The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

November 10, 2010 #4,007 Publisher-Barry Block, DPM, JD

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We've just mailed the November 2010 issue of Podiatry Management. This special 236-page diabetes issue includes over a dozen articles on this important topic. In addition, you'll  find our usual assortment of features, including our columns, and a CPME-approved CME.
 

November 2010 Podiatry Management

KY Podiatrist "On the Fence" About Barefoot Running

Dr. Orla Rooney, a podiatrist with Lexington Clinic, said she's on the fence about barefoot running. "I don't think the research has shined enough light on it to really make the determination about how healthy it might be," she said. Part of her reluctance to endorse the trend comes from the people she sees in her office who are having trouble with their feet. They have stress fractures or cuts, which she sees as potential side-effects from barefoot running.

Dr. Orla Rooney

"That alone changes our perspective," she said. In her mind, "Most people are really putting themselves at a lot of risk" if they take up barefoot running. Perhaps, she said, people who are experienced runners, who aren't carrying too much excess weight, could do it successfully if they started slowly. She said she wouldn't recommend barefoot running for someone who is generally inactive and who is looking to start running.

Source: Mary Meehan, Quad Cities Online [11/1/10}

Query: Dermagraft Layers
 
Is there any data on using multiple layers of Dermagraft on a single wound (as opposed to wasting any excess graft)? Anecdotally, I have tried it and it seems to accelerate healing.
 
Bob Kuvent, DPM, Chandler, AZ

Query: Moving Office and Notifying Carriers

I am moving to a new location as of January 1, 2011 and was wondering if anyone has a thought about a simplified manner in being able to notify each insurance carrier (primary or secondary) other than a separate letter to each and every one. I realize that they will require, as a minimum, my NPI# and/or their individual identifier, and it would seem that a template of some sort might suffice.
 
CMS advised me that I will need to complete a 27-page form (the same one as when I originally applied to be a provider) with some minor changes to the original document. These would seem burdensome if every carrier required a new application form. Any thoughts or suggestions would be appreciated.

Chuck Ross, DPM, Pittsfield, MA

Query: Joint Injection for Acute Gout Attack

A patient comes to the office complaining of a gout attack. The doctor examines the patient and diagnoses an acute gouty attack, joint, right foot, and injects a steroid cocktail to the area of the midfoot around the cuneiform-navicular joint area to reduce the inflammation and relieve her pain. How is the injection coded?

Cristina Marquez, El Paso, TX

Response: If the injection is for the cuneiform-navicular joint, I would consider this an intermediate joint, and would recommend CPT 20605.

If it's within the tendon or ligaments area around that joint, then see CPT 20550-20551. Where the needle is placed will determine which code best describes what was done.

Leslie Johnson, CCS-P, CPC, Cranford, NJ

Codingline subscription information can be found here
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RE: Bunion Procedure? (Angelo J. Bigelli, DPM)
From: Multiple Respondents

I would consider an opening base wedge with a locking plate or a Ludloff, both of which are good for reducing big IM angles.

Bill Trabulsi, DPM, Lutz, FL, trabulsidpm@tampabay.rr.com

I hope that when Dr. Bigelli wrote Moderate IM angle, it was a typo.  If not, he shouldn't be doing the surgery. I haven't measured it, but it is obviously a very large IM angle. He failed to mention one important factor: is there hypermobility at the first met cuneiform joint? High IM with hypermobility suggests a Lapidus. High IM without  hypermobility suggests a Ludloff, base wedge (opening or closing). If trackbound, a Reverdin may be necessary at the head to correct PASA.

Conservative therapy sounds good to me.

Ken Meisler, DPM, NY, NY, kenmeisler@aol.com

I think you are "between a rock and a hard place." Procedure choice always hinges on multiple factors. Health and weight issues aside, with respect to this case presentation, active individuals with severe bunion deformity with very high intermetatarsal angles, hypermobile 1st rays, and concomitant metatarsus adductus screams for a Lapidus fusion. That would address...

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

RE: Prolotherapy for Achilles Paratendosis (Brent Rubin, DPM)
From: Geoffrey Bricker, DPM

I recently lectured at the Goldfarb seminar on this subject and posted notes with my exact injectables and dosages on their website. In regard to the number of steroid injections, in my experience if there is no improvement after two, then alternative treatment (surgery, prolotherapy, physical therapy) should be considered. I will repeat a series of 2-3 injections in the same area with a 3 month interval especially in the case of plantar fasciitis. So what if the fascia tears? That is essentially what surgery does. Major rearfoot tendons usually respond to prolotherapy and there is no limit to number, and sometimes three injections are necessary to see a response.

Geoffrey Bricker, DPM, Springfield, MO, geoffreybricker1@msn.com

RE: Three Strikes and You're Out? (Frank Lattarulo, DPM)
From: Jason Gross, MHA

Obviously, the previous responses have been purely clinical, and rightfully so, but when I read PM News, I am always looking at it from an administrative standpoint. If you are reliant on reimbursements from third-party payers such as Medicare, there are LCDs to reference. In NC the “chapter and verse” for Cigna Medicare can be found in the LCD # L6168, which states that …”these indications are usually resolved after three (usually weekly) injections.”  The LCD does make allowances for another series of injections, but the need for such must be clearly documented with obvious improvement noted. 

As stated by Dr. Lattarulo earlier, there are also other requirements such as medical management, Pt and/or OT, and psychiatric evaluation and therapy. (I am just stating the rules according to Medicare for reimbursement). Of course, as a physician, you would rather follow your solid medical training than an LCD, but if the nurse/auditor reviewing your notes decides you did not meet the guidelines, then you’re likely not going to get paid – but that is another discussion altogether.

Jason Gross, MHA, Forest City, NC. jgross@footandanklenc.com

RE: The Langer Comprehensive Orthopedic Management of Lower Extremity Ailments Seminar
From: George F. Jacobson, DPM

This past weekend, I attended  “The Comprehensive Orthopedic Management of Lower Extremity Ailments,” whose chief sponsor was Langer Biomechanics. Jason Kraus pointed out the many fallacies that we have within our practices, limiting our own incomes. There are many items we can incorporate into our practices that we have shied away from because of cost. This seminar was a good reminder (in a relaxed small setting) of what we are capable of, but simply not utilizing in our practices.

The seminar was a good refresher for orthotics to diabetic shoes to AFOs or products as simple as diabetic socks that our patients need, but perhaps are not getting from our offices. The hands-on casting lab for AFOs using the synthetic tubular sock was easy and relaxed. I have never dispensed an AFO, as I had no casting experience with them. I am now comfortable enough not to send the next one out. 

George F. Jacobson DPM, Hollywood, FL, fl1sun@msn.com

RE: Allscripts EMR (Daniel Cohen, DPM)
From: Robert M Cropper, DPM

I find Allscripts to be of very limited usefulness. The interface is neither user-friendly nor intuitive. It requires a lot of input manually, and the database of pharmacies is inadequate.

Robert M Cropper, DPM, Sarasota, FL, Ftdrbob@aol.com

RE: Fringe Faux Pas (Peter J Bregman, DPM)
From: H. David Gottlieb, DPM, Michael Felicetta, DPM

It was brought to my attention a few years ago that TV shows, ads in magazines, and other media use the foot for x-rays and MRIs. I didn't believe him at first, but I paid attention and sure enough he was right. You will notice foot/ankle x-rays and MRIs all over, even in episodes of House.

H. David Gottlieb, DPM, Baltimore, MD

If you ever notice any TV show or movie, and even news stories involving medical topics, there are always foot x-rays on the view box in the scene. We get no respect for what we do by the medical establishment, but they will accentuate the body part of our expertise to highlight their medical specialty. My wife and kids also noticed this chicanery.
 
Michael Felicetta, DPM, Toms River, NJ

RE: Medicare Made Funny

I think that PM News readers would get a kick out of this movie I made.

David T. Weiss, DPM, Richmond, VA

ASSOCIATE POSITION – IOWA CITY AREA

Modern practice seeking a well-trained (PSR 24/36) associate to start immediately. Excellent opportunity for an energetic, hardworking individual with strong surgical and medical skills. Solid referral network and 13 years of growth. Come live in the Iowa City area and enjoy the quality of life and stability of a Big Ten University community. Competitive salary and benefit package available. If interested, fax CV to 319-354-1014 or e-mail to dave@341foot.com

ASSOCIATE POSITION - MICHIGAN - (OAKLAND COUNTY)

Outstanding opportunity for associate in well established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.com. All replies kept strictly confidential

ASSOCIATESHIP - MARYLAND

A great opportunity to join and gain ownership interest of a well established, diversified practice in Maryland. 2-year residency needed, EHR, ultrasound, ASC, hospital close by with wound care center. Fax resume to 410-749-6807.

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

ASSOCIATE POSITION - FREDERICK, MARYLAND

Well-established group practice is located only 45 minutes from both DC and Baltimore. Immediate opening for a minimum PSR 36 Podiatrist for full time position. We have it all: EMR, digital x-ray, ultrasound, ASC, etc. Excellent salary with bonus structure and benefits. Please email resume to docsbnb@aol.com

POSITION AVAILABLE -  NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office multi-doctor practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Florida has a great scope of practice law and we rotate for ER call at all 4 hospitals. Candidate needs to be ethical and motivated. Established practitioner or new practitioner OK. Fax CV to (239)566-8778 or Email CV to Drgordon@gulfcoastfootcare.com

IMMEDIATELY AVAILABLE- ASSOCIATE POSITION - DAYTON, OHIO

Join a well-established modern practice with an excellent reputation and referral base. Base salary $100,000 and benefits with a bonus structure. EMR, diagnostic ultrasound, all aspects of DME, Padnet vascular studies, and CO2 lasers. We seek a surgeon that is well trained, personable and motivated to join our group of 3 Podiatric Surgeons. Would like this individual to buy in the practice eventually. Please send resume and photo to ohiodoctors@aol.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate opening for the right candidate. Join a well-established podiatric group in Southwest Florida. We are a multi-office practice with EMR, Digital x-ray, and more. Seeking full-time associate that is PM and S-36 trained, personable, independent and highly motivated individual. Must be BC/BS in rearfoot and ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary, excellent lifestyle. Please respond to JLH459@aol.com

ASSOCIATE POSITION - CALIFORNIA

Busy, surgically-oriented practice in Bakersfield, CA seeks ABPS qualified/certified surgeon to join our existing two surgeons. Must be hard-working and honest. Strong reconstructive surgical practice with trauma privileges and wound care center/diabetic limb salvage center. Starting in December or January. E-mail CV to aghams2@aol.com

ASSOCIATE POSITION – NORTH, CENTRAL & SOUTHERN ILLINOIS

Quality Podiatry Group provides quality services to residents at long term care facilities. We are currently offering full-time or part-time positions for motivated ethical podiatrists. Immediate openings are available. If interested, fax curriculum vitae to 847-674-2113 or e-mail to feetwork@aol.com

SEEKING EMPLOYMENT OPPORTUNITY - NORTHERN, NJ

Looking to relocate my current position closer to home. I am honest, ethical, punctual and hard-working. PM and S-36 trained with over four years of work experience. Seeking a full-time employment opportunity starting as an associate with the potential for partnership in the future. If interested, please contact  footdoctor36@gmail.com

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to f-massuda@footexperts.com

ASSOCIATE POSITION - NYC, NY

Part/time, full/time associate for busy, well established multi-doctor, multi-office NYC group. Seeking motivated, ethical, NYC licensed DPM with excellent office management and clinical skills in all phases of Podiatry. Board Qualified/Certified preferred. Salary plus incentives, pension/medical/dental. Partnership potential. Fax CV to 631-369-6570.

ASSOCIATE POSITION - MARYLAND AND DC

Immediate opportunity to join our group in Maryland and DC. Will consider full or part-time. Our practice is general podiatric care with a heavy slant on sports medicine/orthotics. In-office ASC. Must be PSR 24-36. Send cover letter and CV to hgodpm@verizon.net

ASSOCIATE POSITION - PHILADELPHIA, SOUTHERN NEW JERSEY

Seeking motivated, independent foot & ankle surgeon to join large practice. Our multi-office practice covers all aspects of foot and ankle pathology, including heavy hospital volume. Offering competitive salary and benefit package. Send CV and two references to bleich5252@yahoo.com

EQUIPMENT FOR SALE - WHIRLPOOL AND WHIRLPOOL CHAIR
 
Professional, Whitehall brand 15 gallon Podiatry Whirlpool and Whirlpool Chair. In excellent condition. $2000.00. Please contact fergusondpm@aol.com

TRAUMA FELLOWSHIP - FOOT & ANKLE

Broadlawns Medical Center in Des Moines, IA is currently accepting applications for its 12 month trauma surgery fellowship beginning August 1, 2011. Fellowship to include advanced techniques in all foot and ankle surgery with an emphasis on lower extremity trauma, reconstruction & total joint replacement. Residency training required. Competitive salary and benefits. Please submit a letter of interest, CV, and 3 letters of recommendation to: Ben Olsen, DPM, Director: Foot and Ankle Trauma Fellowship, Broadlawns Medical Center, 1801 Hickman Road, Des Moines, IA 50314, 515-282-7927, bolsen@broadlawns.org

PRACTICE FOR SALE - MARYLAND, DC SUBURB

Own your own practice and be your own boss.Great opportunity. Retiring after 38 years in practice at the same location. Practice is fully equipped with digital x-ray, diagnostic ultrasound, computer network, orthotic scanner and state licensed ambulatory surgical center. Owner will stay on as needed for easy transition. dpmpracticeforsale@yahoo.com

ACTIVE PRACTICE FOR SALE - NYC

Part-time practice, capable of expansion to full-time, desirable Mid-town Manhattan location, fully-equipped, established for over 30 years. Doctor is retiring. (212) 247-5148 Fax (212) 581-0148.

PRACTICE FOR SALE - CONNECTICUT

Outstanding solo practice for sale in northern Fairfield county, CT. Shared space with other medical professionals. Very low overhead. Grossing almost $300K on 30 hours per week. Referrals from three different primary care physician offices. If interested e-mail CTPodiatry@gmail.com

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