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05/18/2023
RESPONSES/COMMENTS
RE: Unequal Treatment of Ex-Patriot DPMs by ABPM
From: Jeff Carnett, DPM
There are many of us American trained DPMs working overseas who are not eligible to be board certified by either board as we did one or two-year residencies, but not three-year programs. So, how shocking to see that ABPM will certify those with bachelor degrees in podiatry from the UK, SA, Australia, Malta, and New Zealand who did not take the MCAT, have no basic medical sciences in their courses, and no residencies. These degrees are right from high school.
Doesn't that discredit anyone with the ABPM certification in the U.S.? So, we expatriate DPMs need to take a bachelor podiatry degree so we can get certified, but we can't get certified with a CPME-approved DPM degree and residency? I’m trying to understand how that helps the profession. While overseas, our work is often highly surgical, but alas that doesn't count.
Jeff Carnett, DPM. Auckland, New Zealand
Other messages in this thread:
01/02/2026
RESPONSES/COMMENTS (NON-CLINICAL)
From: Elliot Udell, DPM
Dr. Kesselman, as usual, started a fascinating discussion. To what extent are podiatrists trained in general medical issues and to what extent are we allowed to share this information with patients? Many times in our practices, patients might ask for general medical advice, having nothing to do with the foot. To what extent are we legally allowed to give such advice even though the knowledge is correct and the advice is sound? If we give non-podiatric advice and something goes wrong, can we be sued, and will our insurance companies accuse us of practicing out of scope? One way out is to give the advice but let the patients know that they must confirm it with their MD, DO specialist before acting on the advice.
Yesterday, I saw a patient with severe gout. I wanted to prescribe a short course of an NSAID, but the patient has severe systemic GI and cardiac issues. I called and got clearance from the gastroenterologist. Still, when I asked him if there were any cardiac issues to be concerned about, he was quick to tell me that he is a GI doctor and even though he is boarded in internal medicine, I must run that question past his primary care doctor or cardiologist. I did and all was okay and I felt that I covered all potential medical legal bases.
Elliot Udell, DPM, Hicksville, NY
01/02/2026
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Rod Tomczak, DPM, MD, EdD
Two things happened this week that have led me to pen this letter to PM News. One was Dr. David Gottlieb’s December 31, 2025 letter to PM News and the conclusion that national advertising leads everyone to believe that podiatrists are universally considered physicians. The second is the rediscovery of the August 12, 2021 letter from Dr. Eric Stamps, then Dean of Samuel Merritt, representing AACPM to the APMA and ACFAS, stating the majority of podiatric deans did not support DPM graduates sitting for USMLE as part of the process of becoming recognized as physicians by the MD and DO professions.
To summarize Dr. Gottlieb’s letter, he states that because a retired New York podiatrist is featured in a national advertisement endorsing an OTC peripheral nerve medication and the advertisement erroneously calls the podiatrist a retired physician implies our profession has reached...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
01/01/2026
RESPONSES/COMMENTS (NON-CLINICAL)
From: Paul Kesselman, DPM
Last night, toward the end of a zumba class, the young instructor began to feel weak and said she could not safely continue the class as she was not feeling well. Later, the other regulars in the class told me she had a myriad of medical issues. After the class, the instructor admitted she had been suffering from hypokalemia for years, but her doctors were not sure why. One of my neighbors then told her I was a doctor, but not of the whole body, rather of the foot and ankle. Totally deflecting those remarks, a conversation proceeded with the instructor with many questions. Her answers and some follow-up questions, especially about various prescription potassium supplements, were shocking to this nosey neighbor. Despite not having those two magical letters after my name, the conversation which took place left my neighbor speechless. Then came the quote of the evening from the instructor, “See, he understands what I am talking about,” especially when we discussed potential cardiac events, one of which she admitted she had a few years ago.
It was only later that evening when having a private conversation with my neighbor, one question asked of her: If you were undergoing the simplest of foot/ankle surgery or had blood work ordered by a “foot and ankle” doctor, wouldn’t you want them to understand the implications and...
Editor's Note: Dr. Kesselman's extended-length letter can be read here.
01/01/2026
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 2
From: Lawrence Rubin, DPM
In previous posts, there has been some uncertainty about Medicare considering podiatrists to be physicians. Here is the actual rule announced in 1965: Section 1861(r) of the Social Security Act which defines a "Physician" for Medicare purposes, generally a doctor of medicine or osteopathy, but also extending to dentists, podiatrists, optometrists, and chiropractors for specific services.
Here's a breakdown of the definition:
Core Definition: A doctor of medicine (MD) or osteopathy (DO) legally authorized to practice medicine and surgery in the state where they work.
"Physician" includes:
Dentists: When acting within their license for dental care.
Podiatrists: For specific foot-related services (e.g., in sections 1814(a), 1832(a)(2)(F)(ii), 1835).
Optometrists: For certain vision-related services (e.g., eye exams).
Chiropractors: Licensed chiropractors for spinal adjustments.
Interns/Residents-in-Training: Under approved medical education programs.
Lawrence Rubin, DPM, Las Vegas, NV
Editor's note: This definition applies ONLY for federal programs such as Medicare. Podiatry licenses and scopes of practice are state-mandated functions as per the 10th Amendment.
01/01/2026
RESPONSES/COMMENTS (MEDICAL-LEGAL) - PART 1
RE: Asking Medicare About Your Billing Profile
From: Name Withheld
I remember reading a query on PM News about providers requesting their billing profile information from local Medicare carriers. This information consists of the providers' patient billings to Medicare as compared to those of their fellow peers. I am not offering advice about requesting this. I am only sharing my experience with Medicare after I requested this information.
Several years ago, I was involved in a statewide audit in Florida from First Coast Medicare relating to codes billed for painful corns and calluses. I had a very busy Medicare practice and used these codes frequently when my patients' symptoms and criteria reflected the use of these codes. The audit involved several hundred podiatrists in Florida. While Medicare always advises providers to follow the published LCD requirements to justify billing a particular code, they literally changed the....
Editor's note: This extended-length letter can be read here.
12/31/2025
RESPONSES/COMMENTS (MEDICAL-LEGAL)
RE: Who thinks podiatrists are physicians? National Advertising, That's Who
From: H. David Gottlieb, DPM
The commercials for the neuritis supplement Nervive feature (according to the manufacturer) the retired physician Dr. Samuel Ruggiero. Purely on a hunch, I did a Google search. It turns out that the retired physician, as promoted on national advertising, is a retired podiatrist. Referencing the court room scene in the movie Miracle on 34th Street when the preponderance of the nation calls something to be true, as in this case, it can be considered as a true reflection of national belief.
When a national marketing campaign calls a retired member of our profession a 'retired physician', I think it's safe to say that we are considered physicians by the majority of the American public. Should one think otherwise, it betrays their lack of confidence in their own worth. Don't put your insecurities and inferiority complex on me. "Woe is me" is a cry for pity, not action.
H. David Gottlieb, DPM, Baltimore, MD
Editor's comment: Dr. Samuel Ruggiero is a retired New York podiatrist. In New York podiatrists are not legally permitted to call themselves physicians. Hopefully, this will eventually change.
12/30/2025
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
RE: Cherry Picking
From: Rod Tomczak, DPM, MD, EdD
On December 19, 2025, I received a publication titled “The Wonderful Mind of a Med Student” by Haroon Tariq. This particular issue literally scared the hell out of me. Over the past year, I have been criticized and condemned by my podiatric confreres who have interpreted my submissions as calls for the demise of podiatry. In reality, they have been just the opposite, but many short-sighted podiatrists have neglected the long-term ramifications of the almost quadratic growth in osteopathic schools where we can grow while sustaining our heritage, belief system, and philosophy as DO podiatrists.
My postings have been met with responses that flaunt the economic status of some podiatrists, the financial stability of the profession, and the responses of debt-free, well established, familial practices that push the seven figure mark while neglecting the young podiatrist who cannot partake in...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
12/30/2025
RESPONSES/COMMENTS (ROUTINE FOOT CARE)
from: Allen M. Jacobs, DPM
A very common example of the pathology in the diabetic patient requiring evaluation and treatment of a podiatric healthcare provider is that of neuropathy. We are all aware of the fact that neuropathy and ulceration associated with neuropathy are responsible for up to 80% of overall amputations. The most significant manifestations of neuropathy are the result of non-painful neuropathy, such as Charcot's joint disease, ulceration, and infection. Painful neuropathy is associated with decreased quality of life.
With reference to non-painful neuropathy, it has been my experience that unless a patient has profound sensory deficit of which the patient is aware, or has a frank sensory ataxia, many patients are not aware that indeed neuropathy is affecting them. With reference to painful neuropathy, there are many standard protocols which can be followed utilizing various...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
12/30/2025
RESPONSES/COMMENTS (NEWS STORIES)
From Ron Werter DPM
Everybody knows that the purpose of the pinky toe is to make sure your furniture is in the right place.
Ron Werter, DPM, NY, NY
12/30/2025
RESPONSES/COMMENTS (MEDICAL EDUCATION)
RE: Looking Back at Medical Education
From: Bruce Lebowitz, DPM
When I attended The MJ Lewi Podiatry School in NY in 1967, I learned that Dr. Lewi had founded the school in 1911 because medical schools didn’t cover foot problems adequately. In his day, medical schools didn’t cover much medicine either. After retiring, I entered a new career in volunteering. I’m a docent at a historic home on the Johns Hopkins Homewood campus.
Johns Hopkins died in 1873 and left a will calling for a university, hospital, and a medical school. The University was founded, a hospital was built, but there was no money for a medical school. The Hopkins board went to another wealthy family, the Garrett family. Mary Elizabeth Garrett, a spinster daughter, controlled the family wealth and agreed to pay for the establishment of a medical school. There were two strings attached: First, they had to take students who went to college and studied biology and chemistry. Second, they had to accept women with the same criteria as men! The board agreed. Her demands were important as many so-called medical schools required two years of high school. Students had to supply the tuition, and they worked to get their degree after two years. Mary Elizabeth wanted to change the course of medical training and she did.
Bruce Lebowitz, DPM, Baltimore, MD
12/29/2025
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Lawrence B. Harkless, DPM,
For the record, I was not part of who approached ACGME. I am for the exploration. Why? During my 30-year career at University of Texas Health Science Center San Antonio, all programs were accredited By ACGME. My goal was to earn the respect of all disciplines and be treated similarly. All departments had one thing in common: weekly case conference, grand rounds, or a combination of both to hold everyone accountable for one word learning. Every level of learner was present: students (UME), residents, and fellows (GME), faculty, private practitioners, retirees (CME). Hence there was a culture of learning with accountability and transparency. I had conferences 6-9 AM for 30 years. Everyone was learning how to learn to become their best. Be, Behave, Become.
Lawrence B. Harkless, DPM, San Antonio, TX
12/29/2025
RESPONSES/COMMENTS (ROUTINE FOOT CARE)
From: Benjamin W. Weaver, DPM
Dr. Jacobs makes an important point that’s worth reinforcing from an E/M and compliance perspective. During at-risk foot care, when tools like Arche LEAP Vitals are used to evaluate sudomotor function and often elusive points of irritation (“hot spots”), a podiatrist is not simply performing routine nail or skin care. They are truly engaging in comprehensive care that leads to a significant reduction in diabetic wounds and amputations.
Using the Arche LEAP Vitals tools and identifying sudomotor neuropathy as the underlying cause of dry, xerotic skin represents a meaningful clinical assessment with direct implications for risk stratification, patient education, and management in patients with diabetes. Dry xerotic skin related to autonomic neuropathy significantly increases the risk of fissures, infection, and ulceration. Evaluating this condition, interpreting objective findings from LEAP Vitals, discussing risk, and initiating or adjusting a care plan constitutes a medically necessary, separately identifiable Evaluation and Management service. When properly documented, this clearly supports reporting an E/M service (with appropriate modifier use) in addition to at-risk foot care, reflecting the full scope of cognitive work performed during the visit.
I have been using the Arche LEAP Vitals protocol in my practice for quite some time, and it has demonstrated significant results for my patients. Disclosure: I have no financial relationship with Arche Healthcare.
Benjamin W. Weaver, DPM, Wichita, KS
12/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) -PART 1B
RE: Source for Cantharidin
From: Sandy Amador, DPM
I've been using cantharidin from Akina Pharmacy for several years. It is very effective with one or two treatments. I apply a small amount on the wart after debridement and cover it with mole skin. I inform the patient that a blister will usually form the following day, and the patient should return for a follow-up within one week. I use Cantharidin Plus which has podophyllin and salicyclic acid. Supplier: Akina Pharmacy (855) 792-5462.
Sandy Amador, DPM, North Bergen, NJ
12/29/2025
RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A
From: Rob Tyrrell, DPM
In Elliot Udell's post, he referenced his original Cryoprobe is no longer supported by the company and he misses using it. I too love using my original Cryoprobe but have found a way around the unavailable original cartridges and filters, using after-market suppliers. I buy commercial grade NO2 cartridges used for whipping cream, which work just as well as the more expensive HO cartridges.
For the filters, I use Whatman 50 mm slow filter paper. They come in large discs and my regular paper hole cutter cuts out smaller discs the perfect size to fit the Cryoprobe head. Both items are found on Ebay and are inexpensive. I have been using this combo for the past 3 years and they work as well as the original equipment. There is no need to upgrade to the newer more expensive Cryoprobes if you don't want to.
Rob Tyrrell, DPM, Cherry Hill, NJ
12/20/2025
RESPONSES/COMMENTS (NON-CLINICAL)
From: Elliot Udell, DPM
Frequently on PM News, people ask for information on where to get Cantharidin. Sometimes there are positive answers and sometimes not. If you cannot find Cantharidin, there are lot of other ways to treat verrucae. One product that we are getting great success with is having the patient apply a product called GlyCylic®' Wart Remover. This can be dispensed in the office and you can debride the wart weekly. It’s available from the Tetra Corporation.
Another product that we loved was Cryoprobe, where you freeze the warts. Unfortunately, they no longer make cartridges for my older version so we had to stop using it in the office even though it was a great modality. There are virtually countless other products and modalities for the treatment of verrucae. One should not be bound by the availability of Cantharidin or any other product.
Elliot Udell, DPM, Hicksville, NY
12/20/2025
RESPONSES/COMMENTS (ABPM NEWS)
From: Ron Werter, DPM
Congratulations to David George DPM, I cannot think of a more deserving person to receive the award. I have known Dr. George since we were both living at the 92nd Street Y in New York City when we were at the NY College of Podiatric Medicine. Dave was a couple of years ahead of me and I would ask him questions if I didn't understand something at school.
One day, I asked him an anatomy question and he said that's on page 167 in Grey's Anatomy, which it was. I was impressed that he was so smart that he could memorize Grey's anatomy book with page numbers. He was and is that smart, but he finally admitted to me about 30 years later that he had been studying the same thing just then and he knew what page he was on.
Ron Werter, DPM, NY, NY
12/18/2025
RESPONSES/COMMENTS (ROUTINE FOOT CARE) -PART 1B
From: Allen M. Jacobs, DPM
The "direct pay" or "concierge" practice models are certainly an option for a select number of podiatric healthcare providers whose patients have the capability of paying for healthcare directly. Unfortunately, the majority of Americans cannot afford the "direct pay" model of healthcare.
I would remind Dr. Roth and others who advocate the direct pay model that many of our patients struggle just to pay for their cardiac or diabetic or cancer or other needed medications or therapies. We have an increasingly large geriatric population (that is correct before you say it, people such as myself) who are on a fixed income and struggles to maintain a date to the existence for basic food and housing. Yes, there is a sub-population of well-heeled individuals who can afford to pay directly for medical care, and there is certainly nothing unethical or illegal to care for such patients and receive direct pay. However, what do we do for the majority of...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
12/18/2025
RESPONSES/COMMENTS (ROUTINE FOOT CARE) -PART 1A
From: Joseph Borreggine, DPM
This discussion centers on a single diagnosis that is significantly under-utilized within the field of podiatry. While there are other conditions that can be “evaluated, managed, and treated,” the LCD for routine foot care has unfortunately limited many podiatrists to believing that is the sole service they can bill for and utilize.
As Dr. Jacobs states, regrettably, many lecturers who are considered “experts” on this subject derive their income from this practice and speak from authority despite their limited practical experience or lack of clinical care. In their lectures, these experts assert that all routine foot care codes include the E/M component within their RVU for those specific codes. While this may be true, it does not imply that the diagnosis of an acute or chronic condition should be disregarded solely to avoid audits. This attitude is unfortunate and should be addressed at all costs.
As podiatric physicians, we encounter complex patients daily who require specialist evaluation, management, and treatment. Therefore, it is imperative to engage with the patient, conduct a thorough examination, and provide appropriate treatment based on our podiatric knowledge and experience. Minimizing this attitude by simply trimming nails and calluses, either through the typical foot doctor mentality or delegating it to medical assistants, is neither prudent nor efficient. The potential revenue lost due to clinician fear, ignorance, or the desire to see as many patients as possible on a daily basis is unfortunate. Furthermore, to avoid the need to use routine foot care codes entirely, some podiatrists may resort to billing the E/M code to encompass all the care they provide to a patient. This practice is also unfortunate, unwarranted, and constitutes a misrepresentation of the actual situation.
Joseph Borreggine, DPM, Fort Myers, FL
12/18/2025
RESPONSES/COMMENTS (BOARD CERTIFICATION)
RE: ABPM Notice on ABFAS Communications
From: The ABPM Board of Directors
I am retired and now on the outside looking in. Some of the persistent problems I read about are hard enough, but the need for the ABPM board to write their letter (regarding defamatory statements pre-written by another podiatric board) is so sad.
Paul Stepanczuk, DPM, Munster, IN
12/18/2025
RESPONSES/COMMENTS (ABPM NEWS)
RE: NJ Podiatrist Receives ABPM Lifetime Achievement Award for Advocacy
From: Richard H. Mann, DPM
Congratulations to my professor, mentor, and friend, Dr. David George, on receiving the Michael P. DellaCorte, DPM, Lifetime Achievement Award for Advocacy. This is truly well-deserved recognition of his long-standing leadership, service, and unwavering advocacy and support of our profession. Dr. George's dedication has had a meaningful and lasting impact, strengthening standards and advancing the credibility of podiatric medicine for generations to come. This honor reflects not only his professional achievements but also the respect and appreciation he has earned from colleagues throughout the field.
Richard H. Mann, DPM, Boca Raton, FL
12/17/2025
RESPONSES/COMMENTS (ROUTINE FOOT CARE) -PART 1B
From: Ivar Roth, DPM, MPH
Dr. Jacobs makes some good points, but the answer is much simpler and is staring us in the face in my opinion. While we have obligations as a provider, if the insurance provider informs the patient properly, meaning presenting them with a well written explanation and informed consent for them to sign, we have done our job. In the end, it is up to the patient to work within their insurance and decide the path forward for them. The simple solution is that they will have to pay you out of their pocket for your services they require. The machinations discussed are very complex and this solution, I believe, solves and absolves the provider from this dilemma.
As a concierge direct pay provider, I no longer have to jump through any hoops and the patients leave happy and satisfied with paying a reasonable fee for the required services.
Ivar Roth, DPM, MPH, Newport Beach, CA
12/17/2025
RESPONSES/COMMENTS (ROUTINE FOOT CARE) -PART 1A
RE: -25 Modifier and RFC And Diabetes
From: Allen M. Jacobs, DPM
Regarding the use of the -25 modifier in order to allow maximal and to optimize care of the diabetic patient, particularly the older patient, we must recall that there is true fraud, "honest fraud", and creative billing or billing "gamesmanship". True fraud, in my opinion, is a conscious/willful effort to deceive a third-party such as Medicare in order to receive payment. I suspect that many of our colleagues are accused of fraud and abuse, when in fact they are guilty of "honest fraud", meaning that they provided needed and legitimate services but failed to meet documentation or other requirements.
Many of the billing and coding seminars, in my opinion, fail to provide the necessary detailed documentation required to satisfy the E/M office visit, together with the provision of so-called "surgical services", meaning needed skin and nail care. Speakers at these meetings emphasize the definition of the -25 modifier, but quite frankly are individuals who make their living lecturing, and some have never been in...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
12/17/2025
RESPONSES/COMMENTS (MEDICAL-LEGAL)
From: Daniel Chaskin, DPM
My non-attorney opinions are:
The monies billed get associated with the rendering podiatrists' NPI and the monies sent go to the tax id of whomever received such funds. Medicare and other insurers may require the NPI of the provider who actually rendered the services in the box that asks for the NPI of the rendering provider. This is why any podiatrist who assigns their benefits in return for a salary, etc. should call their Medicare carrier for online access to all activities under their NPI, and to document a self-audit about what the employer (be it another podiatrist or hospital facility) actually billed using the rendering podiatrist’s NPI.
Both the person(s) who received monies as well as the rendering podiatrist may be responsible for any improper billing. Thus, I want to ask: If you are an employed podiatrist, when was the last time you contacted Medicare or any other health insurer to actually audit claims a facility billed out for using your NPI?
If an employed podiatrist does not have documentation that an audit of what was billed for under their NPI, it might be possible they had a duty to have such documentation to justify that their NPI is not being misused. My question is does APMA provide a list of independent auditing companies that can actually help the employed podiatrists?
Daniel Chaskin, DPM, Ridgewood, NY
12/17/2025
RESPONSES/COMMENTS (BOARD CERTIFICATION)
RE: ABPM Notice on ABFAS Communication
From: The ABPM Board of Directors
The American Board of Podiatric Medicine (ABPM), as a professional courtesy, wishes to warn podiatric physicians of the potential for personal liability for distributing the false, misleading, and defamatory statements being encouraged by the American Board of Foot and Ankle Surgery (ABFAS), including the pre-drafted letters it is encouraging its Diplomates to send to hospitals regarding ABPM’s Certificate of Added Qualification (CAQ) in Podiatric Surgery.
Physicians who transmit false, misleading, or defamatory statements about ABPM or its Diplomates will be considered by ABPM to be acting in their individual capacity and could face potential liability for defamation, tortious interference, and unfair competition under state and federal laws. Use of ABFAS supplied language does not automatically confer immunity, and professional liability or D&O insurance may not apply.
ABPM encourages all physicians to exercise independent judgment and seek personal legal guidance before engaging in credentialing-related communications. Furthermore, we call upon all podiatric organizations to engage in responsible dialogue and to uphold the integrity of our shared missions; serving the public with excellence.
The ABPM Board of Directors
12/16/2025
RESPONSES/COMMENTS (ROUTINE FOOT CARE)
From: John V. Guiliana, DPM, MS, Joseph Borreggine, DPM
Every podiatrist should read Dr. Jacobs' post SEVERAL times.
John V. Guiliana, DPM, MS, Fort Myers, FL
I wholeheartedly concur with Dr. Jacobs’ perspective on the appropriate course of action for podiatric physicians. His response has effectively defined our profession. If a podiatric physician solely bills for routine foot care without providing comprehensive evaluation and management, they should be regarded as mere nail technicians. The apprehension regarding the use of evaluation and management (E/M) codes with the -25 modifier due to potential OIG audits stems from inadequate documentation. Proper documentation is essential to qualify for these codes.
Recent changes were implemented a few years ago to establish new categories and guidelines for billing medical decision-making and time spent in the E/M code arena. If you have not reviewed the updated documentation requirements, I recommend consulting the relevant resources and utilizing them to your advantage. This will enable you to effectively practice as a podiatric physician.
The abuse of E/M codes has been identified through random audits that focused on poor or non-existent documentation. While this constitutes fraud, it is important to note that if you have thoroughly examined a patient, documented all necessary findings, and provided appropriate care, you are not engaging in fraudulent activity. Your actions benefit both the patient and the podiatric profession.
Joseph Borreggine, DPM, Ft. Myers, FL
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