08/11/2023    Robert D Teitelbaum, DPM

Nail Avulsion Guidelines (Ivar Roth, DPM, MPH)

I was around in the mid-eighties when the nail
avulsion guidelines were established. Right then, I
knew there was a problem. The issue was one of
enforced overtreatment. To get paid to relieve a
potentially dangerous condition, especially in
geriatric and diabetic patients, was to make one or
more injections to a toe with local anesthesia,
when freeze spray anesthesia was often adequate.
Using freeze spray also cut the time to a fraction
of the other procedure. And when you are dealing
with an anxious patient, time is trauma.

Also, strange requirements were made to incise
eponychial tissue that seemed to be 'make work'
type of actions that were not clearly correlated to
the issue that was causing the pain and incipient
infection. In other words, I was on the razor's
edge of 'assault and battery'. All that was
required was removal of 'the offending spicule" and
carefully curetting that side of the nail to avoid
leaving my own spicule.

But 'removing the offending spicule' became dirty
words not worthy of reimbursement because some
podiatrists fraudulently invoked that phrase every
time they came upon a toenail. So overzealous
podiatric consultants helped to create unreasonable
requirements for the 97% of ethical podiatrists who
were not committing fraud. Nice going, as they say
where I grew up. What was needed at that time, and
now, was a step-down procedure that removed the
'offending spicule' and at a lesser reimbursement
than a 11730. Instead, practitioners are billing
for paronychias, maybe when there are not any, and
doing P & A procedures on almost all patients,
because this way one can avoid a nasty audit for an
ill-defined procedure.

Robert D Teitelbaum, DPM, Naples, FL

There are no more messages in this thread.