The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 14, 2007 #3,092 Editor-Barry Block, DPM, JD

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Special Workshop Added to 2008 PM News - Codingline - AAPPM Hawaii Meeting

Due to popular demand, we've added a special no-cost, limited registration workshop on how to create and send a patient newsletter via the Internet for free. PM News editor Barry Block, DPM, JD will show you step-by-step how to utilize this powerful, cost-effective way to internally market your practice. This workshop will be open to the first 25 registrants who sign up. For registration visit www.podiatrym.com/hawaii

Dry and Cracked Heels Need Lactic Acid Exfoliant: TX Podiatrist

Doctors like podiatrist Mary Beth Crane know summer foot fashions leave many people asking for help with their heels in the fall. Some of Crane's patients' heels are so dry that they are plagued by discomfort and even pain. "It's the repetitive stress of wearing an open-heel or sandal all summer. Your body thinks it has to make thicker skin to toughen up," said Crane.

Dr. Marybeth Crane

Crane said that dry and cracked heels can be more than just a nuisance. The condition is also a symptom of many serious health problems like an underactive thyroid where the body's metabolic rate is lower and there is less sweating, making the skin drier.

Dry heels are also seen in diabetics and people with psoriasis or athlete's foot. Ordinary lotion won't cure the condition, but experts advise the solution is simple if you know what to look for. "You're looking for a lactic acid exfoliant. Everything from a 12 percent to a 20 percent that's over the counter," said Crane.

Source: NBC5.com [11/9/07]

FL Podiatrist is First to Lecture at AAAM's International Congress

Dr. Bret Ribotsky of Boca Raton, FL recently became the first podiatric physician to lecture at The American Academy of Aesthetic Medicine’s International Congress (AAAM) in Los Angeles, CA. Ribotsky’s presentation was on pedal soft tissue temporary augmentation (PSTTA) to an international audience of dermatologists, plastic surgeons and other physicians.

Dr. Bret Ribotsky

The technique of PSTTA that Dr. Ribotsky has developed has enabled many women wishing to wear high heel shoes, and walk pain-free. Michel Delune, MD, Congress President said, "Dr. Ribotsky's unique style, captivated and mesmerized the audience.”

AAPPM Fort Lauderdale Meeting Another Sellout Success

Another year, another sellout. That’s been the recurring theme of the American Academy of Podiatric Practice Management’s annual practice management meeting. There’s no mystery as to why. Combine top practice management experts, a luxury resort hotel, and a tropical climate, and you get one of the most valuable experiences available to the podiatric community.

Dr. Bradley Bakotic conducts biopsy workshop at AAPPM Ft. Lauderdale Meeting

Attendees, ranging from new practitioners to seasoned veterans participated in lectures, roundtables, and workshops. In the small roundtable discussions, they shared their pearls as well as their problems.

Those who missed this unique opportunity are advised to register early for AAPPM’s next seminar in Pittsburgh on March 6-9, 2008 (www.aappm.org). That meeting is also a traditional sell-out.

Query: Dox EMR

I am in the process of setting up my own practice and I am seriously considering starting with an Internet-based EMR system. My favorite at this point is the DOX EMR which is advertised on this site. Does anybody use this now? It looks good on the demo and it seems that it would streamline the whole patient flow, making documentation and coding a lot more efficient. The initial costs are the lowest I have seen among several other systems I have looked at, which is why I would consider starting a practice with it. But, I would like to hear from anybody who is using this system or for any other reviews of systems out there that would be highly recommended or warned against. In theory, these systems are supposed to make our practices more safe, efficient, and effective. How well does this translate into practice?

Jeff Hagen, DPM, Danville, CA

Query: Orthotic Casting Coding

When casting for a pair of custom foot orthotics is S0395 (impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic) an appropriate code to use? Do insurance companies recognize and pay for S0395?

Michael Piccarelli, DPM, Staten Island, NY

Response: I have found that if you are the supplier of custom foot orthotic devices, most payers consider the impression casting as "global" to the reimbursement of the orthotic. This is typical of any type of orthotic dispensed, e.g., upper extremity, lower extremity, back etc.).

The only code I have had any success with (when payers consider cast impressions separately payable) is CPT 29799, the unlisted cast code. When I bill this, I find payers want a narrative description of what kind of casting I am doing. In my experience, most payers that reimburse CPT 29799 include the materials used within the code allowance.

Paul Kesselman, DPM, Woodside, NY

Editor's note: Dr. Kesselman will be a featured speaker at both the Codingline New York Meeting on January 24th and the 2008 Hawaii Coding and Practice Management Workshop (www.podiatrym.com/hawaii)

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

RE: Post-Alcohol Injection Rash (Ivar E. Roth DPM,MPH)
From: Ira Weiner, DPM, Jason Nolan, DPM

I had a similar reaction for injections in the past. I had attributed it to several things. When doing nail surgery, I found that the patients who applied topical antibiotic cream developed a rash, so I changed my protocol to judicious use of triple antibiotic, or discontinuing it after 7 days and this seemed to help. On the other hand, I have also found that excessive use of either ethyl chloride, or flouroethyl seemed to promote a skin reaction. For the most part, I have discontinued the use of it, as in my opinion it has more of a placebo effect, and my skin reactions from injections have decreased to nearly zero.

Be advised that your patient could be having an allergic reaction of sorts, and this of course should be investigated as well.

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

I have had a similar response in one of my patients after giving injections number 3 and 4. Based on the appearance I believed it to be a dermatitis reaction to the sclerosing alcohol touching the skin when a drop or two touched after removing the needle. Since alcohol cleansing evaporates, I cleansed the area with Technicare to create a barrier before the next injection and have since done 3 injections without the rash appearing again. If you try this and they still develop the rash, I recommend stopping the therapy.

Jason Nolan, DPM, Stark, OH, jasonenolan@hotmail.com

RE: Visa Gift Cards For Co-Pays
From: Paul Kesselman, DPM

On November 6, The Wall Street Journal published a story about Highmark Inc selling Visa Gift Cards which can be used for co-payments. This wealthy insurance company has now figured out a way to take even more of your money well in advance of providing you with health benefits.

Some may have thought insurance companies maxed out on ways to reduce their exposure with higher premiums, deductibles and co-payments. Now they've found another way to scheme patients and health care providers out of even more money.

Buy a gift card ranging from $25 to $5,000 which can only be used for co-payments. Of course the insurance carrier makes interest on your hard earned money until the card is redeemed. They also fail to mention that this transaction will cost you a percentage based on the contract you have with your bank. They also will charge you $4.95 for the privilege of purchasing this card. Presently, the card is only available in Pennsylvania, but Highmark expects to soon go national. They expect to sell several thousand cards between $75 and $100 during the next year.

If the insurance carriers can do this why can't I. Perhaps I too should sell off a few thousands of these cards to patients and their families etc in anticipation of their needing my services. I too could then earn a nice tidy some on the interest in anticipation of seeing these patients. Why stop there? I could sell advertising space on the card, charging a fee to the advertiser making yet even more money. And you thought you'd heard it all!

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

ASSOCIATE POSITION - WEST COAST, FL

Outstanding opportunity for PSR-36 graduate to join highly successful group podiatry practice in Summer 2008. Seeking a sociable, articulate graduate who is confident in rearfoot and ankle reconstructive cases but also enjoys all phases of podiatry. Long-term opportunity for the right candidate with generous pay and benefits. Reply to jwicks@ips.med

ASSOCIATE POSITION- NORTH LOS ANGELES COUNTY

Full scope of podiatry. Requires usual skills in surgery, medicine and biomechanics. Must be self-starter and highly motivated. Two full days per week. May soon increase to three days per week. All billing and administrative aspects handled by staff. Can practice autonomously. footguy1@pacbell.net

PRACTICE FOR SALE - MISSISSIPPI GULF COAST

Near Casino's and beaches. Busy Practice with no HMO's and good insurance coverage. Hospital and Surgical Center privileges available. Call (228) 762-9531 or email me at jwbenus@yahoo.com

PART-TIME LONG-TERM CARE OPPORTUNITIES- Chicago, Peoria, & East St Louis areas

We specialize in providing conservative care to residents in long-term care settings. Immediate part-time positions available. Very flexible scheduling. Competitive compensation and expenses. Contact Dr. Brian Aronson. Phone-773-775-0300, or Fax resume to 773-775-0883

DPM-PT POSITION AVAILABLE - NEW JERSEY

Podiatrist/Physical Therapist dual-degree (DPM-PT) needed to join expanding 2 DPM practice and develop an internal Physical Therapy department with strong emphasis to all phases of Podiatric PT; including foot/ankle surgery, sports medicine, peripheral neuropathy and advanced wound care. Will hold position for right candidate. CV/Questions: pat_caputo@alumni.rutgers.edu

ASSOCIATE POSITION - ILLINOIS

Excellent opportunity for ethical & personable hard-working individuals to join a busy multi-office two physician practice. Looking for one podiatrist with interest in conservative care, including sports medicine and one podiatrist trained in rearfoot surgery. Rearfoot surgeon must be board eligible and working toward board certification. Competitive salaries, 401-K, health insurance, paid vacation and more. Please forward CV with references to nrussell@neondsl.com

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