The Voice of Podiatrists

Serving Over 13,500 Podiatrists Daily

December 31, 2011 #4,346 Publisher-Barry Block, DPM, JD

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High Fashion Shoes Also Cause Blisters and Ingrown Toenails: CA Podiatrist

“High fashion shoes can cause low back pain, blisters on the tops of toes, ingrown toe nails, arch cramps, tendon problems, and ball of the foot pain," says podiatrist Steven L. Rosenberg, DPM. Blisters are formed because of friction or constant rubbing of your toes that occur in the toe box. 

Dr. Steven L. Rosenberg

“When you wear shoes that are a bit too small, they can cause toe jamming where the tips of your toes will abut up against the end and top of the toe box and buckle the toes,” say Rosenberg. This can lead to blister formation on the top and tip of the toes, pain, swelling and redness on the pads of your toes. Pumps with a narrow or shallow toe box can also irritate toenails that are too thick causing toe pain or increased pressure along the sides of the great toe nails, eventually causing an ingrown toe nail to develop.

27% Medicare Pay Cut to Return March 1 Unless Congress Makes New Deal

The threat of an across-the-board Medicare physician pay cut was defused with just over a week to spare, but the congressional agreement only maintains rates for an additional two months before Congress must act again to avoid a steep reduction.
 
The House and Senate on Dec. 23 approved a two-month payroll tax cut extension package that included a two-month doctor pay freeze. That means physicians will continue to receive 2011 rates for Medicare services they provide through the end of February, and lawmakers will need to agree on a longer-term patch if they are to prevent the 27.4% cut from taking effect on March 1.

Source: David Glendinning, AM News [12/27/11]

Weekly Reports

To increase communication and drive improvement in your practice, have each of the doctors and those in a managerial role write a short weekly report to themselves answering this question, "Why should the partners (or whomever you deem appropriate) be glad I work in this office?” This report should include the high points and low points of your week. This weekly report can be sent to the managing partner or whomever is most appropriate. This is a great way to kick off the new year to have an even more successful 2012.
 
Hal Ornstein, DPM, Howell, NJ

Query: RAC Repayment Demand

I just received a demand for payment from the RAC program for $32.46. I treated a patient with a non-displaced fibula fracture with a BK CAM boot and crutches. I coded 99212-25 and 27786,73610 on 1-29-09 The audit claims the evaluation and management is part of the fracture care.

Should I appeal for $32.46? Back then (3 years ago), my records were hand-written and not as comprehensive as they are now with EHR. Am I exposing myself to further inquiry by sending my admitedly inadequate records?

Name Withheld

Editor's comment: PM News does not provide legal advice. While no one can guarantee what will happen, in general, paying back a small sum based on a single, isolated case does not expose one to further inquiry. Sending in "admitedly inadequate records", however, can expose one to further audits.

Query: Total Contact Cast Certification/Course?
 
Is there a course available for cast technicians at a local wound care clinic to learn how to apply total contact casts?
 
Hans Blaakman, DPM, Spartanburg, SC

Query: Medicare Coverage of Wound VAC

Does California Medicare cover application of a wound VAC? If they do, will they cover the VAC application (CPT 97605) on the day of surgery? What modifier would be added to CPT 97605? How about post-op applications? What modifiers would be appropriate?

If application of VAC is reimbursed by Medicare post-op, are there a maximum number of times Palmetto typically approves payment?

Dick Green, DPM, San Diego, CA 

Response: The CCI and many active wound care management LCDs may preclude payment for application of the wound VAC (CPT 97605, CPT 97606) at the same time as many of the surgical debridement codes. Additional allowance for CPT 97605, CPT 97606 is dependent on the surgical debridement code and whether or not the wound VAC is being applied to a different application site than the site being debrided. One needs to check both the CCI edits and your carrier debridement LCD. Coverage parameters for the wound VAC system itself may be found in Noridian DMAC's LCD #L11489 - Negative Pressure Wound Therapy Pumps.

The HCPCS codes for negative pressure wound therapy pumps and supplies are:

A6550 - wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories

A7000 - canister, disposable, used with suction pump, each

Paul Kesselman, DPM, Woodside, NY

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RE: The Passing of Seema Ramcharitar (Amante), DPM

Seema Ramcharitar (Amante), DPM of Forest Hills, NY, died suddenly last night, at the age of 47. She was a former student of mine and then a close friend since then...a truly beautiful person.

Dr. Seema Ram-Charitar

She was married to Michael Amante (the well known singer), and had 3 kids 9, 7 and 6. Unbelievably sad. The wake will be either Sat/Sun or Sun/Mon, with cremation on Tues.

Artie Gudeon, DPM, Rego Park, NY

RE: Orthotic Therapy For Hallux Rigidus (Keith Gurnick, DPM)
From: Jeff Root

Dr. Gurnick said that he does not understand the rationale behind using a non-rigid Morton’s extension or a Cluffy wedge to treat hallux limitus or rigidus because these devices would simply take up the limited range of dorsiflexion available at the 1st MPJ. I know that Dr. Gurnick is extremely well-versed in biomechanics, so I have to assume that he is referring to true hallux limitus and not functional hallux limitus. In the case of functional hallux limitus, the patient will exhibit an adequate range of hallux dorsiflexion during an open chain examination of the ROM of the 1st MPJ, but will demonstrate restricted motion during gait. A Cluffy wedge may be indicated in the case of functional hallux limitus.

In the specific case in question,...

Editor's Note: Mr. Root's extended-length letter can be read here.

RE: Creating Patient E-mail Addresses (Mark Stempler, DPM)
From: Alan Bass, DPM

Before you go ahead and create all these email addresses, you may have been given some bad advice. Since most everyday email is non-encrypted, sending of patient information in that way may be ill-advised. I would check again. Sending un-encrypted email with PHI, if it gets to the wrong place, may be a HIPAA violation.

Alan Bass, DPM, Manalapan, NJ, abassdpm@optonline.net

RE: CMS Proposes Sunshine Rules on Industry Payments, Gifts to Doctors (Peter Smith, DPM)
From: Ivar E. Roth, DPM, MPH

Forget the bureaucrats. If you are tired of chasing your tail in practice and want to enjoy practice each and every day, I advise you to check out concierge podiatry. I have had an exclusive concierge practice for over 5 years, and it is the practice of the future for those brave enough to make the leap. I have recommended that my son go into podiatry, and one day he will follow in my footsteps. The practice is great and growing every day. I hope to franchise the concept in the near future.

Ivar E. Roth, DPM, MPH, Newport Beach, CA, ifabs@earthlink.net

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RE: Outrageous Shoe of the Day

Something's fishy with these sandals.

Source: Submitted by Dr. Arthur Gudeon

SPACE AVAILABLE - NYC & LI

ASSOCIATE POSITION - HAWAII (OAHU)

Full-time position available. Join this fantastic practice in paradise. Diagnostic ultrasound, Digital X-Ray, EHR, Surgical Privileges, Competitive Salary plus benefits package. Send CV  toyoleven316@yahoo.com.

ASSOCIATE POSITION - EAST TENNESSEE

30 year old practice with 5 offices in greater Knoxville area seeking ethical, personable, hardworking, team player. $160,000 base salary with bonus incentives and benefits. Post-residency experience a plus. Please send resume to ddavidphawk@yahoo.com

ASSOCIATE NEEDED - NORTHERN CINCINNATI, OHIO (FAIRFIELD)

Lead to partnership &/or buy practice. Well-established, reputable & successful (700K collection annual) 25+ year practice. Newer 2k sq.ft office condo & w/5 tx rooms, Aver.80 new patients monthly, full hospital privileges, DME, Padnet, digital x-rays. Inquires to email: gsherwood1@cinci.rr.com

ASSOCIATE POSITION - NAPLES, FLORIDA

Great opportunity for PSR- 24/36 BE/BC podiatrist with strong surgical skills to join multi-office practice. Hospital privileges available at 648 bed hospital system, 200 bed hospital system and multiple surgical centers. Candidate should have the skills and desire to perform rearfoot/ankle surgery. Florida has a great scope of practice law and we rotate for ER call. Candidate needs to be ethical and motivated. Established practitioner or new practitioner. In a cover letter tell me why you should be selected for the team. Email cover letter and CV with subject line "I am your new team member." toDrgordon@gulfcoastfootcare.com

PART-TIME PODIATRIST NEEDED - LOS ANGELES, CALIFORNIA 

ASSOCIATE POSITION - CENTRAL VALLEY/SOUTHERN CA

Seeking associate with partnership availability. Must be highly motivated and have good patient skills and personality. Salary excellent with all paid benefits/incentives including malpractice/401k and profit sharing. Compassionate and well-trained for immediate position. Surgery Center and hospital-based with no HMOs/no rest homes. Bilingual in English and Spanish preferred. Offering a permanent position/partnership in a multi-million dollar hi-tech practice with Partnership also in Surgery center. Please e-mail CV and short bio to: Tonya@wetreatyourfeet.com

ASSOCIATE POSITION - ALBANY/CAPITAL DISTRICT AREA

Immediate position available with generous salary, fringe benefits and percentage. All phases of Podiatry. For more information please contact Dawn at (518) 828-6516 or fax your resume to(518) 828-9510.

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