM, Toms River, NJ

RE: Ultrasound Machines (J. Velazquez, DPM)
From: Eugene A. Batelli, DPM, Bruce Krell, DPM

I've had my share of ultrasound machines and the best, by far, is the PICO Sonace color unit. It is extremely easy-to-use, portable, and has excellent resolution. As far as companies, hands down, Peter Brunelli from Universal Ultrasound (800-842-0607) is the vendor you should use. Not only is he fair with pricing, he is a true gentleman. Universal provides training by qualified instructors who are actual physicians. You definitely will feel comfortable is all aspects of musculoskeletal sonography, as well as basic vascular screening tests which do pay quite nicely. As far as support, I never had to wait on hold for more than a couple of seconds, and, if they need to look something up for you, they get back to you very quickly.

Eugene A. Batelli, DPM, Clifton, NJ, ebatelli2001@yahoo.com

I've been using the SIUI CTS-5500 diagnostic US for 6 months and I am extremely happy with it. The product was professionally sold by the owner of the company, Fisher Biomedical. The post-purchase education has been excellent and the insurance reimbursements are worth the price. No complaints here.

Bruce Krell, DPM, Chandler, AZ, footdoc352@cox.net

RE: X-Ray Interpretation Software (Paul Bishop, DPM)
From: Larry Kosova, DPM

I am working with Sigma Digital X-ray and TextalkMD EMR to do this with plain film. You will be able to take the plain film and scan it in and use the software to do measurements and manipulate the film just like with digital x-rays. With Textalk, a button is being created so when you are in your patient’s case, you can automatically bring up the digital x-rays of the patient. We are working on having a normal printout at the same time on your report.

If you have a scanner that can do Dicom images, offsiteimage.com can store your images off-site. You can also use their software to do angles, bone lengths, etc. You can download and use the software to see what you can do with it. Talk to Eric. They also have scanning services. I am trying to get them to work with .jpg images. I have not used, but have been told to try Photoshop, as well.

Larry Kosova, DPM, Chicago, IL, lkosova@yahoo.com

ASSOCIATE POSITION – ILLINOIS

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

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