The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

October 22, 2011 #4,286 Publisher-Barry Block, DPM, JD

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Modern Ankle Replacements Allow for More Mobility: NJ Podiatrist

While replacement of other joints is common in the orthopedic world, ankle replacements are rare. “We are seeing more ankle replacements due to advancements in medical technology and design and a better understanding of how the ankle functions,” states Dr. Nicholas Bevilacqua.

Dr. Nicholas Bevilacqua

“Total ankle replacements are extremely unique in that they can be customized for the individual patient.” Dr. Bevilacqua explains that the modern day design advancements in ankle replacements allow for more ankle mobility and do not just function like a hinge joint, moving your foot up and down.
 
Source: Mybergen .com

AZ Podiatrist to Lecture on the Charcot Foot for Barry’s Brand Research Center

The Paul & Margaret Brand Research Center at Barry University is launching a new national lecture series highlighting vital topics in podiatric medical research. Robert Frykberg, DPM, MPH, chief of the podiatry section and podiatric residency director at the Carl T. Hayden Veterans Affairs Medical Center, Phoenix, Arizona, will present the first lecture on The Charcot Foot 2011 at Barry’s Broad Center for the Performing Arts on November 7 at 6:30 pm.

Dr. Robert Frykberg

This free CME lecture will discuss the most current information on the cause, natural history, and management of the diabetic Charcot Foot. This often misunderstood complication of peripheral neuropathy places the limb at risk of amputation. Dr. Frykberg will present findings from world experts and offer his assessment of what we have learned about Charcot, and what remains to be discovered. Frykberg is the former chair of the Foot Care Council of the American Diabetes Association and a past president of the American College of Foot and Ankle Surgeons.

IA Podiatrist's License Reinstated by State Board

The Iowa Board of Podiatry has reinstated Dr. John Redenius' license after a two-week suspension. Board members, Sept. 30, issued an emergency adjudicative order suspending Redenius' license after receiving a patient complaint about his Waterloo office earlier this year. According to board documents, Redenius completed the ordered evaluation and presented credible evidence that the "defects in his treatment environment" had been remedied.

Source: Waterloo/Cedar Falls Courier [10/20/11]

Send Flawless e-Mail Messages

Find the mistakes in your e-mail before you hit Send. Use these tips to catch errors:

•  Prevent premature distribution. Don’t address the email until after you have checked it thoroughly. If you are replying to a message, delete the recipient’s name before you start typing.
•  Read slowly and aloud. Stop your brain from automatically correcting what you read. Say each word out loud.
•  Expect an error. Keep checking until you find at least one error.
•  Bring in a new proofreader. For very important messages, ask a colleague to check the message for you.

Source: Adapted from “How to Avoid Mistakes in Email: Four Surefire Suggestions,” Barbara Pachter, Pachter’s Pointers via Communication Briefings

Query: Audit Request from Non-Contracted Provider

My office has been contacted by an agency hired by Humana to audit ALL our Humana patients in the last two years. They are requesting ALL the charts for EACH visit. My documentation is perfect, but I am reluctant to send these notes off to be "scrutinized." I DO NOT have a contract with Humana, and I feel I have no legal obligation to oblige. Does anyone know the legalities when it comes to third-party audits?

David Weiss, DPM, Richmond, VA

Query: Removal of Gout Tophi in MPJ

How would the following be coded? A patient presents with tophaceous material at the metatarsal-phalangeal joint. The procedure included:
- opening of the joint;
- removal of gout crystals from the joint, and;
- debulking of joint capsule.

Anna Marie Brooks, Office of Vita Rizzo, DPM, Bay Shore, NY
 
Response: These procedures could best be described as either a joint arthrotomy and removal of gouty crystals (CPT 28022) or a joint synovectomy (debulking of the joint capsule - CPT 28072).

If attempting to bill both, the problem will be the CCI bundling edits. CPT 28022 is a component of CPT 28072. Because both were performed on the same site, one could not bill them both at the same time.

The RVUs for these procedures are:
CPT 28022 - 13.55 non-facility RVUs
CPT 28072 - 14.52 non-facility RVUs

Paul Kesselman, DPM, Woodside, NY

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Chronic Ankle Ulcers (Pat Caputo, DPM)
From: Jefferson J. Mennuti, DPM

Dr. Caputo described an appropriate algorithm for this wound. I can only add to it. When using NPWT, you can use Duoderm around the wound edges and overlap the normal skin with wound tissue by 0.2cm. If you can get a SnAP Vac, I believe your patient would be more compliant, as it is very simple for the patient, but a hassle for the practitioner.

That wound needs a good debridement. If you can, use a VersaJet (Smith and Nephew). Following that, you need good MMP management. Prisma works for that, or try topical Doxycycline. If you go with Doxy, you have to get it in capsule form for easy application. In tablet form, you would have to crush it up. You have to manage the bioburden as well. Again, topical doxycycline is good. I recommend antibiotic creams or gels. Silver isn't enough. You need dressings changed qod if NPWT, or qd to bid if no NPWT is employed.

If you can control the drainage well enough, attempt advanced modalities. Apligraf is indicated. Otherwise, I like Acell. HBO2 sounds like a good method, but unless the patient is diabetic with Wagner III, there is no indication.

Jefferson J. Mennuti, DPM, Orange City, FL, dr.mennuti@gmail.com

RE: Not So fast to Criticize Suturing Nails
From: Donald Arenson, DPM

While the routine suturing of a traumatized toenail back to the nail bed may not always be the best practice, I have found that technique beneficial under some circumstances. When there is a nail bed laceration that accompanies the trauma, e.g., an open fracture, removing, antiseptic cleansing, and replacing the nail plate can offer a handy biologic cover and splintage after repair of the nail bed laceration. 

I have performed that technique on many occasions with very satisfactory outcomes and without intervening infections. Obviously, severely contaminated wounds or those associated with devitalized tissues require special attention to debridement techniques and prophy antibiotic therapy.   

Donald Arenson, DPM, Elmhurst, ILdarenson@pol.net

RE: Mitek Bone Anchor (Mark K. Williams, DPM)
From: Fred Birnbaum, DPM 

In reply to the question as to which Mitek bone anchor to use for a Kidner procedure, I have been using a Mitek G-2 Quick-Insert bone anchor. It's exremely easy to insert and has 2 sutures attached for re-attaching the PT tendon. It has excellent pull-out strength.
 
Fred Birnbaum, DPM, Bensalem, PA, themick8@comcast.net

RE: Stay Away from Trimming Toenails (Peter Vannucchi, DPM)
From: Barry Mullen, DPM

Wow...talk about simply not getting it and missing the mark! So...trimming toenails is beneath you; fine, then either hire and properly train a podiatric medical assistant to perform the service for you, or REFER to a neighboring colleague who does. This country's medical advancements, coupled with the baby boomer era, in conjunction with an ever increasing diabetic population absolutely NEED a specialty that performs "routine" foot maintenance services like nail trimming.

There are a myriad of vascular-compromised senior citizens who need this service and who face the potential dangers inherent to self-care provision that you clearly don't appreciate. NATURALLY, a component of fraud and abuse exists with respect to "routine" foot care billing. So what! Fraud occurs within...

Editor's note: Dr. Mullen's extended-length letter can be read here.

RE: OH Court Rules That Podiatrists Need ABPS Certification for Staff Privileges (V. Kathleen Satterfield, DPM)

Basically, Dr. Satterfield wants to do an end run around the ABPS. She claims that her board is recognized, and that they do 90% of what DPMs do. Fine, get privileges for what you do and leave the surgery to the gold standard for surgery, the ABPS. If you want to do surgery, get your surgical boards; otherwise stick to your own area.  Don't try to have your cake and eat it too. To do what Dr. Satterfield suggests would make the ABPS surgical board weaker by allowing medical boards to encroach on a different skill set without passing the same requirements. Podiatry has to define itself, once and for all. 

Robert Bijak, DPM, Clarence Center, NY, rbijak@aol.com

Part-time practice for sale or lease. Flexible terms, will consider lease with option for sale. Structured for a fast sale, first option on real estate. Great opportunity for a start-up or satellite with immediate income. Call 201-573-0555 or 551-574-0776 billfeet@aol.com

PRACTICE FOR SALE - SOUTHERN OH

Busy, well-established, full-time home visit practice. 100% referral-based. Wound care, pain management, routine care & DME’s. Excellent income, low overhead. Great opportunity for husband/wife business team. DPM relocating out-of-state for family. Contact: nanetter@zoomtown.com

PRACTICE FOR SALE - NORTHERN NJ

Well established, part-time practice is for sale in Northern NJ. Digital X-rays, EMR, located in a medical condo building. Surgery 35%, Routine 30%, Average Gross is $130K on 2 half days per week. Priced for quick sale. Real estate available for purchase. Please call 800-983-4194, or e-mailcontactus@podiatrypracticeconsultants.com

ASSOCIATE POSITION - SOUTH WEST FLORIDA

Full-time associate positions for an established group practice in Southwest Florida. Willing to train the right new graduates. Job will involved all aspects of podiatric care. You must be ambitious, hard-working and should have good people skills. Please e-mail your resume/CV to contactus@ankleandfoot.net

ASSOCIATE POSITION - NYC and SW CONNECTICUT

Podiatrist needed in Nassau county to start immediately. Flexible hours 2 days a week. Please email pittpod@gmail.com with inquiries.

ASSOCIATE POSITION - LOS ANGELES COUNTY, CA
 
Interested in hiring a part-time leading to full-time podiatrist for northern Los Angeles County busy practice. Possibly leading to associateship. Please e-mail CV to avfootdoc@mail.com or fax to 661-265-1877.
 

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. Extremely competitive base salary with bonus incentives and benefits. Knoxville is consistently ranked in top 5 places in U.S. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE POSITION - FLORIDA/N.W. FLORIDA- TALLAHASSEE AREA

Home of Florida State University. Great university town! Well established full scope solo physician with busy practice. Looking for a full time associate leading to partnership in a short time. Great general practice with 2 locations. Staff privileges with 2 local hospitals and 2 surgery centers. Offering competitive salary, health insurance. Will need forefoot and rearfoot surgical competency. Friendly office with fun staff that’s easy to work with. Call/Text – 850-510-4371.

ASSOCIATE POSITION – IOWA CITY AREA

Well-established, rapidly growing practice. Motivated, ethical and personable with well-trained PSR-24/36. Modern office with complete EMR, digital radiography, diagnostic ultrasound, and laser. Competitive salary/benefits package. If interested please email your CV, letter of intent and references to: NHFootDoc@yahoo.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate position for associate to potential partnership available for a surgeon that is BQ/BC by ABPS. Must be personable, competent and a team player. Salary with bonus, partnership for right person.  Email CV to: susmitad86@yahoo.com

SOUTHEAST GEORGIA & SOUTH CAROLINA

Seeking associate physician to join practice to cover both private practice and some nursing home facilities. Comprehensive package including Salary, Travel and Bonus benefits. Email cover letter and CV to melissafoot@pol.net.

ASSOCIATE POSITION - SOUTH CAROLINA

Upstate practice seeking PSR-24/36 trained associate. Full-time position with partnership opportunity. Must be ethical, highly-motivated with strong surgical and medical skills. Please send CV topalpodiatry@att.net

PODIATRY OFFICE TO SHARE - SEATTLE, WASHINGTON 

Fully equipped podiatry office in North Gate area of Seattle. Office located in medical professional building near I-5. Office has 3 treatment rooms, 3 physical therapy rooms, direct digital x-ray, PAD- net, NCV testing equipment, physical therapy equipment. Please contact us: http://podiatrym.com/go.cfm?n=852 Tel. 425-643-8901 isbinc2006@gmail.com

SPACE AVAILABLE - NYC & LI

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,500 DPM's. Write tobblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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