The Voice of Podiatrists

Serving Over 9,000 Podiatrists Daily

December 28, 2006 #2,776 Editor-Barry Block, DPM, JD

A service of Podiatry Management http://www.podiatrym.com
E-mail us by hitting the reply key.
COPYRIGHT 2006- No part of PM News can be reproduced without the
express written permission of Kane Communications, Inc.

WV Podiatrist Treats Lingering Stingray Wound

Normal treatment at the Wound Care Center at Thomas Memorial Hospital is for bedsores or diabetes ulcerations. Rarely does someone come in with a wound caused by a venomous, flat fish lurking on the ocean floor. That changed when Brandon O'Callaghan, a 35-year-old pharmacist, limped into the center. He had a stingray wound which he had gotten during the Summer, and he needed help.

His doctor was John White, a podiatrist. White has treated stingray wounds before, but rarely one that lingered the way O'Callaghan's did. "Typically when you see them here in West Virginia, it's a couple of days, not a couple of weeks after the sting," White said.

Dr. John White

It's best to see patients with stingray wounds immediately, White said. In that case, the patient needs to soak in hot water immediately to neutralize the venom. The water is usually very hot -- about 113 degrees Fahrenheit.

Source: Brad McElhinny, Charleston Daily Mail [12/27/06]

New Health Credit Cards to Provide Access to Patient PHI

With a swipe of a card, patients covered by UnitedHealth Group starting in 2007 can grant physicians access to a personal health record and pay for healthcare services. As cards that combine financial and medical information become increasingly common, and more information about patients gets stored on patient portals, health insurers are seeking new ways to guard against identity theft and ensure patient data doesn't fall into the wrong hands.

UnitedHealth Group's card will not contain any protected health information (PHI), says Daryl Richard, a spokesperson for Exante Financial Services, the financial services arm of UnitedHealth. Instead, the card will contain a magnetic stripe that will launch United's Web portal.

A patient would have to authorize a doctor to swipe the card, which would then lead to the portal where the patient would supply the physician with a user name and password. From there, the physician would have access to a medical history summary that's based on claims data and other information that patients may have provided.

Source: Report on Patient Privacy

Query: Orthotics For Skier with Achilles Tendinitis

I have a patient with a slightly abducted right foot during stance. When he skies and attempts a turn to the left, he has a lot of difficulty staying with the turn. He also has insertional Achilles tendonitis with a retrocalcaneal spur. The spur was resected about 10 years ago and has just started coming back. At this time, his pain is a 1. Any suggestions about an orthotic that will help him ski and may also relieve the retrocalcanael pain and prevent it from progressing?

Edward Orman, DPM, Perry Hall, MD

Query: Warm, Red Toes

I recently saw a 73 yr old women who was hospitalized. The family called my in because the women's toes were very warm and red. She also had pain on the hallux of one of the feet. Her toes were red and much warmer then her foot and legs. There was no evidence of infection, and her pulses were fine. The pain in the toe was located in the IPJ and had ended. I diagnosed the toe pain as joint inflammation, but I am at a loss to explain the reverse temperature gradient Does anyone have a similar experience?

Art Lukoff, DPM, Ellenville, NY

Query: Medicare Denial

I performed a muscle flap from the plantar musculature to fill a defect in a large diabetic foot wound. This was the covered with a split thickness skin graft. For the muscle flap, the arterial supply to the abductor digiti minimus was identified, the muscle was freed and rotated to fill the defect.

The procedures were all paid except the muscle flap. This was billed as CPT 15738 (muscle, myocutaneous, or fasciocutaneous flap - lower extremity) along with various other procedures performed at the same setting. The explanation was "Payment is denied when performed/billed by this type of provider." We appealed and were again denied: "The records show that the service in question was performed by a podiatrist. Medicare does not cover this service when rendered by this type of provider. Therefore, no payment can be made."

I am credentialed by my hospital to do this. I am licensed in my state to do this. I am trained to do this. Why am I being denied by Medicare? How should I go about getting this paid?

Daniel Cohen, DPM, Melbourne, FL

Response: This is an unfortunate all too familiar scenario, particularly for procedures which podiatrists do not usually perform, or are becoming more in vogue to podiatry (i.e., wound care using human skin equivalents, tissue expanders, etc.). Your carrier's computer software is attempting to limit payment for procedures based on what specialty groups normally perform procedures. While one would expect to have procedures excluded from use by a specialty, when the procedure is, in fact, permitted by licensure, the carrier has an obligation to modify their software.

I would first to attempt to find out if the software is the problem, and find out how you can have this resolved. However, if you do find out that the carrier is discriminating against podiatrists, this is a clear violation of CMS regulations. Under these circumstances, you would need to appeal this to the Medicare medical director, and if that fails, to the regional CMS office.

In either scenario, your CAC rep and the Florida State Podiatric Medical Association should be able to assist you in overturning this denial, and more importantly permanently resolving this issue.

Be prepared to have your state practice act, and your delineation of privileges available for the carrier. This will take time, but it is well worth the fight! [By the way, don't forget to ask for interest on your payment, your state law may require it].

Paul Kesselman, DPM, Woodside, NY

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

RE: 1st MPJ Fusion (Donald Carlson DPM)
From: Adam Cirlincione, DPM

I believe that if you have attempted fusion with iliac crest graft and it has failed you have two options - The first being to remove the plate and hope a painless pseudoarthrosis forms combined with the use of a well constructed orthoses. The second procedure would require a skilled plastic surgeon to do an extensor digitorum brevis muscle interposition within the joint to keep the hallux from retracting proximal. I have had the opportunity see this type of a procedure and anecdotally, the patient did well- again with a well- constructed orthotic device. I believe the bone loss from the previous surgeries will most likely not allow for an implant procedure at this stage.

Adam Cirlincione, DPM, Glen Cove NY, pittpod@aol.com

RE: Office Assistants Rendering Unsolicited General Medical Advice (Sam Bell, DPM)
From: Elliot Udell, DPM

I agree with Sam Bell on this issue. Patients may not like being given medical advice by a non doctor member of the staff. I got very upset when I called my internist about a flu symptoms and his office manager took a medical history over the phone and gave me her opinion that I should "take two aspirins" and go to bed. She would not allow me to speak directly to the physician. Now in this case the doctor allowed and probably encouraged his office manager to screen out non serious problems however I resented it.
In my office I do not allow any staff person to give podiatric medical or general medical advice to any patient. The only exception I have ever made was when I had an assistant who was also a certified nutritionist. I gave her free reign to give anyone free nutritional advice so long as they asked her for it. The difference is that the patients as well as I perceived her as being an expert in that area.

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

ASSOCIATE POSITION- KANSAS CITY, MO

Excellent opportunity for a hard working, ethical podiatrist to join a vibrant, successful and growing podiatric medical and surgical practice. Dedicated, supportive staff with strong marketing and medical knowledge. Must be board eligible/certified. PSR/24. Partnership opportunity. Competitive salary, bonus structure, benefits. Wonderful place to raise a family. Fax CV to 816-455-8901

ASSOCIATE POSITION--PHOENIX SUBURB

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

ASSOCIATE POSITION - LOS ANGELES/SOUTH BAY AREA

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.

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

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

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.

WEEKLY SPECIAL - One week of ads (6x) for only $75

PM Classified Ads Reach over 9,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 9,000 DPM's. Write bblock@podiatrym.com for details. Note: For commercial or display ads contact David Kagan at (800) 284-5451 dekagan@aol.com

• To Post a message, send it to:    bblock@podiatrym.com
• Notes should be original and may not be submitted to other publications or listservs without our express written permission.
• Notes must be in the following form:
  RE: (Topic)
  From: (your name, DPM)
  Body of letter. Be concise. Limit to 250 words or less). Use Spellchecker
  Your name, DPM City/State
• Subscribers are reminded that they have an ethical obligation to disclose any potential conflicts of interest when commenting on any product, procedure, or service.