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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:
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 (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
12/29/2025
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
12/20/2025
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
12/20/2025
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
12/18/2025
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
12/18/2025
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 (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 (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.
12/17/2025
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
12/17/2025
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 (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 (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.
12/16/2025
RESPONSES/COMMENTS (MEDICARE)
RE: This CMS Graphic Signals Urgent Need for Provider Compliance
From: Lawrence Rubin, DPM
The Centers for Medicare & Medicaid Services (CMS) is actively disseminating a critical graphic to the entire public, a move that serves as a powerful warning to healthcare providers nationwide. This public outreach highlights that CMS and the Office of Inspector General (OIG) are focusing heavily on fraud, waste, and abuse, putting all providers under increased scrutiny.
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CMS/OIG Notice to Medicare Recipients |
The graphic, which illustrates common compliance pitfalls, underscores the necessity for immediate action. Providers should view this public awareness campaign as a direct signal to fortify their internal compliance programs. Developing a robust, OIG-approved compliance plan should be an immediate priority.
Having a documented and effective compliance program in place is a critical mitigating factor if the OIG decides to open an investigation or suspects a provider of engaging in questionable practices. Such a plan demonstrates a good-faith effort to adhere to federal regulations, potentially reducing penalties.
Lawrence Rubin, DPM, Las Vegas, NV
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
12/15/2025
RESPONSES/COMMENTS (HEALTH INSURANCE)
From: Chaim (Ira) Cohen, DPM
I read Dr. Gurnick’s post and agree with what he has to say, but in the same breath I say, "What a tragedy that in 2026 especially after Obamacare and EMR touted sharing of information that an office essentially needs one or more full-time employees to verify benefits.” What a waste of time and money. I retired five years ago. What was even more disconcerting was that managed care would send authorizations for patients who weren't enrolled. The disclaimer at the bottom that "authorization does not guarantee payment" is despicable. My heart goes out to those still having to deal with this insanity.
Chaim (Ira) Cohen, DPM, Brooklyn, NY
12/15/2025
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Charles Lombardi, DPM, Robert G. Smith DPM, MSc, RPh
Lee Rogers, Patrick DeHeer, and Larry Harkless approached ACGME and not as stated in Dr. Tomczak's letter. Please make a correction.
Charles Lombardi, DPM, Bayside, NY
As a daily reader and consumer of the news, advertisements, and fascinating accounts of accomplishments reported in PM News, even before my graduation from a podiatric medical college, I have enjoyed the content and witness that as a profession ideas, opinions, and point of views can be translated and defined as a geometric area of a circle (360 degrees) over time ever expanding in size but consistently a circle. Thank you, Dr. Block, for a great account, these many years.
The year 2025 has ushered in some previous views and introduced some new ones that have given this reader cause for pause as 2026 begins to peak over the horizon. The changes to the healthcare arena will be paramount as they will change for patients, care givers, and all providers uniformly. Over the years, I have held the belief that a podiatrist, podiatric physician, and podiatric physician and surgeon with head held high embodies parity with all those who...
Editor's note: Dr. Smith's extended-length letter can be read here.
12/15/2025
RESPONSES/COMMENTS (PODIATRIC EDUCATION)
RE: What Does the Undergraduate Pre-med Major Think?
From: Rod Tomczak, DPM, MD, EdD
It doesn’t matter much to the undergraduate pre-med major in Tuna Fish, Wyoming if a podiatrist father and his scion are making $600,000 per annum. The Wyomingite is interested in multiple specialties, not just podiatry. They could be attracted to podiatric sub-specialties like limb salvage, vascular work, plastic surgery as applied to the lower extremity, trauma, etc. This is best achieved by becoming a DO rather than a DPM, where matching into a DPM residency offers him or her a low potential of fulfilling dreams if the residency match doesn’t meet their wishes at that time. Fellowships are, well, not approved.
If we want to keep podiatry alive, we had better start listening to students’ wants and needs rather than pontificating over their choices by telling them how we listened to what we were told by our elders and how lucrative DPM podiatry has been to us and our families. Undergraduate pre-med advisors will be alerting pre-med students to the multipotential aspect of increased DO seats. If we need to provide attainable podiatry options within...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
12/15/2025
RESPONSES/COMMENTS (OBITUARIES)
From: Stefan Feldman, DPM
I am very sad to hear of the passing of Stephen Wittenberg, DPM. I had the good fortune of spending a few months with him in his office following podiatry school graduation and the start of my residency. He was a charming, soft spoken man, and a good friend to both my father and me. I learned a lot about office management and communicating with patients, something not taught in school. May his memory be a blessing.
Stefan Feldman, DPM, Spring Hill, TN
12/13/2025
RESPONSES/COMMENTS (THE FUTURE OF PODIATRY)
From: Rod Tomczak, DPM, MD, EdD
The question is not, “Who are we?,” but should be, “Whom do we want to become? “Who we are is too much of what we used to be, practitioners who could only use a scalpel parallel to the skin, then experts in soft tissue surgery followed by forefoot bone surgery, then a Kirschner wire. Being a podiatrist was like landing on Iwo Jima and fighting for every inch of the foot. ACGME has now asked us, not we asked them, if ACGME would like to look at our post-graduate training to see if we are on par with MD and DO residencies.
They are asking us; something we never thought would happen. There is a chance ACGME learns something from us and vice versa. What we cannot do is shun them by rejecting that once in maybe a lifetime offer because we have become complacent in our own apathy. It’s no time to reminisce about how much we made last year or how happy we were because we were elected secretary of the hospital staff because we got an MPH at the same time we earned a DPM degree and because...
Editor's note: Dr. Tomczak's extended-length letter can be read here.
12/13/2025
RESPONSES/COMMENTS (HEALTH INSURANCE)
RE: Private Practice Management and Health Insurance 2026
From: Keith Gurnick, DPM
Health insurance should be verified on each new patient and each returning patient on every visit. It is not enough to ask the patient, "is your insurance still the same? Asking such a broad and general question may make the office staff feel they have done their job of checking insurance in a kind and non-confrontational way, but this is not focused enough. Patients need to be asked to show their current member I.D. insurance card which they almost always carry in their wallet or purse, or they can also easily produce virtually on their cell phone. A simple request from office staff, "Can I please see your current health insurance card, or cards?" is a polite way to check for insurance changes such as a new I.D. card or different insurance altogether, policy or group # changes, or plan coverage and benefit changes including office visit co-pays. Assuming nothing has changed is a way of the past.
Although time-consuming up front, doing it this way is much more efficient than assuming the patient's insurance has not...
Editor's note: Dr. Gurnick's extended-length letter can be read here.
12/13/2025
RESPONSES/COMMENTS (PODIATRISTS AND DIABETES)
RE: -25 Modifier and RFC
From: Allen M. Jacobs, DPM
The -25 modifier appended to “routine care“ visits is a subject about which I am now passionate. For the last several years, Michael Warsaw and I have spoken on this subject in detail at the St. Louis Podiatry Seminar and will do so again this year.
Why? My job as a podiatrist is in no small part the evaluation of the diabetic patient for risk factors which increase the likelihood of skin breakdown, infection, ulceration, and ischemia. When such risk factors are present, my job is to either treat or refer, or both. My job is also to improve the patient’s quality of life.
As a profession, we have accepted the role of diabetic foot care. This is wide-reaching. Yes, Charcot’s joint reconstruction and stabilization...
Editor's note: Dr. Jacobs' extended-length letter can be read here.
12/11/2025
RESPONSES/COMMENTS (MEDICARE NEWS)
From: Farshid Nejad, DPM
Minnesota has been identified with $70M in healthcare fraud. Grafts being billed by the billions: Medicare Advantage programs are stealing money by the millions. Vascular surgeons billing millions by unbundling endovascular procedures. And I am sure there are billions more in fraud. But the OIG is worried about $4M in overpaid RFC billing. Where are their priorities?
Farshid Nejad, DPM, Beverly Hills, CA
12/11/2025
RESPONSES/COMMENTS (PODIATRISTS AND SPORTS MEDICINE) - PART 1A
From: Carl Solomon, DPM
Dr. Smith, thank you for sounding the alarm. As testimony to your comments, I can describe my own very recent experience. For over 6 months, I've had increasing connective tissue pain unrelated to overuse, stiffness, rotator cuff problems, a hamstrings strain from simply drying off after a shower, then a biceps tendon rupture. There was an obvious predisposition to these injuries due to something systemic. I reviewed my meds with my internist and we decided to do a 3-month holiday from rosuvastatin. My symptoms gradually subsided to the point I was pain-free after only 3 weeks. The biceps rupture us healing on its own.
If you do a PubMed search for keywords "statin", "tendonopathy", "rotator cuff", "rupture", etc., you'll find a wealth of articles in well-respected peer-reviewed the journals that describe this.
Carl Solomon, DPM, Dallas, TX
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