The Voice of Podiatrists

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December 27, 2008 #3,435 Editor-Barry Block, DPM, JD

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FitFlops are Footwear Flops: NY Podiatrist

Women have another reason to love shoes thanks to new footwear designed to firm up your legs as you walk: Workout shoes like FitFlop claim to tone your muscles and reduce cellulite with every step. FitFlops are built with what's called a multi-density midsole, which makes leg muscles work harder than they would in a normal shoe.

Dr. Robin Ross

But some experts aren't convinced. "For the most part, FitFlops are not beneficial for use other than going to the beach or pool," says Robin Ross, D.P.M., a podiatrist practicing in Shelter Island, NY. "Wearing flip-flops opens you up to problems ranging from cuts and lacerations to twisting an ankle because of the lack of support."

Source: Redbook [January 2009]

OH Podiatrist Pedals to Prevent Diabetes

Cycling indoors is one way to avoid the sedentary tendencies that the winter months encourage. “It is very important to stay active through the winter months,” said Dr. Guy Del Prince, a local podiatrist. Del Prince will be riding a Sidewinder adult recumbent tricycle in the Cleveland Tour de Cure on June 14, 2009. The cycling tour supports the mission of the American Diabetes Association (ADA): to prevent diabetes and find a cure for it. ADA also aims to improve the quality of life for all people affected by this disease. Preventing obesity and diabetes is a year-round challenge. So is the fundraising effort for the 2009 Tour de Cure. “We need a cure, and this event can make a difference,” Del Prince said.

Dr. Guy Del Prince

“As a podiatrist, I see a lot of people who are affected by diabetes. This is how I got involved.” In his new book, “Pedal Against Diabetes,” Del Prince stresses the disease-managing merits of diet and exercise. “Diabetes prevention is the most effective cure for millions of American prediabetics,” Del Prince said. Last year, more than 32,000 cyclists in 78 Tour de Cure events across America raised nearly $13 million for diabetes research.

Source: Ashtabula Star Beacon (OH) [12/24/08]

Query: Developing a Relationship with Nursing Homes

I am looking to contact nursing homes in the area to have our physicians become on-site podiatrists. Does anybody who presently treats in nursing homes use a sample introduction letter? Has anyone contacted the Director of Nursing at these facilities?

Chad Schwarz, Howell, NJ

Query: Bilateral 11750 Denial

GHI paid for the first matrixectomy procedure, CPT 11750, but denied the second CPT 11750 procedure. The reason given was that "The modifier used is inconsistent with the procedure code, or a modifier is missing."

I billed it: CPT 11750-RT, CPT 11750-LT-59.

How should this be billed?

Wayne Feldman, DPM, Little Neck, NY

Response: Rather than using "LT" and "RT," you should use the appropriate "T" codes to distinguish digital sites.

Mark Schilansky, DPM, Catskill, NY

Codingline subscription information can be found here

RE : Benfotiamine Shown to be Efficacious in Treating Diabetic Peripheral Neuropathy (Michael Turlik, DPM)
From: Multiple Respondents

I applaud Dr. Turlik’s analysis but would redirect the focus to one critical feature which in medicine is paramount – the patient. While initially a serious skeptic of this treatment regimen, I have found that in clinical practice, the results of using benfotiamine to inhibit pain from peripheral neuropathy cannot be disputed. Many patients who have tried this have benefited and return for continued relief. I concur with Dr. Katz’s comments in this regard and challenge anyone who has seriously tried this therapy to tell those patients who have benefited, not to use it. I acknowledge Dr.Udell’s sentiments regarding evidence-based medicine.

I have been ordering pre-treatment laboratory studies prior to prescribing benfotiamine. Dr. Kornfield is also correct in his analysis since peripheral neuropathy is much more than a simple condition reversed by Vitamin B1. Then again, diabetes mellitus is not a simple disease treated only by insulin. We have a myriad of oral and injectable agents used in daily clinical practice. Similarly, even if it does not address ALL the mechanisms of this pathology, it is unfair not to use benfotiamine which has little if any known side-effects to benefit patients who have painful peripheral neuropathy.

Henry Stark, DPM, Lake Park, FL, hkstarkdpm@aol.com

With all due respect to Dr. Katz, I think his logic leaves little to be desired. What you see is not necessarily what you get. This is the reason why we institute well-performed and well-controlled studies. I beg to differ that “there are few studies available for most treatments performed in our offices each day.” I’m not sure what treatments he is referring to, but when I medicate a patient, perform surgery, or institute other therapies, the overwhelming majority of these can be referenced with a multitude of conclusive studies. In my practice, there are very few modalities I use that are linked to minimal compelling studies or no studies at all.

We practice Westernized medicine, which is based on the Hippocratic oath we took. That oath is based on the scientific method and therefore what our public is expecting when they walk into our offices. I feel it would be nothing less than unethical to treat patients with any significant deviation, not informing them of such, or providing alternative services under the umbrella of our stated training.

Our minds are extremely good at making us believe what we want to be the truth. When studied and put to analysis, we often find things were not as we thought. To state “we successfully treat patients and the studies become irrelevant” is disturbing to me. The success or failure of a treatment is in the studies, not the other way around.

Jon Purdy, DPM, New Iberia, LA, jpurdy@mindspring.com

Editor’s Note: An extended-length note by Michael Turlik, DPM appears at: http://www.podiatrym.com/letters2.cfm?id=23776&start=1

Editor's Note: This topic is now closed

Re: Patient Recall System (Sloan Gordon, DPM)
From: Edward Fryman, DPM

I've been using the Sammy 2000 system by ICS Software for several years. This is a great practice management tool. If you get patients' email addresses, not only can you email recall letters but you can also email billing statements, appointment reminder letters (no more phone calls), referral letters, etc. The system is intuitive and user-friendly, so staff resistance to this new program is minimal.

Edward Fryman, DPM, Seaford, ny, EFrymanDPM@gmail.com

RE: Coding Amputation and I&D (Michael Fein, DPM)
From: Robert Wunderlich, DPM

Based on Dr. Fein's description, I would code the procedure(s) as follows:

CPT 28820 -RT or -LT (amputation toe, MTPJ)
CPT 28122 -59 -RT or -LT (partial excision, metatarsal bone)

I agree with Dr. Poggio that CPT 28810 implies the toe and the ENTIRE metatarsal were amputated, so I think a partial ray amputation is best described by the combination of the two codes above.

Robert Wunderlich, DPM, San Antonio, TX, rwunder@gmail.com

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