The Voice of Podiatrists

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November 26, 2008 #3,410 Editor-Barry Block, DPM, JD

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OH Podiatrist Stresses the Importance of Educating Diabetics

In a recent article in the Journal of the American Podiatric Medical Association, Jeffrey M. Robbins, DPM and his team at the Louis Stokes Cleveland VAMC make the case for more aggressive risk communication for patients with diabetic foot ulcerations. “We know that there is an alarming 5-year mortality rate for patients who present with their first diabetic ulcer regardless of whether they go on to heal their ulcers or suffer an amputation. Our experience, and the experience of others, has shown us that close to 50% of those who suffer an amputation will die within 5 years and close to 45% of those that heal will be dead in 5 years. This despite the evidence that there is a lot more we can do to prevent this high mortality due mainly to cardiovascular complications.”

Dr. Jeffrey Robbins

Robbins said that “once a diabetic foot wound or ulcer is present, discussion about mortality rates should be essential. The podiatrist or foot-care specialist treating diabetic foot wounds should consider primary-care or cardiology consultation for assessment, considering the strong association between CAD, PAD, and diabetic foot wounds, as well as the mortality associated with all three. Our approach to patient communication and education may need to change in order to properly communicate the risks to patients with diabetes. The message needs to come from the entire healthcare team and should be consistent and clear.”

Source: Journal of the American Podiatric Medical Association, Volume 98, Number 6, 489-493 2008.

Three OCPM Faculty Named for Excellence in Education

Ohio Magazine recently named three Ohio College of Podiatric Medicine (OCPM) faculty members in its “2009 Excellence in Education” edition.

Dr. Bryan Caldwell

Dr. Bryan Caldwell has been a faculty member at OCPM for 14 years. He is currently the Department Chair of Podiatric Medicine and Assistant Dean of Clinical Education and Director of Clinical Operations. His expertise includes dermatology and infectious diseases. He has authored several student manuals on infectious diseases and antibiotics.

Joanne Eble

Joanne Eble has taught at OCPM for over 19 years as a histology instructor and course coordinator. She introduced computer-assisted instruction to support both lecture and laboratory learning. Her dedication is demonstrated by being consistently available for student consultation and instruction. She has received the OCPM Faculty Innovation Award.

Dr. Lawrence Osher

Dr. Lawrence Osher has taught radiology and imaging at OCPM for over 26 years as a Professor in the Department of Podiatric Medicine. He is the Director of the Radiology Department at the Cleveland Foot & Ankle Institute. He is a national authority on imaging of the foot and ankle.

Query: Parts for PDM Podiatry Chair

Does anyone know how to get parts to repair a PDM podiatry chair?

Matt Connolly, DPM, Edgewood, KY

Query: Billing Separate Nail Avulsions on 2 Toes

Which would be the best modifier to delineate CPT 11730 times 2 performance for 1st and 3rd right toes (one border each)?

Susan Lesser, Howell, NJ

Response: I would bill CPT 11730 for the first nail avulsion, and then bill CPT 11732 for each additional nail avulsion - per the CPT descriptor.

It would be inappropriate to bill multiple CPT 11730 on a single encounter.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found here

RE: Botox For Recalcitrant Plantar Fasciitis (Loren Miller, DPM)
From: Karen Malley Banks, DPM

Please be advised that Botox is contraindicated in anyone with neuromuscular problems. I have surgery-induced hypoparathyroidism (hypocalcemia). This is not usually considered in this class, but Ca+ is greatly involved with neurologic well-being. The plastic surgeon next door called me one day saying he had some extra Botox for the day and offered me a great deal on his extra supply. He never mentioned the contraindication as we all tend to think people are neuromuscularly healthy if they don't exhibit weakness or paralysis somewhere. WRONG!

The friend got rid of my wrinkles in my forehead, but I was a sick girl for a very long time. I felt like I had IV Botulinum toxin. Just be cautious in who you consider for this therapy as we are not as familiar with the side-effects as some. Take a complete history and don't hesitate to get clearance from the patient's family doctor. If I had asked my neurologist or endocrinologist before this treatment, they would have been able to warn me. Vanity was a bad thing and I will keep my wrinkles from now on.

Karen Malley Banks, DPM, Thomasville, GA, kmbwwjd@rose.net

RE: Marketing to Pediatricians (Chad Schwarz, Howell, NJ)
From: Tom Silver, DPM, Keith Gurnick, DPM

I have been able to develop a good relationship with certain pediatricians who I know personally in my community. One of these was able to help me to get on the "Children's Physician Network" which became the main program for all the pediatric clinics in the Twin Cities. Fortunately, the only other podiatrist on the plan is completely across town about a 30-40 minute drive away. I get referrals on a regular basis from docs at these large group practices with the bulk being ingrown nails, warts and orthotics.

The question I have is how to market to more of these docs in these groups as some of these clinics have 10 or more pediatricians (I may get regular referrals from 1-3 in the group). It would be impossible to give a presentation to all the docs and I would be running around all the time if I met them individually. Should I do a mailing to all the docs in these groups? Any suggestions to tap further into these large groups would be appreciated.

Tom Silver, DPM, Minneapolis, MN, tsilver01@juno.com

Editor’s note: An extended-length letter by Dr. Gurnick appears at:
http://www.podiatrym.com/letters2.cfm?id=23295&start=1

RE: Out-of Network
From: Seema Ramcharitar-Amante, DPM, Dennis Shavelson, DPM

I feel that I must remind people that there is nothing wrong with being "out-of-network" as long as you follow the rules, i.e., bill for the deductibles and co-insurance. Somehow, some of our colleagues make us out to be "greedy" if we stay out-of-network. I don’t want to run a mill. I give patients good service and don't overbook. I don’t receive the benefit of being in the insurance referral system and rely on personal referrals. No one should be telling me what to charge if I don’t sign up to be in their network. Does anyone tell Cartier what to charge? Patients know upfront that I am out-of-network and that they will have to pay a deductible and co-insurance- as long as they accept that I am doing nothing wrong by being out- of-network- and that does not make me greedy.

Seema Ramcharitar-Amante, DPM, New York, NY, pamperurfeet@aol.com

Editor’s note: An extended-length note by Dr. Shavelson appears at:
http://www.podiatrym.com/letters2.cfm?id=23296&start=1

RE: Bunion Surgery is Last Resort: CA Podiatrist (Keith Gurnick, DPM)
From: Howard Kimmel, DPM, MBA, Simon Young, DPM

With great interest I read Dr. Gurnick's response to the posting of Dr. Carl Wagreich's article in the Torrance Breeze. As Dr. Wagreich’s chief resident in the early 1990’s, I spent a lot of time with him in his office. Dr. Wagreich ALWAYS explained all the options for treating patients' deformities and problems, including surgery in exhaustive detail. As we know, reporters interpret and leave pertinent facts out of articles. I agree that patients come from other physicians and have exhausted conservative treatment, and are ready for surgery. If a patient seeks treatment or another physician, they might not have had the faith or trust of the previous doctor. Would you want to do surgery on that patient? The informed patient is always the best patient.

Howard Kimmel, DPM, MBA, Cleveland, OH, Howard.Kimmel@va.gov

Orthotics do not treat bunions! I am an avid believer in conservative care. Bunions are an orthopedic and musculoskelatal malady. You either accommodate with footgear modifications, orthotics, or use inserts to allay the inevitable, and/or consider surgical intervention. The only way to treat a bunion deformity is through surgery. Surgery treats the osseous deformity and intra-operative muscle balancing, followed by custom-molded orthotic appliances for the musculoskeletal aspect. Bunion surgery in the vast majority of patients can be deferred without impacting the surgical procedure or outcome.

Generally speaking, I feel bunion surgery is more imperative if premature degenerative joint disease is forming, and the 2nd toe is overriding the hallux.

Simon Young, DPM, NYC, NY, simonyoung@juno.com

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Excellent opportunity for a highly-motivated, entrepreneurial individual to join a very successful, rapidly growing multi-office practice, North of Boston. Seeking a PSR-24/36 trained podiatrist to join our group. We offer a competitive salary/benefit package with the opportunity of partnership after one year, for the right individual. Send CV and letter of interest to drfleishman@nefootankle.com

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN

Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Please send CV to slurie@papapc.net

POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes.Top hospitals. Fax CV with references to 703-491-9994

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