The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

December 12, 2007 #3,115 Editor-Barry Block, DPM, JD

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Don’t Judge Running Shoes By Price Tag – GA Podiatrist

A study in The British Journal of Sports Medicine says cooler isn’t always better. In the published study, 43 men each tested 9 pairs of running shoes. The researchers report “no significant difference in comfort between the shoes, regardless of the price.” That doesn’t surprise Emory podiatrist Rami Salis.

“I've seen some at Wal-Mart that do just as well as some at the more specialty shoe places. It's really not the shoe, but the make of the shoe,” said Salis. No matter what the price, there are important things to look for in a shoe. “What you want to do is to take the shoe and see if you can torque it side to side and if it moves just a little bit too easily, it generally means that the shoe is pretty weak and it’s not going to give you much support at all,” said Salis.

You also need to make sure you have support in the heel and adequate cushioning. Bottom line: if it feels good, it should work for you. So decide based on the way the shoe is made and not the markup on the price tag.

Source: WSBtv.com, GA [12/10/07]

Use of Skin Thermometer Drastically Reduces Diabetic Foot Ulcers: Study

Clinical trials, including one that will be published in December in the American Journal of Medicine, are proving that skin temperature monitoring significantly reduces foot ulcers in diabetics who suffer neuropathy - numbness in their extremities. Dr. David Armstrong, director of the Scholl College Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science and the James A. Lovell Federal Health Center in North Chicago, IL, was principal investigator and lead author on the latest study using the infrared TempTouch.

Dr. David G. Armstrong

Diabetics can now use the wand-like, gooseneck TempTouch before they begin their day’s activities. A spike in temperature warns that an infection is brewing so they can stay off their feet until the threat of an ulcer subsides. “A wound will heat up before the skin breaks down,” said Armstrong, professor of surgery and associate dean at Rosalind Franklin’s Scholl College of Podiatric Medicine. “You can detect infection by checking one foot compared to another foot, one toe compared to another toe.”

The latest clinical trial found that study participants who used the TempTouch were three times less likely to develop ulcers compared to those in the standard therapy group who were instructed on how to visually inspect their feet.

Source: Newswise Medical News [12/10/07]

Florida Begins EHR Pilot Program for Medicaid Recipients

Medicaid recipients in Tallahassee and surrounding Leon County are the test subjects for a bold Florida experiment: a pilot program giving them their own electronic health records. The initiative, administered by Florida's Agency for Health Care Administration, runs from November to February 2008 and seeks to create EHRs for each of the 25,000 Medicaid recipients in Leon County, said Peter Finney, program manager of the Electronic Health Records Center of Excellence for Electronic Data Systems, a Plano, TX, information technology corporation.

The effort, called EDS CareNetwork Solutions, is based on an existing EHR system that was created by CentriHealth, a Nashville health information company. The program collects medical information from the diagnostic and procedural codes entered for a patient's Medicaid claim and assembles these data into a single, coherent file, Finney said.

The information already is filed electronically into the state's existing Medicaid Management Information System, said Alan Strowd, bureau chief of Medicaid contract management for the state's AHCA. Up to 98% of Florida physicians who participate in Medicaid file electronically, Strowd said, creating a huge database of information. In turn, this file will act as the foundation for an individual health record, consolidating key information such as current health records, lab results and x-rays, EDS said.

Source: Dave Hansen, AMNews [12/17/07]

Query: Nerve Transposition Code

The surgical orders state "release nerve entrapment IDCN" for which I already have a code. The doctor also noted performance of a nerve transposition. What would be the CPT code for a nerve transposition?

Nikki Mitchell, Office of Andrew Lowy, DPM, Phoenix, AZ

Response: Neuroplasty is the decompression or freeing of intact nerve from scar tissue, including external neurolysis and/or transposition.

If the doctor did a release and transposition of a digital nerve (IDCN), then the coding would be CPT 64702 (neuroplasty; digital, one or both, same digit)

If the doctor did a release and transposition of a foot (non-digital) nerve, then the coding would be CPT 64704 (neuroplasty; nerve of hand or foot).

Harry Goldsmith, DPM, Cerritos, CA

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

RE: Digital X-rays or Fluroscope? (Kevin Pham, DPM)
From: Juliet Burk, DPM, Bob Kornfeld, DPM

The most important thing to do is find out for sure is that your local Medicare carrier allows podiatrists to bill for Fluoro exams. We have a fluoro, but have to bill XR codes in Oklahoma. Also, we got taken on price when we bought ours. We spent nearly 30K on our from a vendor at a conference, and found out later that good used machines retail at $12,500 to $15,000. We keep having some company call us to repurchase ours and get offers of $7,500, but we still owe 20K. So if you are going to buy one, buy smart.

Also, be aware that each image you print will cost nearly $1. And the largest screen you get is 4". I still send some folks to the hospital when I want a full foot XR, but mostly, I still like my machine. And it does cover its cost even to bill as XR.

Juliet Burk, DPM, Tahlequah, OK, juliet@autismteachingtools.com

I have been using in-office fluoroscopy for 7 years. I find it an indispensable part of my diagnostic, injection and surgical armamentarium. It gives real-time images in an instant and is extremely helpful in placement of internal fixation devices and intra-articular injections. Since I do not participate with any insurance companies, I cannot speak about reimbursement in-network, but the out-of-network benefits for it's use are very fair and reasonable.

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

RE: H & P's versus "Clearance for Surgery" (Angelo J. Bigelli DPM, DPM)
From: Tim Vogler, DPM

Dr. Bigelli is correct… The history and physical is not synonymous with the medical clearance. The history and physical outlines the patient’s medical history, basic medical appraisal, and planned treatment; It is not necessarily a medical clearance for surgery. Information in the history and physical (such as a history of heart disease, or detection of a heart murmur on examination) allows the operating surgeon and/or anesthesiologist to classify the patient as to potential risk or need, thereby justifying consultation and further evaluation by an appropriate medical specialist (for medical clearance) if needed.

Tim Vogler, DPM, High Point, NC, Timothy.Vogler@cornerstonehealthcare.com

RE: Malpractice Case Challenges IA Podiatrist’s Qualifications (Lee C. Rogers, DPM)
From: Gerald Mauriello Jr., DPM, MA, Name Withheld

I cannot agree with Dr. Rogers comments more. Having just completed the credentialing process I can relate with difficulties associated with our board certification process.

Gerald Mauriello Jr., DPM, MA, Lakewood, NJ , mauriellodpm@gmail.com

I agree wholeheartedly with Dr. Rogers’ conclusion that the ABPS should re-examine their certification process. I completed a CPME-approved PSR-12 residency in 1997. I took, and passed the ABPS board qualified written examination in 1999. I subsequently went to work for a diabetic foot specialty group for 6 years....literally 100% of my patients had diabetes. My surgical case load consisted primarily of limb salvage procedures, and very little elective surgery.

As I compiled my surgical cases and began to look more closely at the ABPS case diversity requirements, I realized that I wouldn't have the required number of hallux valgus procedures to meet their requirements in the 7-year window following my board qualification status. I called the ABPS to explain my situation, and was told "we don't offer certification in diabetic foot surgery."

To make matters worse, the ABPS bylaws were changed to require a 24-month residency as a prerequisite for board certification beginning with the 2006 exam year. So this left me in a situation where: a) my board qualification status would expire, b) I could not submit my cases for certification because they didn't meet the case diversity requirements, and c) I could not reapply for board qualification without quitting my practice and doing another 12 months of CPME-approved residency. How many of you would quit your practice after 7 years and enter a PPMR residency program for $25k/year?

Despite the fact that I had personally performed over 600 surgical cases in my 7-year window (many of them complicated limb salvage), I'm still not "qualified" to be board certified by the APBS. I followed a path that they "approved" for me, and then they changed the rules to exclude me from completing the certification process.

Name Withheld

RE: Video Recording Informed Consents (Marc Katz, DPM)
From: Richard W. Boone, Sr.,

Editor’s note: This extended-length note appears at: http://www.podiatrym.com/letters2.cfm?id=16990&start=1

ASSOCIATE PART-TIME POSITION MARYLAND

Part-time, Leading to a full time position. A well-established, successful podiatry group in Washington Suburban area of Maryland , Ownership opportunity. Surgery Center on-site. Great office staff. Flexible schedule. Great opportunity. Biomechanics and or Surgical residency experience preferred. Fax Curriculum to 240 465 0332. Email pmrypmry@yahoo.com. Call 240 604 4564.

ASSOCIATE WANTED – NEW YORK IMMEDIATE OPENING

Busy multi-dimensional practice; 70 miles north of New York City . Currently five (5)-doctor practice. looking to expand – all phases of podiatric medicine. contact: (845) 454-8308 EXT: 106

FULL OR PART-TIME POSITION WANTED – LOS ANGELES COUNTY

Well-trained podiatrist looking for a full or part-time position in Los Angeles County area. Professional, motivated, courteous and interacts well with patients and staff. Recently completed Kaiser 3-year surgical training program. CV and letters of recommendation available upon request. samiam_dpm@yahoo.com or 818-693-4790.

A well-established, ethical solo podiatry practice wishes to expand its current surgical services by hiring a full time associate with PSR-24/36 training which includes strong surgical rear-foot and ankle reconstruction, diabetic limb salvage (AZ is a no amputation state) and ER trauma. ABPS qualified/certification required. Applicant must be personable and caring to patients. Practice in an office base within a state-of-the-art orthopedic surgical hospital environment and plenty of future expansion capabilities for a bright, eager, reliable associate. Email complete CV with current references and photo to footdoc352@cox.net

PRACTICE FOR SALE-CENTRAL WYOMING

Come enjoy the great outdoors. Growing practice. Established referral patterns. Full hospital privileges available. No nursing home care. No HMO’s. Few PPO’s. Great opportunity for surgical growth for the right individual. Currently grossing $200,000+ with 20 hours patient contact. E-mail for more info at mvfc@wyoming.com

ASSOCIATE POSITION - CHICAGOLAND AREA

We are a large multi office practice that covers from the Chicago area to Northwest Indiana. We are currently looking for two hard working motivated individuals to join our practice in these two areas. It is a long-term opportunity with unlimited growth potential in all phases of podiatry for the right person. Please contact for more information @ m-lacey@footexperts.com

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

PRACTICE FOR SALE (OR ASSOCIATE POSITION) - QUEENS, NY

Practice available. Terms available to work as an associate towards partner/ownership, or buy practice outright. Excellent opportunity for motivated podiatrist. Busy practice grossing $400K without surgery. Medicare 70%. Surgically trained podiatrist can significantly increase income. Close to hospitals and transportation. Call (646) 373-8921.

PRACTICE FOR SALE - SOUTH CAROLINA

Upstate SC practice of 25 years. Retiring. High Volume. 65% routine foot care, 35% surgery. Several nursing homes. Plenty of opportunity for growth. Grosses over $450,000.00 yearly. Hospital and Surgery Center privileges. Financials available upon request. Serious inquiries only! Beautiful area. Contact: Carolinafootdoctor@yahoo.com

PART-TIME PRACTICE FOR SALE - FLUSHING, NY

40 year old part time practice for sale. Priced for quick sale. Please contact me at footdoc60@gmail.com. Serious inquires only please

ASSOCIATE POSITION - SOUTHERN ILLINOIS

Tired of Nursing Home Care? Ready to join a well-established practice with 2 Board Certified Foot Surgeons? If you are a personable, ethical and responsible, hard-working podiatrist with interest in conservative care, including sports medicine, this may be the position for you. Competitive salaries, 401-K, health insurance, paid vacation and more. Please forward CV with references to nrussell@neondsl.com

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