The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 28, 2007 #3,103 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2007- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

FL Podiatrist Uses Sculptra for Fat Pad Atrophy

Podiatric physician Dr. Cynthia Marzouka-Losito at Miami's Protech Sports Medicine is now offering a procedure that will create a pillow-like cushion on the ball of the foot. By injecting Sculptra®, a safe, synthetic, and biocompatible material (a material that does not harm the body) below the surface of the skin, it "puff ups" areas that have atrophied over the years due to wear and tear.

Dr. Cynthia Marzouka-Losito

Sculptra®, also known as poly-l-lactic acid has been widely used for many years in dissolvable stitches, and soft tissue implants. Now, it is being used in the feet to eliminate pain.

"We are now utilizing this material to supplement areas such as the balls of the feet and other bony areas where there is atrophy of the fat pad, often caused by wearing high heels," said Dr. Marzouka-Losito. "Sculptra® fills those flattened areas and provides internal cushioning in the feet, creating padding between the skin and the bones of the foot. Loss of fat on the bottom of the foot is common, especially in women. This can result in pain and burning on the ball of the foot.

Life is Sweet For CA Podiatrist

Podiatrist Mark Wolpa of Berkeley, CA, had been dabbling in chocolate for years, making gifts for his patients when he started thinking about gummies. The result is Stinky Feet, a foot-shaped gummy candy in sour apple and cinnamon that has been picked up by NECCO candies.

Dr. Mark Wolpa

Wolpa, chief of podiatric surgery at Alta Bates Hospital, calls his candy company Toe-rific Candy. Among the chocolate offerings are Mazel Toe, Mistle Toe and Heart & Sole.

Source: Marcella S. Kreiter, UPI, [11/26/07]

N.Y. State Lawmakers Back Doc-Ranking Bill

Two top New York state lawmakers are backing legislation based on the state attorney general’s physician-ranking model that has been adopted by top insurers. The bill, the first of its kind in the nation, will codify the physician-ranking standards agreed to by six leading health insurers in recent weeks, including Aetna, Cigna Corp., UnitedHealth Group and WellPoint.

The physician-ranking model, created with the American Medical Association, AARP and Consumers Union, prohibits insurers from ranking physicians based only on cost. In addition, insurers promised to adopt measures endorsed by the National Quality Forum and other reputable national standards. The insurers will use risk-adjustment and valid-sampling data to compare physicians and disclose to consumers and physicians details on the ranking design. A ratings examiner, paid for by the insurers, will oversee compliance and report to the New York attorney general’s office every six months.

Source: Rebecca Vesely, Modern Healthcare [11/26/07]

Query: Duty to Report Violation

My office is located a few blocks away from another podiatrist. As a result, I see many of his patients, several who have shown me EOB’s for services they claim he never performed. In some cases, services were billed on days, such as weekends, when his office is not even open! When patients ask me what to do, I tell them that I don’t want to get involved. Do I have any ethical duty to report these incidents?

Name Withheld

Editor’s comment: PM News does not provide legal advice. If a single patient complained to you about a single disputed EOB, there is certainly a possibility that the patient misunderstood the billing. A common situation occurs when a patient receives an EOB which states CPT 11721 Nail Surgery.” In such a case, there would not appear to be any duty to report this.

The scenario presented, however, appears to far more problematic. When a pattern of fraudulent billing becomes obvious, a duty to report this to the insurance carrier/ and or your state licensing board arises. In some states, such as NY, failure to report professional misconduct is, in itself, professional misconduct and could subject you to professional discipline.

In addition, the APMA Code of Ethics addresses this point: BE5.1 Duty to Report Violation

BE5.11 The podiatrist is obliged to report known violations of conduct by providers to the appropriate authority.

Query: Coding for Repair of a Subluxed MPJ

One year ago, I performed and arthrodesis of the 2nd digit. Unfortunately, the 2nd digit became subluxed at the metatarsal-phalangeal joint with associated changes to the overlying skin.

I performed an extensor tendon lengthening along with a capsulotomy and flexor tendon transfer. I also performed a V-Y skin plasty. What would be the proper CPT code(s)?

Michael Fein, DPM, Bethel, CT

Response: There are several ways this repair can be coded.

Given the surgical description you provided, I would recommend the single code, CPT 28313 - reconstruction, angular deformity of toe, soft tissue procedures only.

Harry Goldsmith, DPM, Cerritos, CA

[Dr. Goldsmith will be a featured speaker at the Codingline-NYSPMA 2008 "Strictly Coding*" Seminar (www.codingline.com/events-ny.htm) - approved for 8.0 PMAC CEUs and 7.5 American Academy of Professional Coders CEUs (prior approval obtained)]

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

RE: Gray/Black Bone? (Michael Nirenberg, DPM)
From: Multiple Respondents

I have seen this before and I believe it is a copper depositions disease, like Wilson's disease. Have her see an endocrinologist.

Peter J. Bregman, DPM, Tewksbury, MA, footguru@comcast.net

We had a case in my residency with a similar finding. The patient was taking or had taken Minocycline over a long period of time. Minocycline is an antibiotic similar to tetracycline but without the photo-sensitivity issues. If my memory serves me correctly, a literature search revealed other cases describing gray pigmented bone in patients taking this antibiotic. The biochemistry has something to do with the interaction of this type of antibiotic with calcium. The same way tetracycline can cause enamel stains on teeth.

David T. Taylor, DPM, Flint, MI, dttaylor_19@yahoo.com

Be sure to rule out aseptic necrosis, which can occur for a variety of reasons.
1. Compromise of the arterial supply to the bone.
a. Failure to re-approximate the periosteum.
b. Iatrogenic loss of the nutrient artery.
c. Previous trauma
2. Thermal necrosis from power equipment
3. Septic necrosis of the joint is also consideration if the clinical picture fits.

Jay Lieberman, DPM, Margate, FL, drjayl@prodigy.net

RE: PM’s Policy on Coding and Billing Questions
From: Mike Rosenblatt, DPM

PM News has a policy of first forwarding all billing and coding queries to Codingline.com for posting. I agree with this restriction and believe that it is appropriate.

Regrettably, I have read and heard "false information" on coding. Your readers can be confident that PM News is reporting authoritative information.

Since I am retired, I stay away from specific coding issues. I do not advise clients on this issue, however, I do disclose the results of Digital Chart Audits (TM) for E and M codes, since it is a matter of "consonance" with the Digital Chart Audit Module.

Mike Rosenblatt, DPM, San Jose, CA, rosey1@prodigy.net

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com -- www.homephysicians.com

WEEKLY SPECIAL - One week of ads (5x) for only $85

PM Classified Ads Reach over 10,000 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 10,000 DPM's. Write bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451 Ext 110

• 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.