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December 20, 2008 #3,430 Editor-Barry Block, DPM, JD

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TX Podiatrist Uses Topaz Procedure for Heel Pain

Doctors have a new, less invasive way to treat a common medical complaint: heel pain. It's a tool that makes recovering from surgery and getting back on your feet easier. It’s a new treatment — a 15 minute outpatient surgery called The Topaz procedure. Podiatric surgeon David Hughes makes a tiny incision on both sides of the heel and inserts a metal tube. Then, using a wand with a radio frequency tip, he makes tiny holes in the soft tissue. "The instrument uses radio frequency in order to stimulate this non-healing ligament to heal. So, really the only thing you're cutting is the skin. So, you have about two stitches with this procedure," he said.

Dr. David Hughes

Hughes uses the Topaz wand to create small holes in the ligament that's causing the problem. Each hole is only about an eighth of an inch deep. No major incisions, no casts and a quicker recovery. "Some of the patients I've seen have gone to multiple doctors, multiple foot stores; they've tried shoes, they’ve tried orthotics, they've had injections, they've had drugs," Hughes said. "This is finally offering them something that'll work. And it's really gratifying to see their improvement." Hughes has used this technique on about 25 patients over the past six months with good results. Besides the foot and ankle, the Topaz procedure can also be used to help patients with soft tissue problems in shoulders, elbows and knees.

Source: Wendy Rigby, KENS 5 Eyewitness News [12/18/08]

Query: Heloma Neurofibrosum

I saw a patient today with two chronic painful heloma neurofibrosum. She relates that she had less than one week’s worth of relief after debridement of the lesion. Does anyone have any treatment pearls to help me relieve this poor woman’s symptoms? I have started her off with debridement (which was very painful) and attempted to shift weight-bearing off the first and fifth metatarsal heads.

Gary A. Lieber, DPM, Delray Beach, FL

Query: Hourly Rate for Surgery?

I am employed at an Indian Health program in northern California. Currently, I am seeing clinic patients only and paid an hourly rate. I am negotiating to add surgical services at the local hospital, but have been asked to propose what would be reasonable compensation for my surgery hours. Since my surgery hours would vary from week to week, I would most likely be paid an hourly rate for these as well. Any suggestions as to what I might ask for in compensation?

Name Withheld

Query: Abscess After Wart Treatment

A patient came in for debridement and chemical treatment of a wart. I billed CPT 17110 (destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions).

The patient returned within the 10-day global period with an abscess in the same area of the treated wart. Can I bill incision and drainage of abscess - CPT 10060 - with a modifier, or is this considered global and related to original treatment?

Laurie Bodo, Lake Orion, MI

Response: The patient underwent a destructive procedure for a plantar wart. Now, the patient has a new diagnosis, abscess of the foot, that requires treatment.

I think it is perfectly reasonable to bill for incision and drainage of the abscess, CPT 10060. I would add modifier "-79" to indicate the abscess is an unrelated procedure by the same physician during the post-operative period.

Howard Zlotoff, DPM, Camp Hill, PA

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RE: TX Podiatrist Debunks Foot Detox Pads (Lewis Teich, DPM)
From: Elliot Udell, DPM

Kudos to Dr. Teich for exposing another fraud being perpetrated on the public under the guise of alternative therapies. We need to expose these fake treatments because we have a prime responsibility to educate and protect our patients from frauds and corrupt practices, especially when they involve feet.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Insurance Contracts
From: Paul Bishop, DPM, George Jacobson, DPM

Considering the non-parity of payment between specialties, why can’t we use the argument that as "the" foot and ankle specialists, we perform more foot and ankle procedures than other specialties, and thus should be paid better than those practitioners who perform those procedures intermittently. Insurance companies want pay for performance, and I’m sure there are statistics that show those surgeons who do procedures more often have less complications, and therefore the total cost of a procedure is less.

At one of my hospitals, the orthopedic surgeons want to control ankle fractures only. All other ankle procedures we can do. It comes down to money. So, I told the credentialing office that since I do more ankles than the ortho guys, that they should come through ME when they want to be re-credentialed. When a spine surgeon who takes trauma call for the ortho group 3 weeks a year gets credentialed to do ankle fractures that he may or may not see or do one a year. It's wrong. They looked at me like I was from Mars. Why not try it with insurance. We do more, and unapologetically do it better than any other specialty. We should be the ones with the preferred payment schedule and not feel badly about it.

Paul Bishop, DPM, Yorkville, IL, Feetpeople@aol.com

Unfortunately, the line of podiatrists, urologists, and dermatologists... would be unending for 75% of Medicare allowable in South Florida. For decades, "a bird in the hand" was thought to be worth two in the bush. How wrong this philosophy was (is). It now takes 3 or 4 local HMO birds in the hand, to equal one "Snow Bird"* in the bush.

*Snowbirds are patients from the North who spend their winters in sunny Florida.

George Jacobson, DPM, Hollywood, FL, fl1sun@msn.com

ASSOCIATE POSITION -SOUTHERN NEW JERSEY

I’m looking for podiatrist who wants additional practice hours. Perfect for combining your own practice with an additional income. Must be on Aetna Insurance, Horizon Blue Shield, Medicare, and most commercial carriers. I am looking for someone who has a desire to learn how a very successful practice is run, so that I will be able to have time away from my practice. The payscale is based on straight Commission. Could lead to partnership or sale. E-mail contact information, CV, and why you would be perfect for this opportunity. Contact foot.care@verizon.net

PODIATRISTS NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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 Visit our website

ASSOCIATE POSITION - MANHATTAN

Park Avenue boutique practice seeks part-time associate. Experience and integrity necessary. Please fax resume and salary requirements to (212) 889-6150.

ASSOCIATE POSITION – SOUTHERN CALIFORNIA

FLEXIBLE, Part-Time opportunity with growing podiatric medical group. MUST have CURRENT DME supplier and Medicare provider numbers. Earn over $1,000 per day, with no nursing homes. Fill in any openings you currently have in your schedule. Flexible hours available for your available time blocks. If interested, e-mail scpodgroup@yahoo.com

PRACTICE FOR SALE – CONNECTICUT

Well-established. Grossing 200K; Norwalk/Westport CT. Dr. recently deceased. High Volume Medicare ; NO BROKERS; Please email: berist92@gmail.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

ASSOCIATE POSITION – SOUTH JERSEY

Looking for additional income? We are looking for a part-time associate for busy South Jersey, Burlington, NJ area to help with hospital & nursing home consults, house calls and possibly office hours. Very flexible hours that can be scheduled around your open time blocks. If interested, e-mail CV to jstuart24@comcast.net

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for part-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

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