The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

November 24, 2006 #2,748 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2006- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

PM News wishes all our subscribers a Happy Thanksgiving!

Plantar Fasciitis Most Common Foot Problem in Soldiers: Army Podiatrist

Many soldiers experience plantar fasciitis too. "It's the most common problem we see," says Lt. Col. Patrick G. Sesto, DPM, a podiatry consultant to the Army surgeon general. The painful condition -- an inflammation of the plantar fascia, a thick band of tissue along the sole of the foot -- can be caused by a genetic predisposition or, in the case of soldiers, by exertion.

Dr. Patrick G. Sesto

Says Lieutenant Colonel Sesto, that means "overuse from running, marching and carrying extra weight like a rucksack." So how much damage can a pair of shoes (and other foot abuse) really do? A lot.

Source: Eleni Gage, Reader’s Digest [December 2006]

IL Podiatrist Sued For Allegedly Operating on the Wrong Foot

A Belleville IL podiatrist is being sued by a patient who claims her left foot was not the right foot. According to a suit filed Nov. 16 in St. Clair County Circuit Court, Carolyn Arth claims that James L. Olroyd, D.P.M. wrongfully performed surgery on her left foot. Seeking in excess of $100,000 in damages, Arth claims she was scheduled to have surgery performed on her right foot on Nov. 19, 2004, at Memorial Hospital in Belleville.

"The defendant operated on the plaintiff's foot, then recognizing his mistake, operated on her right foot," the complaint states. "As a result of defendant's negligence, plaintiff did experience pain and discomfort in the past, she was disabled and unable to work, and she has incurred hospitalization and other medical expenses for which she would not have been obligated," the complaint states. Memorial Hospital also is named in the suit.

Arth claims the hospital was negligent for failing to properly mark or designate her right foot for surgery and for failing to inform Olroyd of the proper foot to operate on. "As a result of the foregoing act of negligence, James L. Olroyd, D.P.M. operated on both feet of the plaintiff, contrary to her wishes," the complaint states.

Source: Ann Knef , Madison St. Clair Record [11/21/06]

Query: Post-op DVT after HRT

I had a patient develop a DVT after bunion surgery two weeks ago. She is on low dosage hormone replacement therapy (HRT) for menopause. For large ortho cases, surgeons are discontinuing HRT 4 weeks prior. Is there anyone who encountered this and are you discontinuing the HRT prior to surgery?

Michael Chin, DPM, Chicago, IL

Query: Teaching Billing

Our clinics are currently using an outside medical biller, to bill Medicare and other insurances. We have been a lot of problems with them, and would like to keep everything in-house. We do have an employee who has been trained for PPOs, and Medicaid, but has no experience with Medicare billing. Is there a consulting, or "teaching" company which could train our staff at our offices?

Mak Yousefpour, DPM, Los Angeles, CA

Query: Arthrodesis with Graft

The doctor performed a left 2nd toe proximal phalangeal joint arthrodesis utilizing a bone graft (harvested from 1st metatarsal) and K-wire fixation. What is the correct way to code the procedure(s)?

Lisa Maynard, New York, NY

Response: The correct code for interphalangeal joint fusion of a lesser toe should be billed as CPT 28285 (correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]). There is no other arthrodesis code involving a lesser toe fusion.

Obtaining of bone graft from the first metatarsal (presuming the bone obtained is not the bone specimen from a bunionectomy also performed) could be billed using CPT 20900 (bone graft any donor area, minor or small). I have found that some payers will not reimburse this separately (considering it to be a component of the fusion procedure). If that is the case, you may want to consider adding modifier "-22" (greater than usually required for this code) for the extra work needed to obtain the autograft. Be sure to provide a paper claim with operative report, as well as the reason for requesting additional payment.

Howard Zlotoff, DPM, Camp Hill, PA

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

RE: Flouroscan/ Mini C-arm (Ken March, DPM)
From: Greg Mowen, DPM

I have used flouro in my office for over 15 years. I love the speed and convenience but you will not usually be able to pick up stress fx, nor do "biomechanical" x-rays. I find it invaluable for intra-articular injections, foreign bodies, DJD, post-op_eval, and some MIS type procedures such as exostectomies, etc.. It is just not always great for trauma so we often have to send those patients out. DOTMED is a great web site with tons of used flouro units from many different companies.

Greg Mowen, DPM, Matgate City, NJ, gregmowen@comcast.net

RE: Proposed 2007 Medicare Cuts
From: Multiple Respondents

The reason why Congress cuts healthcare provider fees is because healthcare providers permit it. Traditionally, healthcare providers are segmented into conflicting and competitive venues, each pitted against each other for the rapidly shrinking totality. This feature has been an unmitigated disaster for healthcare providers.

The only real solution is for healthcare providers to get together and eschew their traditional competitiveness and internecine battling. This would include those who traditionally are not described as "physicians." I don't know if this will ever happen. But I do know that until it does, we will see more of the "war against healthcare providers by Congress." So far, this prediction has proven true in every respect.

Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1@prodigy.net

Sorry guys, but I am not going to spend my time telling patients they have to fight for me. That is why I now belong to the powerful APMA! Let AARP fight the Congress to keep doctors from quitting the Medicare program.

There is probably at least one person in the federal government who believes doctors will go broke at the current rates and probably assumes that if doctors stay in the program, in order to make a living, they must be cheating.

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

In the clever words of Dr. Udell, whose amusing story eloquently sums up the situation quite nicely, do you want to become the dead horse? I have chosen not to work for one bag of oats because a) I have more self-respect than that and b) one bag of oats is not enough to feed my family, so I taught myself to find the oats on my own. Now we have more to eat than the farmer ever fed me.

The moral of the story is - You can beat a dead horse, but don't mess with a hungry podiatrist!

Bob Kornfeld, DPM, Lake Success, NY, Holfoot153@aol.com

Editor’s note: This topic is now closed

ASSOCIATE POSITION - NEW ENGLAND

Terrific Opportunity Now Available in growing New England practice. Well established and respected practice with new, large office space, latest technology, very helpful staff, loyal patients and solid referral base. Close proximity to hospitals with modern surgical suites. Opportunity for shared ownership. Prefer 24 month PSR with clinical practice experience or an experienced doctor looking to improve their situation. E-mail CV and particulars to NEAFC3@aol.com

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multilocation practice looking for PSR-36 associate leading to partnership. PSR-36 trained podiatrist with great opportunity for reconstructive surgical practice. Practice has Medicare-approved surgery center. Must have excellent interpersonal skills. Excellent salary and incentive. Respond to: westsidefoot@yahoo.com

PRACTICE FOR SALE – ASPEN COLORADO

Part-time practice seeing patients between 2 and 4 days per month. Grossing over $100k. Low Overhead . Last year when staffed 4 days a month, consistently grossed $140k. Fully equipped rooms in approximately 600 sq. feet. Open to any offers. 970.471.2049 mjs10vail@aol.com

EQUIPMENT FOR SALE - Stryker Command II

Set is in excellent condition. Includes console with cable, model 2296-88 wire driver, oscillating, reciprocating, and sagittal saws and 50k drill with hand switch control, 5/32" Jacobs chuck, 0.7mm -1.8mm wire collet, and 2.0mm - 3.2mm pin collet. $5,000. (Lists for $20,000) 503-313-1196 or cseuferling@comcast.net

WEEKLY SPECIAL - One week of ads (6x) for only $75

PM Classified Ads Reach over 9,000 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 8,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.