The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

December 07, 2011 #4,325 Publisher-Barry Block, DPM, JD

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Ingrown Toenails Can Be Genetic: NY Podiatrist

According to podiatrist Dr. Jennifer Hutton, if you have frequent ingrown toenails, it may not be a coincidence; in fact, it may be genetic. Hutton said, “You can see family members coming in and their first question to me is, 'I remember my dad having ingrown toe nails - could it be genetics?'" 

Dr. Jennifer Hutton

Surgery is sometimes used for ingrown toenails, where the side of the nail is permanently removed. "We actually use a cutter to remove the side of the nail, all the way down to the base," said Hutton.

Source: Marcie Frasier, YNN Rochester [12/3/11]

Onychomycosis is a Common and Frustrating Condition: Canadian Podiatrists

There's a fungus among us and it's not very pretty. Called onychomycosis, nail fungus is estimated to affect up to 10% of the population worldwide. "It's everywhere in our environment," says Toronto podiatrist Dr. Andrew Klayman. "Exposure to the gym, unsterile pedicure instruments at nail salons, swimming pools, and public showers can spread the fungus. And it's contagious."

(L-R) Drs. Andrew Klayman and Hartley Miltchin

Dr. Hartley Miltchin, director of Toronto's Accent on Feet clinic says treating fungal nails has been one of the most frustrating challenges during his 30 years as a podiatrist. Fungus causes toenails to become discolored, thickened, and separated from the nail bed. "Patients who suffer from fungal nails are often too embarrassed to wear open-toed shoes or show their feet," Miltchin says.

Source: Marilyn Linton, Toronto Sun [12/5/11]

AZ Podiatrist Lectures at BUSPM on Charcot Foot

The Paul & Margaret Brand Research Center at the Barry University School of Podiatric Medicine presented the first in a series of national lectures focusing on diabetes and its complications. Robert Frykberg, DPM, MPH, chief of the Podiatry Section in the Department of Surgery at the Carl T. Hayden Veterans Affairs Medical Center in Phoenix presented a lecture on “The Charcot Foot 2011” at Barry. 

Dr. Robert Frykberg at BUSPM

More than 200 students, residents, faculty and greater Miami podiatric practitioners attended the event. Dr. Frykberg discussed the most current information on the cause, natural history and management of the diabetic Charcot foot.

Source: MEXexpress [Winter 2012]  

NJ Podiatrist Run for Children Who Can't

Peter Wishnie, DPM, a podiatrist in Hillsborough and Piscataway, NJ traveled to Texas on Sunday to run in the metroPCS Dallas White Rock Marathon benefiting an exceptional children's orthopedic hospital.  Texas Scottish Rite Hospital for Children treats children with all sorts of pediatric orthopedic disorders as well as neurological disorders.

Dr. Peter Wishnie

"The race was especially important to me and I ran it in Dallas to support the Texas Scottish Rite Hospital because my friend, and fellow podiatrist, Dr. Marybeth Crane's daughter was a patient there."

Source: Jessica Gleason, mycentraljersey.com [12/4/11]

Query: Is the EMR Incentive Check Taxable?

We recently received our first EMR incentive check.  Is the incentive check taxable?

James Breedlove, DPM, San Luis Obispo, CA

Response: PM News does not provide legal advice. Yes, the IRS views all payments that you receive under the health IT incentive programs as taxable income. You may be able to write off a portion of the hardware or software purchase costs associated with your EHR, but there are limitations, so consult your tax adviser. Your tax adviser may also be aware of additional tax incentives unique to your state.

Query: Starting a Practice

I recently went into private practice after almost 10 years in the pharmaceutical industry. I am having a hard time trying to establish myself. Does anyone have some good ideas to help me establish my practice. I have tried placing ads in the local papers. I am now going door-to-door to introduce myself to PCPs, nephrologists, endocrinologists, etc. 

Nicole Rubackin-Hayward, DPM, Westwood, NJ

Query: CPT 97597 with CPT 11721 Denials

I have received denials from Tennessee Medicare for CPT 11721 when billed with CPT 97597. After research of these codes, I have found that they are not able to be billed together. What is the logic of this? Would we not be able to add a "-59" modifier to get it paid? What does nail condition have to do with a wound?

Anna Sanders, Clarksville, TN

Response: Yes, you can bill CPT 11721 and CPT 97597 together, but you need a "-59" modifier on CPT 11721 (as well as any other modifier or ICD-9 code to qualify the palliative care). CPT 97597 (CCI edit column 1) and CPT 11721 (CCI edit column 2) are mutually exclusive with a "1" indicator.

About mutually exclusive: "The mutually exclusive edit table contains edits consisting of two codes (procedures), which cannot reasonably be performed together based on the code definitions or anatomic considerations. Just as with the column 1/column 2 correct coding edit table, mutually exclusive edits consist of a column 1 and column 2 code. If two codes of an edit are billed by the same provider for the same beneficiary for the same date of service without an appropriate modifier, the column 1 code is paid. However, in the mutually exclusive edits table, the “column 1” code generally represents the procedure or service with the lower work RVU. Medicare pays the lower-paying of the 2 codes. If clinical circumstances justify appending a CCI-associated modifier to column 2 code of a code pair edit, payment of both codes may be allowed.

As mentioned above, CCI-associated CPT or HCPCS modifiers could override a CCI edit when clinical circumstances warrant. (from CMS/NCCI). About indicator "1": "The '1' indicator means that the modifiers associated with the CCI are allowed with this code pair when appropriate." (from CMS/NCCI)

About CPT or HCPCS modifiers: The CPT modifier that can override a CCI edit when clinical circumstances warrant is "-59" on the column 2 code. If billed CPT 97597, CPT 11721-59 with the appropriate peripheral vascular disease ICD-9 code and the appropriate appended class finding modifier [Q7, Q8, or Q9]. You should have been reimbursed. If not, appeal.

Harry Goldsmith, DPM, Cerritos, CA

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RE: Terbinafine Overdose (Eric Edelman, DPM, Ken Meisler, DPM)
From: Bryan C. Markinson, DPM

Dr. Edelman reports a situation where his patient somehow took 60 terbinafine tablets in 20 days and relates that he ordered blood tests which were normal, and that the patient did not seem to have any ill effects. He then goes on to say that in 5 weeks, which is when he found out about the incorrect dosage, the patient's nails did not clear, and wonders if it is safe to give the patient more terbinafine.

It seems at best, that even after the five weeks he speaks of, the patient had less than 4 months of therapy, incorrect dosage or not. Therefore, any conclusion that the nails did not clear is way too premature, as the rate of clearing is related to...

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

RE: Life-Long Maintenance Regimen for Onychomycosis (Evan Meltzer, DPM)
From: Robert A. Kornfeld, DPM

What I believe is missing from the discussion of life-long management of onychomycosis is "why does this patient have it?" Since we know that these organisms are ubiquitous and everyone has potential for exposure, why do some have chronic tinea pedis and onychomycosis, and others do not?
 
Answering this question will establish life-long management, and it goes way beyond Lysol spray or preventing athlete's foot. One must look at mechanisms. A burdened immune system is at the core of chronic infection. Once you identify the mechanisms and control them, you have a more reliable life-long management protocol. To do this, you need to study this particular patient's epigenetic influences on inefficient immune response, and do functional/molecular lab work to establish the causative diagnosis.

Robert A. Kornfeld, DPM, Manhasset, NY, Holfoot153@aol.com

RE: MN Podiatrist Supports Statewide Single-Payer Health Insurance System (Randall Brower, DPM)
From: Michael B. DeBrule, DPM

Thank you, Dr. Brower for calling attention to the single-payer solution. I believe healthcare should be a basic human right. The U.S. spends about twice as much per capita as other industrialized countries on healthcare, with worse outcomes: fifty some million uninsured, millions more under-insured, and medical bankruptcy remains a reality. One study estimates over 18,000 people die each year in the U.S. from lack of insurance. Private insurance paperwork, lobbying, bureaucracy, and profits consume almost one third of our healthcare dollar. 

Streamlining payment through one non-profit payer could save us over $400 billion, provide high quality insurance for everyone, and compensate physicians fairly. Vermont recently passed a single-payer system, and other states like Minnesota may follow. No healthcare delivery system is perfect, but single-payer costs less and covers everybody. Please visit pnhp.org for more information.

Michael B. DeBrule, DPM, Marshall, MN, Dr.DeBrule@InnovativeFootCare.com

RE: Why This Country is Going Broke (Dale Smith, DPM)
From: Richard Rettig, DPM

Dr. Dale Smith's letter regarding an 8 year old applying for disability with flatfeet (perhaps among other things) resonated with me. So many of my patients under 65 come in the office with Medicare insurance. Many of them fill out my history intake form, listing no serious medical issues. The 'business model' for success in my community is to qualify for welfare, then to bump that up with SSDI payments, and who knows how many other 'programs' (LIHEAP for utilities, etc.) My daughter teaches special ed elementary school, and most of her pupils qualify for SSDI with such things as ADHD.

I saw an episode on "60 Minutes" maybe 30 years ago, where a small town in West Virginia had a huge percentage of children on SSDI, and it turns out the parents would coach the kids on how to fake mental illness. In addition to personal injury law commercials, daytime TV and billboards also bombard people with legal ads from disability lawyers who will help you qualify on a contingency basis. I believe you only have to qualify once; then you are fixed for life. Both political parties were complicit in creating this environment; who could vote against the handicapped?

Richard Rettig, DPM, Philadelphia, PA,  rettigdpm@gmail.com

RE: The World's Most Expensive Shoes Sold for $26K

What’s a brand to do when some of its most iconic pieces are set to be auctioned off? Get in the game and buy them back, of course. That’s what French shoemaker Roger Vivier had to do this week to recover some of his greatest work — and in the process, it turned one pair into the most expensive shoes in the world, according to Women's Wear Daily.

Roger Vivier design for Princess Soraya (Pierre Aubert-SVV Aguttes / WWD.com)

But the world’s most expensive shoes didn’t belong to rock stars — they were made for royalty. The pair you see above was made for Princess Soraya of Iran in 1962. The kitten heels are covered in silver thread, and the little orange sparklers all over them are topaz. The final bid was  $26,600,

Source: Justin Fenner, Stylite [12/5/11] via Dr. Khurram Khan

SPACE AVAILABLE - NYC & LI

Office to sublet and share - East 60th Manhattan, and Plainview, Long Island. access to an MRI, Joint Commission certified operating rooms, digital x-ray, diagnostic ultrasound, and access to a multi-specialty ambulatory surgical center. Also availability E 22nd between 2nd and 3rd and E 70th off 3rd. Turn-key operation - no investment needed 516 476-1815 PODO2345@AOL.COM

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.

RESEARCH AND SURGICAL FELLOWSHIP PROGRAM: BOSTON UNIVERSITY MEDICAL CENTER
 
Join our team and become an expert in limb preservation, tissue repair, and wound healing. This is a unique accredited multidiscipline fellowship program at a major teaching hospital. Fellows will be expected to significantly contribute to clinical research, surgical procedures, teaching and innovation with a world renowned expert team. Requirements: Completion of a two or three-year surgical residency; ACLS certified. Candidate must possess a commitment to an academic career in podiatric medicine and surgery. Program begins 7/1/12. Submit a CV and letter of interest to: Erin Springhetti erin.springhetti@bmc.org and the Director Dr. Vickie Driver,Vickie.driver@bmc.org. If questions call 617-414 6821.

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 DPM  footcare@comcast.net

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

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate position for associate to partnership for a surgeon that is BQ/BC by ABPS. Must be a PSR-24 or PM&S-36 trained. 100K start. Must be ethical, self-starter, hard worker ,team player. Willingness to learn / work as part of a team. Great ancillaries & surgery facility.  Must be proficient in rearfoot/ankle surgery. Email CV and recent cases to: susmitad86@yahoo.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

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 - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." to Drgordon@gulfcoastfootcare.com.

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 - NC PIEDMONT

Excellent opportunity for highly motivated, ethical, and personable PSR 24/36. This well established, 3-physician practice has excellent rapport with physician community, multiple office locations, and hospital privileges. Intent is an associate leading to partnership for the right individual. Competitive salary & benefits. Email CV to dpmassociatenc@gmail.com   

ASSOCIATE POSITION - TEXAS

We are looking for a reliable and enterprising podiatrist who will assist in growing our practice. People skills, clinical/surgical skills and good behavior will be a plus also Texas license required. forward your CV to "divinefootcarecenter@yahoo.com or you can also contact us at 972-790-2800, fax number 972-790-2803. 

PART TIME PODIATRIST NEEDED- LOS ANGELES, CALIFORNIA
 
Busy podiatrist looking for assistance with treating home-bound patients. Flexible hours, independence, and great compensation. If interested, email CV to homefootcare@hotmail.com

ASSOCIATE POSITION - SOUTHEAST GEORGIA - SAVANNAH

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 - 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

PM News Classified Ads Reach over 13,500 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 13,500 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. Weekly ad rates start as low as $109 for a 50-word ad THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451.

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