The Voice of Podiatrists

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November 28, 2006 #2,751 Editor-Barry Block, DPM, JD

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Walk-a-Thon Walkers Need to Prepare: CA Podiatrist

"Start walking slowly before walking quickly. Then build up miles," advises Noreen Oswell, D.P.M., a board-certified podiatrist at Cedars Sinai Medical Center in Los Angeles, who has volunteered as a physician at walkathons and marathons.

Dr. Noreen Oswell

She says inactive women, who may be overweight, are especially prone to foot-related injuries from walkathons and need to prepare and use caution. "The injuries aren't like fall-and-break-your-foot," Oswell says. "It's more like overuse, heel pain, arch pain, and tendonitis. They're so common."

Source: Robin Warshaw, KVOA-TV NBC 4 Tucson (AZ) [11/26/06]

NC Podiatrists To Purchase Shock Wave Machine

A group of North Carolina doctors is leading an effort to form a limited liability corporation that will purchase and market what investors believe will become the first permanently located shock-wave therapy machine in North Carolina. The investing physicians believe the $350,000 machine could have a variety of applications, but initially it will be used to treat heel spurs — a foot problem afflicting as many as 25 million Americans — without surgery.

Dr. Norman Regal

The doctors purchasing the machine, including Dr. Norman Regal of Greensboro, Drs. Jim and Robert Mothershead in Winston-Salem and Dr. Richard Weinbaum in High Point, are already considering other applications. The machine is scheduled to begin Food and Drug Administration clinical trials soon to determine its usefulness for treating other common orthopedic ailments, including tendonitis in the heel and elbow and rotator cuff injuries in the shoulder.

The business potential motivated a total of 20 podiatrists from across North Carolina to form N.C. Shockwave Partners. Regal said the machine will be housed in the Triad because of its central location. He said if demand justifies it, more machines will be added — and patients would get treatment from their individual physicians.

Source: Marc Barnes, Triad Business Journal (NC) [11/26/06]

January 18, 2007 ("The day before the NY Clinical Conference") - Marriott Marquis

Topics: Medicare & CPT 2007 - DME Update - Audits - Routine Foot Care - Surgical Coding - Forms in Practice - Modifiers - Audits - Q&As
Speakers (tentative): Barry Block, DPM, JD (Sponsored by Doak Dermatologics); Harry Goldsmith, DPM; Mark Schilansky, DPM; and Paul Kesselman, DPM.

Go to or click on www.codingline.com/events-ny.htm for details and registration information.

For a list of all meetings go to: www.podiatrym.com/meetings.pdf

Query: Martel's Sign

What is the origin of the word "Martel or Martel's" sign? I am writing a clinical case report on pathological fracture secondary to gout in the first metatarsal.

Dwight L. Bates, DPM, Dallas, TX

Response: Dr. Martel (from U of Michigan, I believe) reported this finding in 1968 (but others coined the phrase "Martel's sign" at a later date): W Martel: The overhanging margin of bone: a roentgenologic manifestation of gout. Radiology 1968 91: 755-756.

For educational purposes, I always like to define what Martel described, i.e. the overhanging margin of new bone along the edge of an erosion. Important also to note that Martel's sign is not present in all cases of gouty arthritis.

Robert A. Christman, D.P.M., M.Ed., Director of Radiology & Online Learning, Temple University School of Podiatric Medicine, rchristman@tuspm.temple.edu

Query: Billing a Radiofrequency Procedure

Our doctor performed a radiofrequency procedure. His colleagues have told him that they are using CPT 64640 (destruction by neurolytic agent; other peripheral nerve or branch) multiple times (one per insertion of the probe) with ICD-9 codes for plantar fasciitis and neuritis, or for Achillies tendinosis and neuritis (as the case may be). Is this appropriate? If not, what would be the appropriate CPT code?

Lisa Maynard, New York, NY

Response: You should exercise caution when using new technology or new procedures when billing.

Rule #1: If a representative tells you to use a specific code or a series of codes. DO NOT JUMP AND USE THOSE CODE(S)...DO YOUR HOMEWORK! Does the code that you SELECTED have the words or description of what you are doing for that specific procedure published in the current CPT BOOK?

Rule #2: Select the exact CPT code that describes the work you are doing. IF NO CODE EXISTS, THEN YOU ARE REQUIRED TO UTILIZE AN UNLISTED CPT CODE IN THE SECTION THAT MOST REPRESENTS WHAT YOU DID (e.g., CPT 28299, unlisted procedure, foot or toes).

Rule #3: Use resources such as this forum. If you are an APMA member, one of the benefits is the ability to send APMA a request for a reply from the Coding Committee.

Rule #4: DO NOT BE IN A HURRY TO USE A CODE THAT IS INCORRECT. This could lead to repaying the insurer, or, potentially, fraud charges. Do not put yourself in a position you cannot defend.

David J. Freedman, DPM, APMA Coding Committee Member, Silver Spring, MD

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

RE: Benfotiamine (Jeffrey Kass, DPM)
From: Greg Mowen, DPM, Bob Kornfeld, DPM

I have regularly used Benfotiamine Neuropathy formula (www.benfotiamine.net), which is basically a good B complex that supposidely gets absorbed better then other forms of b complex. We have to retail this from the office. I will also rx Metanx if patients prefer to use their rx plan. I think B vitamins and folic acid have their place in dealing with most neuropathies, certainly with b1 an b12 deficiencies. I have not seen any real "break through" changes in the patients condition with vitamin therapy but I think there is often subtle improvements.

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

I have had success with benfotiamine as an integral part of a diabetic protocol. But I have not tried it as a stand-alone therapy.

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

RE: Diabetic as a Descriptor
From: Craig Payne, Sam Bell, DPM

This has long been an issue for me and has been widely debated and discussed (mostly outside the USA). In today’s environment, it is becoming more politically incorrect to label people. As Dr. Burrell points out, to call someone a "diabetic" is becoming more and more inappropriate (despite it being in common usage). They are people with diabetes. It’s the same as calling someone with leprosy a "leper". I do notice on my travels that the USA is lagging behind the rest of the world in moving towards this more appropriate use of terminology. Diabetes nurses are also moving (or have moved) faster than diabetes physicians.

Taken to the extreme, I had a smart alec student ask me if they should stop labeling me as lecturer and instead call me a "person who lectures." There will be a happy middle ground in all this.

Craig Payne, LaTrobe University, Melbourne, Australia, C.Payne@latrobe.edu.au

Ever since I saw billboards and bus signs from the Epilepsy Foundation saying "Epilepsy is what I have, not what I am." I have tried to be sensitive to saying that someone has diabetes and not someone is a diabetic. Although the term diabetic may be used commonly, apparently people who have a disease may be sensitive to the descriptor used.

Sam Bell, DPM, Schenectady, NY, dpmbell@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

ASSOCIATE POSITION – VANCOUVER CANADA

Associate superb opportunity- beautiful Victoria, BC, Canada- multi office ,future buy-in. Full scope Podiatry Write Dr.Cole@shaw.ca.for further details. Exam given in June 2007.

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

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