The Voice of Podiatrists

Serving Over 9,800 Podiatrists Daily

October 22, 2007 #3,072 Editor-Barry Block, DPM, JD

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UTHSCSA Creates Lee. J. Sanders Endowed Faculty Position

The University of Texas Health Science Center at San Antonio is working to prevent more diabetics in South Texas from needing amputations.

Dr. Lee J. Sanders

The university's School of Medicine has established the Lee J. Sanders Professorship in Lower Extremity Amputation Prevention. This endowed faculty position will be housed within the Health Science Center's Department of Orthopaedics. The medical school has not yet named an individual to fill this position.

The professorship is named in honor of one of the country's foremost leaders in the prevention of lower-extremity amputations in diabetics. Sanders is chief of podiatry service, acute care and specialty services at the Lebanon VA Medical Center in Lebanon, PA.

Source: San Antonio Business Journal [10/19/07]

IA Podiatrist Appointed to Hawkeye College Board

Hawkeye Community College's board of trustees Thursday appointed Dr. Bill Gronen to its unexpired Director District 5 seat.

Dr. William Gronen

The board held a special meeting to interview Gronen, voting to appoint him afterwards. The 62-year-old retired podiatrist was also sworn in. Miriam Tyson resigned from the seat last month after moving out of the district, which includes parts of northeast, central and west Waterloo.

In the past, Gronen has served on various city of Waterloo boards and commissions. He was appointed to the City Council in 1998 and elected the following year. Two years later, he lost a re-election bid.

Source: Waterloo Cedar Falls Courier - Waterloo, IA, [10/19/07]

Scholl/VA Researchers Shine at Rosalind Franklin University Research Day

Podiatric medical student researchers from The William M. Scholl College of Podiatric Medicine’s Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science and the James A Lovell Federal Health Care Center exhibited a broad array of research at a symposium dedicated to student investigators last weekend.

Dr. Stephanie Wu, CLEAR's Director of Education and Outreach

Two award winners were selected by a panel of judges. These two teams will represent Scholl's CLEAR at the American Medical Association Student Research Forum in Omaha in February, 2008. These research teams included A. Olson, R. Thummel, MP Sarras, Jr., R. Intine for "Development of a Conditional Zebrafish Knock-Out System to Study the Function of MMP's in Wound Healing and Tissue Regeneration" and “Mesenchymal Stem Cell Therapy in Wound Healing” presented by L. Shin, D.G. Armstrong, S. Wu, L. Rogers, D.A. Peterson.

Scholl students Cassandra Tomczack, Lisa Falcon and Michael Bevan

Honorable Mention Awards went to “Podiomics: Proteomic Analysis of Chronic Wound Exudate from Lower Extremity Wounds” presented by M. Bevan, L. Falcon, C. Tomczak, J. Holm, S. Wu, M. Glucksman, V. Driver, M. French, J. Anderson, D.G. Armstrong and “The Association of Foot Print Parameters and Running Training Level/Performance Success” presented by J.M. Fascione, R.T. Crews, J.S. Wrobel.

Query: EMR Systems

I am interested in purchasing an EMR and was wondering what systems currently available are the best (Medinotes, Podmed, Dox, etc.) and why?

Scot C Zindel, DPM, Lynchburg, VA

Query: CPT 10140 or 10160?

A Medicare patient presented with a thick fungal nail. At the beginning of debriding the nail, a pocket of clear fluid was found and drained. After debriding the remained of the nail, I flushed the site with alcohol, applied an antibiotic ointment and a dry sterile dressing. Instructions were given to soak and change dressings.
I coded the diagnosis as ICD-9 924.3 (contusion of toe/toenail).

Do I bill CPT 10140 (incision and drainage of fluid collection) or CPT 10160 (puncture aspiration, bulla or cyst)? Or does another set of codes apply?

Charles Perry, DPM, Cambridge, OH

Response: It is not unusual to find and drain a small fluid pocket beneath a hypertrophic, dystrophic, or mycotic nail. Since you specifically described opening and draining the fluid space, the correct code would be CPT 10140 (incision and drainage of hematoma, seroma or fluid collection). The performance of a nail debridement can, on some occasions, spontaneously incise/open an existing subungual fluid space. Obviously, if you bill for the I&D code, you would take that into account - not "counting" that nail debridement - when billing other services such as the debridement.

Some may choose to include the I&D - if it truly was spontaneous - in with the nail debridement or as part of an E/M service - evaluating and managing the post I&D site.

Be sure to document injury to the toe if you use of the contusion/injury to toe ICD-9 code.

Tony Poggio, DPM, Alameda, CA

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

RE: Surgically-Induced Keloid Scar (Frank Stoddard, DPM)
From: Ira Weiner, DPM, Steven H. Goldstein, DPM

While there are many ways to treat this I have had the best luck using intra-lesional steroid injections coupled with the application of sheet silicone under occlusion. Sheet silicone is usually available in most OR's packaged sterile if the facility does a number of ENT cases. If not, it is also commercially available known as Rejuveness. www.rejuveness.com.

Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005@yahoo.com

I have had success with a product calledScar care from Blaine laboratories it comes as a complete scar care system it may be reimbursable A6025 gel sheet application for scar with diagnosis 701.4 keloid/hypertrophic scar.

Steven H. Goldstein, DPM, Wayne, NJ, stevefootdr1@cs.com

RE: Charcot Dilemma (Arden Smith, DPM)
From: Multiple Respondents

Although the Hippocratic Oath includes the adage “first do no harm”, it should perhaps include the proviso “first, think what the recovery morbidity will be.” Such is the dilemma of the surgeon doing care on diabetic wounds and the Charcot neurotrophic osteoarthropathy foot. I also do a number of Charcot reconstructions and have caused controversy when I suggested to the patient that a functional amputation might be more efficacious than the seemingly endless cycle of wound, hospitalization, care, healing, re-ulceration, etc. This may be the epiphany moment that changes your protocol for these patients and your selection of who would benefit from the reconstruction and who would be better off with a Symes or below-knee amputation.

David Secord, DPM , Corpus Christi, TX , David5603@pol.net

I applaud Dr. Smith's recent posting on Charcot and share similar experiences with my patients and other medical specialists. The same patients who many of us see non compliant pre amputation are often non compliant post amputation with their prosthesis. Many vascular and orthopedic surgeons do indeed pontificate that these patients are better off being initially amputated. This is often NOT in the best interest of the patient's physical or emotional well being. Many patients require higher levels of amputations and/or lower than expected functional capacities post amputation than what was anticipated pre amputation. In part this is due to continued patient non compliance and/or other unexpected complications which were otherwise unforeseen.

Long overdue is a comprehensive study at this serious diabetic foot complication. A comprehensive study of Charcot treatment should not simply address the medial and surgical treatments. It must include treatment complications, risks benefit ratios, alternative therapies, costs as well as the potential socio economic-impact each modality has on both the patient and society.

While I am equally frustrated as Dr. Smith I would not want more havoc created by an overly simplistic formula which is then hijacked by the insurance industry.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

Editor's note: Extended length notes by Drs. Allen Jacobs and David Samuel appear at: http://www.podiatrym.com/letters2.cfm?id=16225&start=1

RE: Practice Brokers (Joe Burckhardt, DPM)
From: Multiple Respondents

We are currently working with Tony at American Doctor Sales to sell our practice. We tried working with a different broker this past summer, but we weren't very happy with them. When we had questions or needed something we would have to leave several voice mails before we would get our calls returned. We finally got frustrated and decided to find someone else to work with. This time around we really did our homework before choosing a broker to sell our practice. We contacted three different brokers and checked a minimum of three references with each one. American Doctor Sales had glowing references from other podiatrists that recently used them to sell their practices. Our experience so far has been a very good one. Tony always responds quickly to our calls/e-mails and has been extremely helpful. We're confident we made the right decision to work with American Doctor Sales to sell our practice.

Christopher Weis, DPM, Minneapolis, MN, info@associatedpodiatrists.com

I have recently sold my practice using a broker. Although it cost me 7% of the sale, I got much more than trying to sell it myself, the broker pre-qualifies the buyer so finances are in place, I received all my money up front, so I am holding no paper. It was a great experience all around. Email me if you want his name.
Steven H. Goldstein, DPM, Wayne, NJ, stevefootdr1@cs.com

I have had a wonderful experience using a consultant well known in podiatry for buying, selling, associated buy-ins, etc., Mike Crosby, CPA (www.providerresources.com e-mail: mcrosby@ providerresources.com). He has done a partner buy-out as well as associate by-in for me. And in my capacity as Chairman of the American Academy of Podiatric Practice Management (www.aappm.org) I have referred him to well over fifteen clients. Mike is very knowledgeable, fair to all parties and a true gentleman. Please be careful who you choose to help you with this, I have heard so bad stories out there.

Hal Ornstein , DPM, Howell, NJ, hornstein@aappm.org

RE: ABPS Certification Preparation (Bruce Williams, DPM)
From: Doug Dickson, DPM, Edwin Hart, III, DPM

I used www.Certifible.com (Boards by the Numbers). Download it on your laptop, carry it around with you, study during breaks in your schedule, evenings and weekends for 10 weeks. I can almost guarantee you will pass.

Doug Dickson, DPM Syracuse, NY, podocny@hotmail.com

Available for purchase now are the 2007 lectures online from the Goldfarb Foundation's Recertification Program to aid in studying for the Recert Exam to be held in January 2008. In addition, February 28-March 2, 2008, the Goldfarb Foundation is presenting the "Intensive Board Review, Refresher, & Recertification Course" both online and at the Marriott Philadelphia Airport, Philly. The brochure will be out in mid-November with all the details. "The Foundation Certification Review Outline Study Guide" book is included with full-course registration, but the books are available to purchase separately now at www.goldfarbfoundation.org. This is the best course around to help you study for the Boards.

Edwin Hart, III, DPM, President PA Podiatric Medical Association & VP, Goldfarb Foundation, Bethlehem, PA

BE AT THE RIGHT PLACE AT THE RIGHT TIME. YOU CAN'T BEAT THIS OPPORTUNITY. Respond to: mhudes@footcaregroup.com

SALES REPS WANTED

Orthofeet is looking for independent sales reps to sell their line of shoes and orthotics. Orthofeet offers high end shoes and diabetic insoles that are covered by Medicare, along with competitive advantages and unique selling points. E-mail: mb@orthofeet.com

POSITION WANTED PHOENIX METRO AREA

Office getting too busy with winter visitors? Young practitioner available for part time help. Seasonal or temporary OK. Surgically trained. Flexible schedule. Direct inquiries to dlmeb5@yahoo.com

HOME FOR RENT- CABO SAN LUCAS, MEXICO

For rent: 2 bedroom-3 full bath fractional home on the Sea of Cortez at Grand Regina Westin, Cabo San Lucas, Mexico. Week of December 29, 2006 until Jan 5, 2008. Sleeps 8, full kitchen with washer and dryer. Outside balcony with hot tub overlooking the water. Ideal for family vacation. $5000. Photos available. Contact Amogreg@aol.com

ASSOCIATE POSITION – SOUTHERN CALIFORNIA

Seeking a position in a warm, friendly, and productive environment? Well, look no further! A well established podiatry facility in North Hollywood, California has an immediate position available for a podiatrist. He/She must be motivated, reliable, and dedicated. Depending on performance, partnership is possible. If interested, email your resume to drnickoghosyan@yahoo.com

ASSOCIATE POSITION CLEVELAND CLINIC

The Section of Foot and Ankle Surgery at Cleveland Clinic is seeking highly qualified board-certified/ board-eligible podiatrists to join our faculty. High volume clinical practice consisting of general podiatric care, wound care, and diabetic foot problems, along with a research background in diabetic foot complications and/or clinical outcomes. Please contact: Joe Vitale, @ vitalej@ccf.org

THE PERFECT CHRISTMAS GIFT

Super Luxurious Custom Oceanfront Dreamhouse on Caribbean island of Bocas del Toro, Panama. FULLY FURNISHED 5000 SQ FT, 5 BED, 5 BATH, 2 KITCHENS, Infinity Pool, satellite TVs, wireless internet, Lush Tropical landscape, NEVER hurricanes. NO TAXES for 20 YEARS. $875,000. photos & info drritarae@yahoo.com

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

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