The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 03, 2009 #3,691 Publisher-Barry Block, DPM, JD

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PA Podiatrist Runs for Township Supervisor Position

Lori McGowan moved to East Hempfield Township because of its quality of life, but said that a community won't "stay healthy unless you get involved." And at a time when her suburban township needs "sensible growth," she said, she is running for elected office to help bring that about.

Dr. Lori McGowan

McGowan, a Democrat is running for East Hempfield Township supervisor in Tuesday's election. McGowan, 45, a podiatrist and adjunct college professor, was unopposed in her party's primary. She is running for a six-year term that will be vacated at the end of the year by current supervisor Heidi Wheaton, who chose not to seek re-election.

McGowan has become active in East Hempfield issues — and has been going to supervisors' meetings for the past two years — and as a candidate seeks to bring about what she calls "responsible" development. "The things that seem to be most important to people are (avoiding) getting stuck in a traffic jam and things like, 'Will my taxes go up to pay for a new school?'" she said.

Source: David O’Connor, Lancaser Online [10/28/09]

Podiatrist's Error Led to Toe Amputation, Plaintiff Alleged (New York)

FACTS: On July 28, 2004, plaintiff Lorraine DiDomenico, 52, a housekeeper, underwent bone-spur removal surgery, performed by defendant. DiDomenico initially went to defendant for a painful callus on her right big toe, which was caused by the bone spur and interfered with her ability to walk. Defendant attempted to treat the condition conservatively with debridements, injections,  and whirlpool therapy, but the symptoms did not resolve. As a result...

RESULT: Verdict-Defendant. The jury rendered a defense verdict.

PLAINTIFF'S EXPERTS: Barry Zingman, MD; Bronx, NY; Steven Stummer, DPM; Baldwin, NY
DEFENDANT's EXPERTS: Bruce Farber, MD; Manhasset, NY; Thomas DeLauro, DPM; New York, NY
 
Editor's note: An expanded version of this report appears at: http://www.podiatrym.com/letters2.cfm?id=30129&start=1

Query: Dermafill

I have heard about good healing results using Dermafill, a wound dressing. I would be interested in hearing comments from anyone about this product.

Peter Mason, DPM, Largo, FL

Query: Digital Cameras

I had been utilizing an Olympus digital camera, but the focal length was not close enough for the detail I had hoped for. I am seeking a replacement without breaking the bank. I would appreciate any comments and recommendations as well as whatever additional lenses might be utilized.
 
Charles F. Ross, DPM, Pittsfield, MA

Query: Medicare DME Denial for L4360

Until very recently, Medicare (DMERC) was paying for claims using L4360 (walking boot, pneumatic, with or without joints, with or without interface material, prefabricated, includes fitting and adjustment) linked to diagnosis code, ICD-9 735.0 (hallux valgus [acquired]). Beginning this month (October, 2009), we have been receiving denials indicating that there is no medical necessity for this DME. Which diagnosis codes will be paid by Medicare for L4360?

Jean Whitford, Norwich, CT

Response: L4360 represents a pneumatic walking boot. Typically, it is used when there is a medical necessity for a specific patient to wear it instead of the less expensive non-pneumatic walking boot (L4386). Examples of medical necessity would be the patient who is unstable in or cannot be fit in a non-pneumatic walking boot (because of deformity or the shape of the leg/ankle/foot). L4360, like L4386, is typically payable in ambulatory patients "with weakness or deformity of the foot and ankle, who require stabilization for medical reasons, and have the potential to benefit functionally." [Medicare Ankle-Foot Orthosis LCD language].

Medicare requires the provider to append a "KX" modifier indicating that "requirements specified in the medical policy have been met." I would also recommend adding an "RT" or "LT" to indicate the extremity to which the walking boot is applied.

If you have done the above, review the 3 policies/articles you have in South Carolina (CIGNA Medicare) on ankle-foot-orthoses to see if you are missing a newly required ICD-9 code.

Tony Poggio, DPM, Alameda, CA

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

Query: Neoplasm of Unknown Etiology (Jeffrey J. Luckett, DPM)
From: Joel Morse, DPM

Was an x-ray done with a lead marker on the lesion? You did say that it was excised - so either it was not all removed or abnormal biomechanics are the culprit. Is there some biomechanical reason for the lesion? If not, I would take the patient to the OR - after the she delivers her baby - and excise the lesion and have it examined by a dermatopathologist. If you desire to repeat the punch biopsy - take a photo before the punch and after so that the dermatopathologist can have a reference point. And lastly - if the patient does not consent to either a punch or an excision - get her to sign a note that she understands she is not heeding medical advice.
 
Joel Morse, DPM, Washington, DC, foxhallfoot@aol.com

RE: Bunion Surgery (Richard Frost, DPM)
From: Multiple Respondents

I would opt for a Keller bunionectomy with a slightly more aggressive medial head resection, then manually reduce the first ray and skewer the 1st MTPJ with an 0.062 K wire for 6 weeks. You must convey limited expectations. Dr. Frost’s x-ray shows joint space narrowing and partial subluxation of the hallux. The bone stock looks lighter on the first ray which may be from your x-ray or may be the warning sign for delayed/non/elevatus healing of an angle correcting base wedge 1st MTPJ fusion. The latter is to be considered if you think she can handle the non-weight- bearing period and healing. 

If a 69 year old steps on a base wedge, you will be fixing bone that has the consistency of wet chalk, screws will pull right through the bone, then you end up with an external rail or multiple K-wire skewers and a trip to the hospital for fixation. If you must correct the angles and 1st MTPJ arthrosis, put her in a cast and wheelchair for 8 weeks. Then, consider thrombosis preventative options. If she is a smoker, nothing but the Keller is an option. 

Marc Garfield, DPM, Williamsburg, VA, mgarfield1@cox.net

What is the patient’s activity level: tennis player, golfer, walks for exercise? If the patient is not too active, I would recommend a Keller with K-wire stabilization. Run a 0.062 K-wire out the hallux and retrograde back into the 1st metatarsal in a rectus position. Perform a Z-plasty lengthening of the EHL tendon. Leave the K-wire in for 3-4 weeks, and when you take the K-wire out, you can put the patient back in regular shoes that fit. If the patient has an active lifestyle and needs a propulsive gait, then consider a proximal osteotomy and use a bone stimulator post-op. The bone looks very porotic.

Bill Lockner, DPM, Minneapolis, MN, billlockner@yahoo.com

In my opinion, the bone stock is too poor to consider any significant osteotomies and the joint is clearly gone. I would do a Keller, take off a very generous portion of the bump at a 45 degree angle, and forewarn the patient that she will have some residual medial prominence, but she will have a foot that will fit shoes much better, with the least morbidity. She can be ambulating on this in a surgical shoe the next day. Also, caution her about a submet 2 callus or stress fracture, but I wouldn't do the osteotomy at this time.

Richard Rettig, DPM, Philadelphia, PA, rich.rettig@verizon.net

RE: Sarapin for Morton's Neuromas? (David Alper, DPM)
From: Ed Cohen, DPM

I used to treat neuromas biomechanically and with dexamethasone phosphate injections. I was pleased with this protocol and had good results. Steroids can cause problems, such as allergic reactions, raising blood sugars in diabetics, and can affect blood pressure and cause soft tissue damage. These usually are not problems because we use such a small dose. About nine or ten years ago, I started using Sarapin made by High Chemical after hearing a lecture by another podiatrist. The PDR information indicates that it is very safe and has essentially no side-effects.

The medication is basically a nerve desensitizer and I liked the fact that I could inject the medication right into the area of inflammation. You have to use a local anesthetic  because the injection is extremely painful when given alone.  The patient will probably not return to your office and will subsequently tell people how horrible you are. I have also combined this with B12 and dexamethasone phosphate, and in my hands, the Sarapin seems to work fine with just local anesthesia. On rare occasions, if I am not getting the results I want, I will combine the injection with B12, dexamethasone phosphate, or just use dexamethasone phosphate by itself.

Even though Sarapin does not increase the blood sugar in diabetics, injections should not be given to diabetic patients with high blood sugars because this could create an infection. Other contraindications are injecting into a swollen foot or where the skin integrity is poor. I keep saying I will try alcohol injections some day, but I have had good success with what I am doing, and on rare occasions, I perform surgery.

Ed Cohen, DPM, Gulfport, MS, ECohen1344@aol.com

RE: TOG Gaitscan (Mark K. Johnson, DPM)
From: Neil Levin, DPM, Sam M. Horowitz, DPM

I used the TOG Gaitscan system for over a year. It was easy to use, but there was a learning curve for interpreting the scans. Support from the company was excellent and patients loved the scans and the "cool factor". The bottom line for me: The orthotics did not fit well in many cases and I ended up with many more lab adjustments than before. Nothing captures the morphology of the foot better than a plaster cast. If you want to use the scan information and then cast the patient, that's one thing, but the results of a foot pad scan alone, sent online to the lab, resulted in inferior fitting devices.
 
Neil Levin, DPM, Sycamore, IL, drfeet1@aol.com

I have been using the TOG gaitscan for three years. I make on average 25-30 pairs a month. The accuracy is amazing. In the old days of plaster, I had a return or modification rate of one in ten. Now since gait scan, it is more like one in a hundred. We also increased the number of orthotics we make by 50% since we have the TOG because it is so much faster and easier to use than casting. The computer visual presentation is excellent and frequently makes the sale.

Additionally, it is really a diagnostic help and has increased my biomechanical knowledge of "flat feet" and "cavus feet." In general, the company is okay to deal with, though they can be stubborn. They want a guarantee of seven pairs a month. It took me a while, but I finally talked them into 21 pairs every three months. That way, the pressure is off if I take a long vacation.

Sam M. Horowitz, DPM, Hialeah, FL, Samsfuture@aol.com

RE: E-Rx Requirements Reduced
From: Lloyd S. Smith, DPM
 
Although the final rule published by CMS is confusing, it seems to me that podiatrists will be able to qualify for the E-Rx payment incentives if they successfully send 25 prescriptions electronically annually from their EMR systems. This is a significant reduction in the volume previously required to qualify. The EMR system must also meet federal standards. I urge DPMs to monitor releases from CMS, their local carriers, APMA, and others for clarification.
 
Lloyd S. Smith, DPM, Newton, MA, lloydpod@yahoo.com

RE: DPMs are Allopathic Physicians
From: Leonard A. Levy, DPM, MPH 

I have resisted bringing this up for long time - many years in fact. It is erroneous to differentiate the podiatric physician or DPM from the MD by using the term “allopathic physician.” Allopathic medicine is not a discipline but rather a system of medical practice. In fact,the system of practice DPMs employ is allopathic medicine and they are, therefore, allopathic physicians. Why not simply refer to DPMs, MDs, and DOs? To do otherwise is grossly incorrect (see PM News, November 2, 2009, NYCPMs Geriatric Foot and Ankle Symposium).

Leonard A. Levy, DPM, MPH, levyleon@nova.edu

ASSOCIATE POSITION – BROOKLYN, NY

Busy medical office in Brooklyn seeking part-time podiatrist. Good conditions. (718) 259-6666 phone (718)259-7000 fax, email zg0109@yahoo.com

PODIATRISTS CHICAGO/NW IND/BALTIMORE/WASHINGTON, DC

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Jake Shimansky, Director of Physician Recruitment. Phone-773-342-5221 FAX 773-486-3548-E-Mail jshimansky@homephysicians.com www.homephysicians.com

ASSOCIATE POSITION-SOUTHERN CALIFORNIA, INLAND EMPIRE

2-office multi-doctor practice looking for ethical, dependable doctor to work 3-4 days per week. State-of-the-art, long established practice. Needs a team player which may lead to buy-in for the right doctor. Must be ABPS BC/BE. High surgical volume. Send cover letter and CV to bkatzman2@earthlink.net

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

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 a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

ASSOCIATE POSITION – MINNESOTA

Well-established podiatry clinic located in the Twin Cities area has an immediate opening for a full-time podiatrist. The clinic is located just minutes from a surgery center as well as 2 major hospitals. Associate position is also open for partnership or purchase. Please email CV and inquires to rmccoy@associatedpodiatrists.com

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)

Well-established, diverse, growing practice. Excellent referral base. Seeking an ethical, hardworking, motivated, caring podiatrist to fill a full-time position. Multiple hospital affiliations. Generous income with room for growth, leading to partnership for the right candidate. See our community www.siouxlandchamber.com. Fax CV, resume, three references to 712-258-9977.

OFFICE SPACE/ MRI RENTAL – NYC, LI

Turn-key space available, daily, monthly; East 60th off Park Ave, East 22nd St. off 3rd Ave, Hicksville and/or Plainview Long Island. JACHO-certified operating rooms available, as well as all surgical equipment and anesthesia. Extremity MRI Rental. Stark compliant. All exams read by board certified radiologist. Call for details. 516 476-1815

ASSOCIATE POSITIONS - INDIANA/OHIO

PrimeSource Healthcare is a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created an immediate need for traveling, independent contractors of podiatry services in Indiana/Ohio. Earn between $175k and $225k per year. E-mail CV to kwright@pshcs.com. Visit us at pshcs.com.

PRACTICE FOR SALE- SEATTLE, WA

Beautiful office for sale in the heart of Seattle, WA. Newly renovated, 2,500 sf, new digital x-ray, vascular lab, state of the art physical therapy equipment, paper-less system, all new podiatric furniture and equipment, popular podiatric products store and beautiful diabetic shoe display. Office is located in the medical building and open 3 days a week. Great opportunity for expansion to full-time. Please send us a letter of interest to the: podiatrygroup@yahoo.com

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Office and diagnostic equipment state-of-the-art. Full benefit package included. If interested, please fax your curriculum vitae to 847.352.0270 or email to foot1st@yahoo.com

DIABETIC RURAL OUTREACH PROGRAM - FLORIDA AND GEORGIA

Seeking DPM to join our program due to a high demand for Podiatric Care to off-site settings in SNF, ALFs and House Calls. Applicants must be willing to travel and must have experience. Current State License, Medicare and Medicaid numbers required. Seeking highly motivated individuals who can be team players, yet work independently. Must have strong work ethic and excellent communication skills. APPLY: Fax CV to: 866-258-9993 include 3 professional references. Please provide the geographic area where you can provide services. Further information call 800-779-8551 or email: info@DROPInternational.org. Visit our website

ASSOCIATE POSITION – RESEDA, CA

Podiatrist needed in Reseda, CA office 2-3 days/wk, 6hrs/day @ $375/day to senior community. Please have an active Medicare #. Position starts immediately. Please email CVs to coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

PM News Classified Ads Reach over 11,500 DPM's and Students

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 11,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. 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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