The Voice of Podiatrists

Serving Over 12,500 Podiatrists Daily

December 25, 2010 #4,046 Publisher-Barry Block, DPM, JD

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ACFAS Consumer Website Wins Award

The American College of Foot and Ankle Surgeons’ (ACFAS) consumer website, FootHealthFacts.org, has been honored with a Bronze Award for website excellence in Association TRENDS’ 2010 All-Media Contest. The website was chosen among more than 470 entries in the annual association publications contest which recognizes the most creative and effective communication vehicles developed in the industry over the prior year.

Dr. Amber Shane

“FootHealthFacts.org is a culmination of the dedicated efforts put forth by committee members and staff at the College to offer the public one of the most dynamic, trustworthy foot and ankle healthcare websites on the Internet,” Amber Shane, DPM, FACFAS, Consumer Education Committee chairperson says. “We are pleased that the site has become such a helpful resource for patients and its value is being honored by members in the association industry.”

NYCPM Prof Travels to Portugal to Teach Intensive Two-Day Podopediatrics Course

Russell G. Volpe, DPM, Professor of Pediatrics and Orthopedics at the New York College of Podiatric Medicine, recently traveled to Gandra, Portugal, to teach graduate students at CESPU – Advanced Polytechnic and University Cooperative an intensive two-day course in podopediatrics. 

Dr. Russell Volpe

Dr. Volpe was invited by Miguel Oliveira, a podiatrist, who runs the podiatry training program at CESPU.  Dr. Volpe taught students enrolled in their “mestrado”, or masters,  program who already have a degree in podiatry and are seeking higher-level, specialized additional training.

Post Transcriptions of Web Videos to Increase Search Engine Visibility

Post a transcription of each video on the same page adjacent to the video player to increase the visibilty of your web videos. Search engines can't actually "see" your videos to determine what the content is, but they can read a transcript. Also, place each video on a separate webpage along with the transcription to generate additional urls for your website with unique titles and keywords to improve the search engine optimization (SEO) of your videos.

Source: Gary Ignotofsky

Query: Undiagnosed Diffuse Skin Lesions

This patient's PMH is significant for esophageal mass, occasional trouble swallowing, alcohol abuse, and prior admission for MRSA of the lower extremities, The patient is MRSA positive on nasal swabs. Physical examination reveals - dry, raised, crusty keratotic areas with fissuring, flaking areas of the ankle, rearfoot and ends of the toes, bilaterally, with  right greater than the left.

Undiagnosed Diffuse Skin Lesions

There is cervical lymphadenopathy, oral -"thrush", perianal silvery bordered scaly, reddish macular blotchy areas of the lower and upper legs, thorax, and back area. 101.1 oral temperature. The vascular system is intact, with evidence of peripheral neuropathy. Prior diagnosis- "tinea corporis", treated by family physician with oral and topical antifungals/antibiotics. Suggestions? 
 
Joe Agostinelli, DPM, Destin, FL

Query: Ultrasound Exam & Guided Injection

A company loaned me an ultrasound unit to try out. I used it in evaluating a new patient. The company rep told me I could bill CPT 99203 for the visit, CPT 76880 for ultrasound examination, and CPT 76942 for an ultrasound guided injection I gave. Is this correct? If so, what modifiers should I use?

Matt Murphey, DPM, Des Peres, MO

Response: In addition to the initial office visit, you are only eligible to bill the CPT 76942 as the injection is bundled with the use of the diagnostic ultrasound code. Your documentation should show medical necessity for use of ultrasound as well as have two printed images in longitudinal and transverse planes showing the pathology.

If you also administered any steroids, the appropriate "J" code is also reimbursable. The documentation should also state the visual guidance of the needle was observed and injection deposited appropriately, given the chief complaint.

Eric J Lullove, DPM, Boca Raton, FL

Codingline subscription information can be found here
APMA Members: Click here for your free Codingline Silver subscription

RE: Plantar Plate Repair (R.D. Teitelbaum, DPM)
From: Jeffrey Kass, DPM

One can always try conservative management i.e., orthotics /shoe modifications. Dr. Teitelbaum asks what kind of modification? The question, to me, would be: what do you think the etiology of the deformity is? If it is a sub-second met situation, I would look to see if my first ray is hypermobile? Is the first met long or short? Try to figure out from that perspective why the plantar plate ruptured. Is there any associated hammertoe? Is there an equinus deformity (hence, overloading the metatarsal region)? Modifications to consider would be: Met pad, dispersion under second, etc. Some podiatrists like rocker shoes for this condition.

Dr. Teitelbaum speaks of surgery and questions the repair. I choose to do osteotomies in my patients, and they work out fine. 
 
Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

RE: Austin Complication
From: Scott Schonfeld, DPM, Barry Mullen, DPM

Biopro manufactures an osteotomy guide in various configurations which, when used correctly, will create perfect distal 1st metatarsal osteotomies. The cuts are parallel with the proper angle. It takes the guesswork out. The capital fragment slides with little resistance and fixation is easy because it provides you with a good sized dorsal shelf. The guide comes in standard chevron, Youngswick, and offset configurations. The set contains 2 K-wires, an elongated saw blade for the saw you are using, and the osteotomy guide.

Scott Schonfeld, DPM, Baldwin, NY, scottschonfeld@aol.com

I couldn't agree more with Dr. Scartozzi's points. Given this Austin complication debate, while tried, true, tested, and fairly simple to perform, I see the Kalish and Youngswick modifications being far superior.

a) each offers greater IM angle correction from the more proximal exit point of the dorsal wing (compared to the traditional Austin), and b) their longer dorsal wing accommodates 2-point fixation, inherently more stable than...

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

RE: Parts for Universal X-Ray Machine
From: Multiple Respondents

This is a fix you can do yourself. Use a tap that is larger than the current screw, and tap the stripped hole. Then replace the existing screw with a larger one. If the screw needs a handle, you should be able to find one and then epoxy it to the top end.

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

To repair the stripped thread, just call a good handyman or handyman service. They should have the hand tools and they can bring them right to your office. Just drill out the old threads and re-thread and use a slightly larger bolt.

Mark E Weaver, DPM, Fort Myers, FL, tcopn@att.net
 
If the problem is just a stripped screw, for a few dollars you can purchase a "tap" slightly larger than the original screw housing, purchase an appropriate screw to match the tapped hole, and in 10 minutes do the repair yourself. It will probably last another 20 years.
 
Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net

RE: Whom Do You Trust?
From: Robert Scott Steinberg, DPM
 
There was a time when you could completely trust your local specialty running shoe shop. Are those days long gone? Recently, a number of New Balance shops have installed foot scanners that recommend a specific off-the-shelf insole. I have sent patients to a New Balance store with a referral slip, indicating they would be getting prescription orthotics, and that the shop should not sell them OTC insoles. I then found out that the shop personnel offered to "scan" their feet. One patient then called my office to say he was changing his mind and did not want the orthotics that I had casted for the previous day.
 
Without hesitation, I confronted the store manager and then talked to the store's owner. But the real problem here is that the New Balance Corp is selling these scanners to the stores. Another store's owner has become a CPed, selling diabetic shoes and complaining that podiatry is taking their business! Is it time for the APMA to yank their Preferred Partnership with New Balance? Maybe so.
 
One suggestion for all of you. If you do refer to a specialty running shoe shop, drop by for a "secret shopper" visit and see what they are up to. Support only those who respect and support you!

Robert Scott Steinberg, DPM, Schaumburg, IL, Doc@FootSportsDoc.com

RE: X-Ray Comparison (R. Alex Dellinger, DPM)
From: Pete Harvey, DPM

There is no question that digital is better. Shop around for the prices of the different systems. Almost all are under 20K now. Specials are offered at some meetings. Consider buying a used system from a reliable source. The CR systems require some mechanical maintenance, and if yours breaks, there may be no replacement available since DR seems to be replacing it. As with any computer software program, there are support costs. I pay support on an as needed basis at $100/hr but, fortunately, rarely need to use it. The system is reliable. I use 20/20 Imaging and they are reliable as well.

There may be fees for the number of workstations you need to network. You must also arrange for reliable backup of the images each day and periodic testing to make sure they are actually getting backed up. This is done by your local computer support company. CR uses plates in a cassette whereas DR goes straight to the plate and then to the computer without the extra step of using a scanner. Both yield excellent quality images which can be flipped, rotated, darkened, lightened, enlarged, magnified, etc. You can also annotate the image for cobbing or measuring angles. The images can be imported to your EMR as part of the permanent record. The images can be accessed remote with tablet, iPad, etc.

If purchased in 2010, it is my understanding that the entire cost can be expensed in that year. That provision may extend to 2011, but your accountant would need to answer that.

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

PART-TIME/FULL-TIME PODIATRIST NEEDED - INDIANA

Part-time full-time Podiatrist needed for our Indiana offices. Must have Indiana license. Must have completed two years of surgical residency. If qualified email to f-massuda@footexperts.com

ASSOCIATE POSITION - CHICAGO

Weil Foot & Ankle Institute, Des Plaines, IL (www.weil4feet.com) is seeking associate position in summer 2011. This 15 member podiatric medical and surgical group is internationally acclaimed. Twelve locations throughout Chicagoland, with a 3 operating room surgery center, MRI’s, computerized footprint analysis, orthotic and brace laboratory, radiofrequency coblation technology, extracorporeal shockwave devices, PRP and clinical research program. Successful candidate will have completed a 3-year residency, experience in wound care, trauma, and sports medicine. Competitive salary, bonuses commensurate with experience and training. E-mail letter of interest and CV to Harriet Kass, HR, hkass@weil4feet.com 847-390-7666

ASSOCIATE POSITION - BOSTON

CPME Board certified podiatrist wanted to join Orthopedic & Arthritis Center at Brigham & Women’s Hospital, Boston, MA. The position is per diem, 2 days/ week. Interested candidates should send their CV to: Brenda Surowiec, Orthopedic & Arthritis Center, 75 Francis Street, Boston, MA 02115. Or email to bsurowiec@partners.org

ASSOCIATE POSITION - CT (FAIRFIELD AND NORTH HAVEN)

Join one of the largest podiatric groups in Connecticut. Well-established and progressive offices, including EMR, digital x-ray, vascular and NCV studies, Pinpointe and CO2 lasers, diagnostic ultrasound and electrical stimulation therapy. You can expect a full schedule of patients the day you start, and a very competitive salary. For more info, www.GreatFootCare.com. Send resume and current photo to Dr.Kassaris@yahoo.com. Applications due by Jan 31st.

ASSOCIATE POSITION – LONG ISLAND

FT/PT Associate position available with busy multi-office podiatry group on Long Island. Our practice is state-of-the-art, and encompasses all phases of podiatric care. We welcome new practitioners, or someone who would be open to merging a smaller practice with ours, and benefitting from our practice management overlay. We also invite residents graduating in 2011 who want to practice on Long Island to apply for this position. Compensation includes competitive salary and bonuses. Vacation pay and malpractice insurance are also offered with a full time position. Please send your CV by fax (631) 293-5984 or e-mail to mets724@gmail.com

ASSOCIATE POSITION - SAYREVILLE, NJ
 
Part time position for growing second office, 8 hours a week. Potential for growth and more days/hours. PSR/36 preferred. Can start immediately. E mail CV to advancedfoot1@aol.com

PART-TIME / FULL-TIME PODIATRIST NEEDED ASAP - CHICAGO

Part-time podiatrist needed for 2 offices in Chicago with an average of 20 hours/week. Must have Illinois license. Must have completed 2 years of surgical residency. If qualified, email to: A-Storjohann@footexperts.com

ASSOCIATE POSITION - SOUTHWEST FLORIDA

Immediate opening. Well-established multi-office practice with EMR, Digital x-ray, and more. Seeking full-time associate with PM and S-36 training. Independent and highly motivated. Must be BC/BS in rearfoot and ankle with confidence in complex reconstructive cases. Full benefits package, competitive salary. Email CV to: JLH459@aol.com

PODIATRIST NEEDED -  NYC/ QUEENS 
 
SPANISH SPEAKING Podiatrist. PSR-24 +. Experience in Current office billing,  interpersonal skills,  business and staff operational skills, knowledge of Ins. policies, ability to sell non-ins. covered products/treatments, well-trained and confident from basic RFC to Surgery, respectful & honest to  patients and staff all a must. Position includes non-paid training as well as paid office sessions. P/T with real potential for growth, full-time position/partnership. Multi-Office practice looking for help towards  growth and expansion. Please call 631-270-4724 and fax cover letter and C.V.

ASSOCIATE POSITION - WILMINGTON, DELAWARE

Largest Practice in Delaware - well organized eight doctor multi-office practice. Seeking PM&S36+ trained podiatrist who wants to perform rear-foot surgery, EMR/Digital X-rays/PADnet/Ultra-sound/Surgery Center, etc. Associated with a PM&S36+ residency program. Call Chris Savage, DPM 302-658-1129.

ASSOCIATE POSITION - MICHIGAN - (OAKLAND COUNTY)

Outstanding opportunity for associate in well-established practice, general & surgical podiatry forefoot, rearfoot & ankle (full or part-time). Well-trained, responsible, motivated with good communication skills, ABPS qualified or better. Send CV & letter of interest to: PodiatristWanted@AOL.com. All replies kept strictly confidential

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Douglas Richie, DPM is seeking a well-trained, motivated podiatric physician to join his two office practice located in North Orange County, California. Applicants must have completed a 3-year residency program and must have exceptional skills in reconstructive foot and ankle surgery, sports medicine and podiatric biomechanics. This is a salaried position with a goal of long-term buy-in for equity ownership. Send letter of interest and CV to drichiejr@aol.com

ASSOCIATE POSITION - NEW YORK CITY

One of the fastest growing podiatry practices in New York City and Queens seeks a podiatrist who participates with HealthFirst, Fidelis, and other Medicaid plans. Preferably a Spanish speaking podiatrist. Contact me at Podocare@aol.com

PRACTICE FOR SALE - BOSTON, MASSACHUSETTS

40 year old updated practice with outstanding potential. Within 5 miles of Boston hospitals and 5 blocks from train station. Buy the practice, equipment and goodwill for a reasonable price. Excellent opportunity for resident or second location for practicing podiatrist. Multiple referral sources. Email vshdeep@yahoo.com

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