10/25/2024    Paul Kesselman, DPM

RE: APMA Should Promote Annual Comprehensive Diabetes Prevention Foot Examination for At-risk Patients (Alan Bass, DPM)

I stand by my partner Alan Bass, DPM, whose
opinion is absolutely correct. Each patient
encounter should have at a minimum an appropriate
history and physical with components of lower
extremity systems including but not limited to
dermatology and must also include neurovascular
and a MSK examination. Any changes in patient
history or PE should be well documented and
incorporated into the note.

But the change in history is not what will get you
paid for a separate E/M nor is documenting a
change in the physical examination. It is that
last part, the management, what exactly did you
do? If all you did was document a change in
history, nope. If all you did was document a
change in the PE, again, no dice. You must
document all 3 issues, a change in history (e.g.
increase pain), a change in the examination (e.g.
increased edema, decrease sensation, etc.) and
what you are doing to manage these.

That should be a sufficient pathway to follow to
obtain payment for an e/m which is separate from
the minor surgical procedure you may or may not be
performing that day.

Whether one chooses to use a proprietary template
from a commercial vendor is your choice, as has
been advocated by others is secondary. There of
course is the problem is managing all the various
different options available for the various
pathologies one encounters and using all these
different workflows and then importing them into
my patient's EMR.

Having shared an office w/an internist for almost
forty years and being a consultant to many
physicians, orthotists, pedorthists and suppliers,
I see them all using their same EMR/EHR for every
type of encounter. It seems that only our
profession feels we must have a myriad of
proprietary electronic records to use.

I would hope that as physicians, one should not
have to rely on a commercial vendor to tell you
what you must do to conduct a proper E/M
examination. As I learned in the mid 1970's its
really quite easy once you know what to listen and
look for. Then it’s up to you to take charge and
order what is needed. So simply listen and record
what the patient tells you, look for what you
should be looking for and document that and
compare it to their last visit and lastly document
why you now need to change course and order what
you are ordering.

That is quite frankly what is needed!

Paul Kesselman, DPM, Oceanside, NY

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