The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

November 23, 2011 #4,313 Publisher-Barry Block, DPM, JD

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BUSPM Professor Presents Research Findings at WOUNDS UK

Dr. Robert J Snyder, professor and Director of Clinical Research at the Paul & Margaret Brand Research Center at Barry University, and his group presented findings surrounding clinicians' perceptions of proteases and wound healing at the WOUNDS UK symposium in Harrogate, England, November 14-16, 2011.

Dr. Robert Snyder at WOUNDS UK

The quantitative research showed that wound specialists appreciate the value of proteases in both acute and chronic wounds, however, the study substantiated the premise that the absence of visual cues make treatment choices challenging. Clinicians overwhelmingly agreed that a point of care diagnostic test could be beneficial. Snyder, along with Dr. Breda Cullen, Lorraine Nisbet and Dr. Thomas Serena, will publish these findings as well as other observations in an upcoming journal article .

AZ Podiatrist Reports Positive Results for Phase III Trial of Wound Product

SANUWAVE Health Inc. has announced that positive data from its phase III clinical trial of dermaPACE for the treatment of diabetic foot ulcers was the subject of a Continuing Medical Education (CME) accredited presentation at Desert Foot 2011. Robert Frykberg, DPM, MPH, chairman of Desert Foot 2011, a surgeon at the Carl T. Hayden Veterans Affairs Medical Center in Phoenix, and a principal investigator in the dermaPACE clinical trial, presented the technology in an exhibition titled "A Shocking RCT: Getting Wounds to Heal." 

Dr. Robert Frykberg

Dr. Frykberg's presentation highlighted the dermaPACE pivotal phase III clinical trial results, which demonstrated statistical significance of 100% wound closure compared to alternative Sham-control treatment. DermaPACE also significantly reduced the size of the target ulcer compared with Sham-control treatment, was associated with low ulcer recurrence, and was well tolerated.

Source: Pharmacy Choice [11/21/11]

PA Podiatrist To Donate Turkeys to the Homeless

Robbins Rehabilitation, a private physical therapy practice and East Penn Foot and Ankle Associates, a private podiatric practice in the Lehigh Valley, are promising to donate a Turkey for every new patient each practice sees until Thanksgiving. The overall goal is to donate over 200 turkeys to Robbins Rehabilitation’s and East Penn Foot and Ankle’s chosen food banks and shelters.  

Dr. Adam Teichman

“Everyone deserves a happy Thanksgiving with a traditional Thanksgiving meal,” said Todd Robbins, owner and therapist of Robbins Rehabilitation. Dr. Adam Teichman of East Penn Foot and Ankle Associates said, “Some people in this country are going through some hard times right now. We can’t change the world, but hopefully we can change Thanksgiving for over 200 people right here in the Lehigh Valley.”

MI Podiatrist Pleads Guilty to 1 Million Dollar Healthcare Fraud

A Clarkston podiatrist faces up to 10 years in federal prison for trimming toenails and then charging more than $1 million for the foot treatments. Dr. Richard Alan Behnan, 55, a traveling podiatrist, pleaded guilty to healthcare fraud today, admitting he charged the government and an insurance company more than $1 million for nail surgeries, when he was mostly trimming toenails.

Source: Tresa Baldas, Detroit Free Press [11/21/11]

Supercommittee Fails to Reach Deal

The co-chairs of the Joint Select Committee on Deficit Reduction announced Monday afternoon that the 12-member panel will not reach bipartisan agreement before its Nov. 23 deadline. This summer's Budget Control Act tasked the supercommittee—composed of six Democrats and six Republicans—to identify ways to cut at least $1.2 trillion in federal spending over the next decade. If the committee failed to achieve this goal, the next step is likely sequestration, in which automatic cuts of $1.2 trillion—split between defense and domestic programs—would kick in starting in 2013. Medicare cuts would be capped at 2%.

“Once again, Congress failed to stop the annual charade of scheduled Medicare physician payment cuts and short-term patches, which spends more taxpayer money to perpetuate a policy everyone agrees is fatally flawed,” Dr. Peter Carmel, president of the AMA, said in a statement. “A decade of uncertainty and repeated threats of steep cuts jeopardizes access to care for seniors and military families who rely on the Medicare and TRICARE programs,” he added. “TRICARE rates are tied to Medicare rates, so a 27% cut to Medicare means a 27% cut to TRICARE.”

Source: Jessica Zigmond, Modern Healthcare [11/21/11]

Query: Foot Orthotic Casting Billing

What code do you use for the impression casting for custom foot orthotics?

Sandy, Office of Allan Hetelson, DPM, Bensalem, PA

Response: You have two options.

1) HCPCS S0395 (impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic) - this would be billed "S0395-RT" and "S0395-LT". A number of payers do not recognize temporary national HCPCS codes.

2) The other option is CPT 29799 which is an unlisted casting code. Since it represents an unlisted item(s), it would be billed once to include bilateral impression casting.

The minimal casting supplies are incidental to the professional service and the orthotics allowance. Because some payers deny casting fees as included in the foot orthotic allowance, you should check with the individual payer for their foot orthotic benefit and payment policies to minimize confusion.

Tony Poggio, DPM, Alameda, CA

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RE: Extra Metatarsal (Joseph Borreggine, DPM)
From: Barry Mullen, DPM, Eric Edelman, DPM

I believe the correct term is polymetatarsia, and it is a rare condition without a supernumerary digit. The x-ray shows an "adult" foot with closed growth plates. My treatment would be to plan to take an additional x-ray in 6-12 months. I would also make the patient aware that a tailor's bunion is likely to occur at some time, and treatment can wait until there are symptoms, or the bone could be resected at their convenience, before it becomes a problem.

In a child, I would encourage resection of the bone once growth plates have closed, and prior to leaving high school. It would be a relatively short recovery, and you would likely prevent them from needing a 5th metatarsal osteotomy later on to correct a tailor's bunion.

Eric Edelman, DPM, Syracuse, NY, ericedelman@gmail.com

I don't know if it has a specific acronym, but supernumerary metatarsal seems appropriate. Uh, no pain, then why treat? An old professor at NYCPM once opined that "if it ain't broke, don't fix it because you can't take something that doesn't hurt and make it feel any better!" Pretty sound advice from a wily veteran that has served me well throughout my career and has withstood the test of time, so consider before proceeding. 

Barry Mullen, DPM, Hacketstown, NJ, yazy630@aol.com

RE: Wavelengths for Laser Treatment of Onychomycosis ( David Zuckerman, DPM)
From: Elliot Udell, DPM

Dr. Zuckerman deserves to be commended for making the following statement: "...you can charge the patient a fair fee for the clearing of toe nails that will probably have a re-occurrence down the road." Too many people who have monetary interests in selling us lasers for the treatment of onychomycosis are willing to charge us over 50 thousand dollars for a unit but are not willing to admit that there will be a "re-occurence down the road."
 
What would probably put a laser into every podiatrist's office, including mine, is if insurance paid for the treatment. Then, no one would have a problem telling patients up-front that the laser is treating an infection, which is a medical condition, and may have to be repeated periodically, but the cost is rightfully covered by insurance.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Sesamoid Pain Right Foot (Bryan C. Markinson, DPM)
From: Lewis Teich, DPM

I don’t think there is enough information provided for any definitive diagnosis, let alone a recommendation for surgery. An x-ray of the contralateral side could rule out bi-partite sesamoid, vs. an old fracture. A lateral weight-bearing view would provide information regarding position of the 1st ray; i.e,. is it plantarflexed? Have you taken an axial sesamoid view? Oblique views? 

Other than starting after a marathon, and lasting for the past six months, I think of initial “comfort” with an orthotic to reduce pressure beneath the 1st MT head is certainly reasonable, sans other possible information of relevance possibly omitted.

If this was occurring at the level of the 2nd or 3rd metatarsal heads, wouldn’t simple capsulitis be a strong consideration? As bi-partite sesamoids are often symptomatic, and often accompanied by a plantarflexed 1st ray, I'd first consider the woman likely “pushed” harder while participating in the competitive marathon, resulting in inflammation of the joint. Untreated capsulitis/sesamoiditis can last a very long time, easily six months.

Why not just pad proximal to the 1st MT head for a week or two, provide an anti-inflammatory of your choice, and see how she feels? If she has relief, make an orthotic which will accomplish the same weight transfer. If no relief is obtained, then perhaps look for other less obvious etiologies.

Lewis Teich, DPM, Bellvue, CO, LJTMesa@aol.com

RE: Foot Strike Patterns in Recreational Runners
From: Kevin A. Kirby, DPM

There is currently considerable debate on proper foot strike technique for runners within the sports medicine and running communities. A number of alternative "running styles", including Chi Running and Pose Running, are being preached to runners as better running styles where the runner is taught to not heel strike during running, but rather is taught to contact the ground on the midfoot and forefoot. These new "fads" of running have now reached the level that many runners who normally heel strike have been told by a friend or coach to modify their running style to a midfoot/forefoot striking pattern which may lead to new running injuries. As a result of seeing this trend of new running injuries grow over the past few years in my practice, I now routinely ask my runner-patients on their initial examination if they tried to change their running form sometime before their running injury started.
 
In this regard, a new paper has just been added to the literature which demonstrates that out of 936 recreational and sub-elite runners, 88.9% of runners at the 10K mark of a half-marathon/marathon road race were heel strikers, 3.4% were midfoot strikers, and only 1.8% were forefoot strikers (Larson P, Higgins E, et al.: Foot strike patterns of recreational and sub-elite runners in a long-distance road race. 2011 Nov 18, Epub ahead of print.) This is only the third scientific study ever published that has classified the percentages of rearfoot, midfoot, and forefoot strikers during long distance road races.
 
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirby@comcast.net

RE: Formula 3 President/CEO Killed in Car Crash
From: Jeffrey Kass, DPM

I want to extend my condolences to the DiMeglio family. PM News reported on Paul's death in a car accident last week. Mr. DiMeglio was President and CEO of Formula - 3. While, I did not know Mr. DiMeglio personally, his company is an integral part of the podiatric profession and deserves recognition.

This company quietly came on the scene and essentially "stole" the market on topical anti-fungal treatments. Two basic prinicples were followed: doctor exclusive branding and a money-back guarantee. I applaud Mr. DiMeglio for his contribution to the podiatric profession - May G-d rest his soul.
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Sinus Tarsi Implant Surgery (John M. Wray, DPM)
From: Michael E. Graham, DPM,  Arnold B. Wolf, DPM 

I would like the opportunity to reply to the comments made regarding the use of HyProCure and 28585. Mostly, I want everyone to be aware of all the supporting facts.

It may be assumed that the use of the CPT code 28585 is for an “acute trauma” but, to my knowledge, nowhere is it written that this code can only be used in a case of “acute trauma.” We have received many expert opinions on 28585, not only by attorneys who specialize in health insurance coding issues but also by leading coding experts. In all of the reviews, not one person, firm, or organization has been able to supply us with documentation that 28585 is a trauma procedure.

The description of the 28585 code entails...

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

"Recurrent dislocation of ankle and foot joint." This is what is defined by ICD-9 code of 718.37. My concern is that now some "among us" may be stretching recognized clinical pathologies to "fit" a diagnosis that will subsequently allow us to use a procedure code that in turn, "fits" the diagnosis. My understanding of joint dislocation is more consistent with disarticulation...where the joint surfaces are truly separated with a concomitant failure of the supporting structures of that joint. My professional concern is that there seems to be a convenient "laxity of interpretation" of what joint dislocation means. Secondly, how does one clinically justify subtalar dislocation?

I think colleagues are walking on "thin ice" if a subtalar dislocation is defined by mild-moderate increases in talocalcaneal angular relationships while, at the same time, the joint surfaces are reasonably in close approximation...as is typically seen when considering a subtalar arthroesis. The fact remains that, in reality, subtalar joint dislocation is a rare "beast", as is surgical repair for that deformity. I think that if we begin to use the diagnosis of subtalar dislocation for conditions that are more accurately defined by pes planus (and the like), our credibility and professionalism should then be called into question. I agree with the salutation in the preceding post: "let us tell it like it is."
 
Arnold B. Wolf, DPM  Sterling Heights, MI, omnifootcare@prodigy.net

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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: website Tel. 425-643-8901isbinc2006@gmail.com

CPME-CERTIFIED WOUND CARE FELLOWSHIP

Open position available Jan.31, 2012. St. John`s Episcopal Hospital, Far Rockaway New York. State-of-the-art wound care center. All aspects of wound care including hyperbaric oxygen & reconstructive surgery. One year, excellent salary & benefits. Must have completed approved residency and passed boards. Contact Mariann (718) 869-7256

EQUIPMENT FOR SALE - CLASS FOUR LASER- USED K-LASERS

I have used K-laser for sale. Still in Warranty. Used for plantar fasciitis, Achilles tendonitis, neuroma, arthritic conditions and even fungus toe nails This laser is portable, re-chargeable and can be move from room to room or office to office. This isn't the cold laser that you see. It is a 10 watt laser. We have used this laser on NFL sports players. For those that understand a good laser. E-mail David Zuckerman, DPM for Details and pricing. footcare@comcast.net

EQUIPMENT FOR SALE - SUPERPULSE 45 WATT PEAK POWER LASER ( LUMIX2)

Superpulse 45 watt peak power Laser ( lumix2) used once or twice. This is a real superpulse 910nw up to 100,000 HZ. Great Laser Used in the super bowl by the Green Bay Packer Why am I selling? I have too many lasers in my office now ( six) This is a great laser for plantar fasciitis. Achilles tendonitis. Lightweight portable. easy to use, fully programmable Sold to first person under $$12,000 You will NEVER get a laser like this at this price. Enjoy. it I just have too many lasers. David Zuckerman DPMfootcare@comcast.net

PRACTICE FOR SALE – NANAIMO, BRITISH COLUMBIA, CANADA

Have you ever dreamed of owning a practice where...you can see 0-50 patients daily * average 100 new patients monthly * have zero accounts receivable * gross $480K per year * live in a beautiful community with skiing, hiking, fishing, and boating on your doorstep. This could be yours! If interested contact pistone@telus.net or call 250-754-4192.

ASSOCIATE POSITION - NORTHWEST IOWA

A well-established, midwest multi-physician practice with strong hospital affiliations seeking FT podiatrist. Applicant should be well trained surgical physician, completed a 24-36 month residency, & board eligible. Practice offers high surgical volume, advanced wound care and good mix of general podiatry. Competitive salary, excellent benefits. Fax resume: 712-258-9977 Diane Coulter, Office Manager

ASSOCIATE POSITION – NEW YORK CITY/ LONG ISLAND

Beautiful weather year round & near the Coast. Opportunity for Early Buy-in. Seeking associate or new residency graduate to join practice. Must be PSR-24/36 trained. Multiple locations. Full range of services with new facilities. E-mail cover letter & CV to melissafoot@pol.net

ASSOCIATE POSITION - BAKERSFIELD, CA

Busy surgically-oriented group in Bakersfield, CA searching for 4th doctor. Wound care center privileges. All 3 current surgeons have 3+ years post-graduate training. Send letter of interest with CV to:aghams2@aol.com

ASSOCIATE POSITION - UPSTATE NEW YORK

Outstanding Opportunity. Our medical surgical group is recruiting a well-trained licensed podiatric physician. Located in Beautiful upstate NY. Full hospital privileges, as well as working with two residency programs. Must be highly motivated and great with patients. Opportunity for growth. Competitive salary and benefit package. Please send CV to associateinfoot@yahoo.com

ASSOCIATE POSITION - SOUTH/CENTRAL PENNSYLVANIA

PSR-24/36 trained individual for busy practice in family-friendly college town. Seeking personable, ethical, motivated individual to join our well established practice providing all aspects of podiatric care. Competitive salary and benefits package. Reply with letter, CV and photo to Jagerone@aol.com.

ASSOCIATE POSITION - DAYTON, OH

Join a well-established modern practice in Dayton, Ohio. Excellent reputation and referral base. Base salary $120,000, benefits and bonus structure. EMR, diagnostic ultrasound, Padnet vascular studies, CO2 lasers, all aspects of DME. We seek a surgeon that is well-trained and personable to join our group of 4 podiatric surgeons. Would like to have this individual buy in to the practice eventually. Please send CV and to Ohiodoctors@aol.com

ASSOCIATE POSITION - MARYLAND

Looking for 3rd associate. Must be personable, well trained and highly motivated. Great locations in Southern Maryland, including an Ambulatory Surgical Center. We currently have EHR, digital radiography, dispensing center and PADNet. Looking for immediate hire! Please send CV to:myfeetfeet@aol.com

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. $160,000 base salary with bonus incentives and benefits. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE POSITION - TEXAS

Well established, expanding podiatric medical and surgical practice with multiple locations Northeast of Dallas, Texas. Modern offices with EHR, digital radiography, Padnet vascular studies and laser. We offer a competitive salary and benefits package for a motivated, ethical, personable and well trained PSR/36 or board equivalent. This individual will also assist managing the residency program. Send resume (CV)to northtexaspodiatry@yahoo.com along with a letter of intent

ASSOCIATE POSITION - MARYLAND

Multi-office group seeks highly trained surgical associate to join us. Prefer person with frame and trauma experience. Our practice is state-of-the-art and has all modalities: EMR, PadNnet, on-site billing, diagnostic US, PRP, digital x-ray, etc. Excellent salary, bonus structure and benefits with partnership available. Please forward CV and letter of intent to docsbnb@aol.com

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