The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

December 24, 2006 #2,773 Editor-Barry Block, DPM, JD

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Rogers a Contributor to USMLE Review Text

Lee C. Rogers, D.P.M. is an associate contributor in the board review book First Aid for the USMLE STEP 1; 2007 released by McGraw-Hill Publisher this month. The First Aid series has been used by over 500,000 students worldwide in preparation for USMLE, COMLEX, and NBPME and features a concise review of basic sciences and clinical vignettes. Dr. Rogers authored the section titled “First Aid for the Podiatric Medical Student,” where he provides facts about the NBPME Part I and study tips for candidates.

Dr. Lee C. Rogers

“It’s well-deserved recognition to podiatric medical education to have a section in this book, which is almost universally used by MD candidates and widely used by DPM candidates. McGraw-Hill and the editors realized that podiatry needed a good review for the NBPME and that our academics are on par with that of MD and DO students, who are the other target audiences,” Rogers stated.

Rogers, a 2004 graduate of Des Moines University, is currently a research fellow under the instruction of Professor David Armstrong at the Center for Lower Extremity Ambulatory Research of the Dr. William M. Scholl College of Podiatric Medicine.

FL Podiatrist Arrested After Initially Eluding Police Chase

It was supposed to be an easygoing trip for three deputies who were delivering holiday food baskets to Pasco County families in need. But then they spotted a silver Chrysler 300 speeding north on U.S. 19, passing vehicles in a no-passing zone and making numerous lane changes, a Pasco County Sheriff's Office report states.

The Chrysler made a U-turn; the sheriff's office pickup followed. The driver being pursued ran a red light and continued speeding, the report states. Miller called off the brief chase but notified the sheriff's Shadow Unit, which hunts traffic violators, Tobin said. Less than 30 minutes later, Deputy Jay Galassi spotted the vehicle near the Hernando County line and, with the help of a Florida Highway Patrol trooper, pulled over the Chrysler.

Stephen Joseph Leonard, 50, a podiatrist who owns Florida Foot and Ankle Center on Mariner Boulevard in Spring Hill, was arrested on a charge of fleeing to elude. He was released from the Land O' Lakes jail Thursday after posting $5,000 bail.

Source: Lisa A. Davis The Tampa Tribune, [12/23/06]

Cleland to Speak at Sold out SuperBones/SuperSkin

Max Cleland, former U.S. Senator and American war hero will be a keynote speaker at the upcoming SuperBones/SuperSkin on Paradise Island in the Bahamas. According to Stanley Kalish, DPM, Scientific Chairman of the seminar, Cleland will be discussing military wound care. Kalish noted that all hotel space at the Atlantis for this popular is completely booked.

Sen. Max Cleland

Cleland lost both legs and his right arm when a grenade exploded during his service in Vietnam. Drawing on his own experience of pain, depression, and frustration, he rose up to accomplish significant improvements for veterans returning from war. Youngest administrator ever of the Veterans Administration, and Senator from Georgia for six years, he has earned respect for his work in healthcare, bio-terrorism preparedness, and homeland security.

Query: First MPJ Fusion

I have a patient who had a fusion that went to non-union possibly because of minor trauma sustained in the post-op period. Another attempt was made with demineralized bone matrix but that went to non-union also. He is now six months post-op on a third attempt with iliac graft and a plate, and this appears to be a non-union as well. His last surgeon told him that if this fails, he will need an amputation of the hallux and most of the metatarsal. Should he opt for the amputation or would further attempts at fusion be reasonable?

Donald Carlson, DPM, Hermiston, OR

Query: Post-op Debridement Modifiers

If a patient has surgery, say a bunionectomy, and 10 days later develops an infection (staph), which modifier would be best to apply to the code for debridement of tissue?

"-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period: The physician may need to indicate that another procedure was performed during the postoperative period of the initial procedure. When this subsequent procedure is related to the first, and requires the use of the operating room, it may be reported by adding the modifier '-78' to the related procedure." [This says return to the operating room. Is that a literal requirement, and in the scenario above, would the procedure be considered "related?"

or

"-79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using the modifier '-79'."

Both have their merits, but which suits this scenario?

Carla Poma, South Lyon, MI

Response: If the carrier is Medicare, then this service would be part of the global allowance and not payable separately.

Some payers may have the same criteria, depending on how much work is involved to address this infection; while others may allow separate payment.

Modifier "-58" (staged procedure) does not require a return trip to the operating room.

Tony Poggio, DPM, Alameda, CA

Codingline subscription information can be found at
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RE: DMERC Medicare Fee Schedule to Increase by 4.3%

On Jan. 1, 2007, the Medicare fee schedule for orthotic and prosthetic services will be increased by 4.3 percent. This is the first fee schedule increase for O&P since 2003.

So in my next life, I'm going to return as a "non-doctor." Being a real doctor just doesn't pay. Four additional years of training, higher expenses, etc.

Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net

RE: Hallux Limitus (Peter J. Bregman, DPM)
From: Dennis Shavelson, DPM

I applaud your use of injection "cranking" ("a la Steinberg") of the 1st MP Joint to remobilize the area. This opens up adhesions and increases total ROM, momentarily. I add exercises to maintain motion, currently utilizing toe fists, toe pick-ups, toes over a book edge and toe creeping in order to maintain motion. If repeated, the treatments should become additive and therefore are repeated X 2 weeks then 4 wks PRN.

Etiologically, if trauma has been eliminated, I predict that the operated foot is attached to a longer limb that needs balancing. Finally, I would immediately place pre-orthitc pads into her shoes, foot type specific to begin to establish FLEB control and if successful, follow that up with orthotics with aggressive forefoot posting and modification for FHL and FHE. If all this fails, surgical criteria should be considered.

Dennis Shavelson, DPM, New York City, DrSha@lifestylepodiatry.com

POSITION AVAILABLE - NEW YORK AND/OR NEW JERSEY

Part-time and full-time positions available for any or all of the following office, assisted living facilities, hospitals, and house calls. Please Fax CV to (212)473-8563.

ASSOCIATE POSITION - CENTRAL CALIFORNIA

Central California multi-location 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 - CINCINNATI, OHIO

One of the largest podiatry practices in the United States is again in need of a PSR 24-36 Associate. All present doctors are in their thirties with similar training. Everyone is treated equally and there is definitely no limit to your success. Please submit resume or contact Karen Roesch via email or phone. Kroesch4poh@aol.com (513) 729-4455

Attractive opportunity for enthusiastic, proficient, and personable associate. Well-established modern practice with multiple newer spacious offices, technology and equipment. Solid referral base, close to hospitals, knowledgeable certified staff. 22% MCR. Practice and surgical center partnership potential opportunity. Prefer 24-36+ PSR. Send CV: AZpodassociate@aol.com

POSITION AVAILABLE - SOUTHEAST TENNESSEE/ NORTH GEORGIA

Immediate position available or will wait for the right individual. Unique practice opportunity in growing multi-physician/multi-office practice. Well established/cutting edge within the medical community. Close proximity to hospitals as well as opportunity to become involved with a free standing podiatric surgical center. Must be BQ/BC. Minimum PSR/24. Competitive salary, bonus structure and benefits. E-mail CV to afcjen@hotmail.com

Multi-office, multi-doctor, well-established practice near the beach cities. Seeking a board eligible/certified PSR-24 or PSR-36 trained foot and ankle surgeon. Well-rounded practice requiring knowledge in biomechanics, pediatrics, sports medicine, diabetic wound care, trauma, and reconstructive foot and ankle surgery. Full-time position available immediately with generous compensation and benefits, including malpractice, and health insurance. Two-year commitment required with partnership opportunity. Send CV to akemfoot@sbcglobal.net or fax to (310) 838-0227.

ASSOCIATE POSITION- MEMPHIS, TN

30 year-old, high volume, multi-office practice in Memphis, looking for 24-36 PSR trained individual. Good opportunity for reconstructive surgery and wound care. No nursing homes or weekends. Potential partnership opportunity. Contact Footdok4@gmail.com.

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