The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 07, 2007 #3,086 Editor-Barry Block, DPM, JD

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We've just mailed the latest issue of Podiatry Management. At 284 pages, this is our largest November special diabetes issue ever, and is filled with interesting, informative, and useful articles. You'll also find our usual assortment of features, including our columns, and a CPME-approved CME.

November 2007 Podiatry Management

Women Should Stick To One Heel Height: MA Podiatrist

Dr. Neil Barney, a podiatrist at Lower Cape Podiatry in Brewster, says regardless of any shoe's comfortable, knowing when to wear them might be the key to saving your feet. His office's disease du jour? Heel pain.

Dr. Neil Barney

"During the '50s and '60s, women were wearing heels on a regular basis to do housework," says Barney. "We think today that that sounds insane but wanting to be like Barbara Billingsley was something women wanted to do." He says women today are just as enamored with the heel.

If you daily wear the same type of shoe, such as a stiletto, your feet become accustomed to the shoe, creating lots of problems when you want to wear a pair of ballet flats. "As the style changes, and the 2-inch heel goes to a flat heel, the stress is on the heel in a different way," says Barney. He jokingly adds that perhaps the safest bet for women is to just stay true to one style.

Source: Amy DuFault, Cape Cod Times [11/5/07]

APMA'S President-Elect Testifies Before Congress on Small Business Issues

More than 60 percent of podiatric physicians in this country own a small business with practices consisting of one or two doctors. Medicare’s program for competitive bidding for durable medical equipment, discussed before a subcommittee on Investigations and Oversight of the House Small Business Committee, could potentially harm patient care at small medical practices. American Podiatric Medical Association President-elect Ross Taubman, DPM, testified Wednesday before the US House of Representatives on behalf of the association, which represents 80 percent of the country’s podiatric physicians.

Dr. Ross Taubman (L) testifies before House subcommittee on Investigations and Oversight

“For a patient with a fracture, I would almost certainly find it necessary to send him or her out of my office, perhaps across town or to another county, to get a necessary DMEPOS product from a large supply house,” Dr. Taubman said. “Mr. Chairman, not only would this be unfair to me as a small businessman, it also would not be good medical care.”

Dr. Taubman's testimony emphasized how the competitive bidding program for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) will impact podiatric physicians’ practices. He gave both written and oral testimony, which addressed the continued ability of podiatric practices to compete in the DMEPOS marketplace, as well as additional obstacles created by accreditation and surety bond requirements to providing essential items of DMEPOS as part of patient care.

Source: APMA.org [11/5/07]

States Strike at "Most-Favored" Pay Clause

The most-favored-nation contract clause is becoming least favored by more legislators and regulators. Indiana and Colorado this year banned the practice of insurers requiring, by contract, that doctors always give them the lowest reimbursement rate, while Maryland did so in 2006. Idaho this year extended its ban to foreign-based insurers. And Ohio's House has passed a ban that covers any insurer that controls more than 20% of a local market, a measure now being taken up by the state's Senate.

The District of Columbia's attorney general is investigating whether the use of most-favored-nation clauses by one major insurer, CareFirst BlueCross BlueShield, violates antitrust law. The company is cooperating with the investigation and says its "cost containment" program violates no laws. In Pennsylvania, the insurance commissioner is looking for assurance from two merging Blue Cross Blue Shield plans -- Highmark and Independence Blue Cross -- that the newly combined entity won't violate a state consent order that has prohibited the use of such clauses.

Source: Bob Cook, AMNews [11/12/07]

Query: Cerner Wisdom Software

We have had Cerner's Wisdom Billing Software (previously DR Software) for years. Has anyone with Cerner had problems with billing since the NPI switch? Has anyone switched to a different vendor from Wisdom, and if so what has been your experience?

Carl Ganio, DPM, Vero Beach, FL

Query: Coding Multiple Fractures

What would be the correct procedure and diagnosis codes for the treatment of the following multiple fractures (closed without manipulation), right foot?

1. Navicular fracture
2. Middle cuneiform fracture
3. Tibial sesamoid fracture
4. Cuboid fracture
5. Fibular fracture.

Lisa Maynard, New York, NY

Response: CPT 28450 would apply for each of the closed treatments of the navicular, cuboid and cuneiform fractures, CPT 27786 for the treatment of the fibular fracture, and CPT 28530 for the closed treatment of the sesamoid fracture.

It's hard to believe that with so many fractures, none are displaced enough or require even manipulation, let alone open reductions.

Tony Poggio, DPM, Alameda, CA

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

RE: Level of Amputation ( David Gurvis, DPM)
From: Multiple Respondents

Dr. Gurvis is faced with a difficult decision. If possible, obtain TCPO2 studies of the effected limb to determine if there a level at which enough circulation is available for healing. Some hospitals do not perform TCPO2 studies, so you might have to look around your area. In Louisville, we have only two hospitals that perform it. According to Dr. Sage and Dr. Pinzur's article on Syme's ankle disarticulation, if you have TCPO2 around 30 in the malleoli region and his albumin is over 2.5, the patient may have a chance of healing a ankle disarticulation. I prefer to do the one-stage procedure and many of times patients who were told they would need BK's have healed the Syme's procedure, if their wound healing parameters are optimized.

Syed Ahmed DPM, Louisville, KY, syedahmeddpm@gmail.com

The vascular surgeon may be correct and the transmet may fail and the patient will be faced with another amputation at a higher level. What I would recommend, however, is having angiography and then taking the results to some other university-based vascular surgeons to determine if there may be some other procedures that can improve the circulation in the foot enough so as to do safe transmet amputation. There are also other modalities such and the circulator boot, which increase peripheral circulation. The patient comes for treatment almost every day of the week for several months and it supposedly makes a difference. They are using it at Temple University College of Podiatric Medicine and Surgery. There are also members who contribute to PM News who have and use this modality. It might not be a bad idea to run this case past the clinicians at Temple and see if they think this therapy would work for your patient. You might be able to save the patient's leg.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

Dr. Gurvis didn't mention in his query whether the vascular surgeon's recommendation was based on angiography findings, transcutaneous oximetry findings, or some other non-invasive test results. If transcutaneous oximetry has not been done, it may be helpful in making a decision whether to attempt a TMA vs. BKA. Response (if any) to O2 challenge during the TcPO2 testing may also be helpful in determining whether peri-operative HBO therapy would be appropriate in the limb salvage plan for this patient.

Robert Wunderlich, DPM, San Antonio, TX., rwunder@gmail.com

RE: James Bates, DPM

It is with much sadness I read about the death of Dr. James Bates. He was president of PCPM during my tenure as a student and as a clinician at that college. He was responsible for the resurrection of the college after its closure by Temple University. He was an inspiration to many but especially to me. It was because of his leadership and inspiration that I decided to pursue a career in Administration. I will miss him.

Thomas V. Melillo, DPM, President, OCPM

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