PM News –February 21, 2006 #2,516 Editor-Barry Block, DPM,
JD
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--QUESTIONS ABOUT BILLING, CODING OR REIMBURSEMENT?-------
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---------PODIATRISTS IN THE NEWS--------
Trail Running Strengthens Outer Leg Muscles: Julien
Running on uneven surfaces improves stability by
strengthening
lower, peripheral leg muscles that get little use on flat
pavement
runs, according to trainers and podiatrists.
"Trail running helps improve balance and makes you a
better athlete
because you have to use the outer muscles of your
legs," says PERRY
JULIEN, a veteran trail runner and team podiatrist for the
NFL's
Atlanta Falcons and the NHL's Atlanta Thrashers.
Steep hills, a staple of most trail runs, also force runners
to
swing their arms more, giving them a better upper body
workout, and
the changing terrain compels runners to take shorter, more
efficient
strides, eliminating the likelihood of overstriding, the
tendency to
take excessively long strides. Overstriding eats up too much
running
energy and can lead to injuries.
Source: Hugo Martín, Los Angeles Times [2/19/06]
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--------APMA COMPONENT NEWS----------
NCFAS Elects Officers
The North Carolina Foot and Ankle Society elected Dr. Eric
Siceloff,
a licensed podiatrist in Winston-Salem, as its president.
Dr. Robb Mothershed, also a Winston-Salem podiatrist, was
named vice
president.
Dr. Tim Vogler, a High Point podiatrist, was named
treasurer.
Source: Jeanne Sturiale, WINSTON SALEM JOURNAL [2/19/06]
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--------- CODINGLINE CORNER --------------
Query: ICD-9 Code for Os Trigonum Syndrome
What would be the appropriate diagnostic code of os trigonum
syndrome?
Howard Dananberg, DPM, Bedford, NH
Response: Os trigonum syndrome [posterior ankle impingement
(PAI)
syndrome; posterior tibiotalar impingement syndrome (PTTIS)]
is the
result of an impingement or compression of the posterior
talus (with
os trigonum present) and the surrounding soft tissues
between the
tibia and the calcaneus on plantar flexion of the foot. It
is seen
in patients whose activities involve excessive or recurrent
plantar
flexion motion (e.g. ballet dancers, soccer players,
basketball
players, runners, and volleyball players).
The symptoms can occur either gradually or acutely. The
patient
complains of pain in the posterior ankle with the area
behind the
Achilles tendon at that site sore to the touch. The syndrome
can
involve swelling and stiffness in the posterior ankle area.
The
differential diagnoses for os trigonum syndrome include
Achilles
tendinitis, calcaneal or talar fracture, retrocalcaneal
bursitis,
posttraumatic arthritis, ankle ligament sprain,
osteochondritis
dissecans, tarsal coalition, and posterior tibialis,
peroneal, and
flexor hallucis longus tendinitis.
There is no specific ICD-9 code for os trigonum syndrome.
There are,
however, a number of possible ICD-9 codes that may describe
either
conditions or signs/symptoms present (os trigonum syndrome
can be
made up of several groups clinical pathologic entities),
including
(but not limited to):
ICD-9 726.90 - Enthesopathy of specified site (Capsulitis
NOS)
ICD-9 726.70 - Enthesopathy of ankle and tarsus, unspecified
ICD-9 726.71 - Achilles bursitis or tendonitis
ICD-9 959.7 - Injury, knee, leg, ankle and foot
ICD-9 729.5 - Pain in limb
ICD-9 719.57 - Stiffness of joint, not elsewhere classified
It is important NOT to code "rule outs" – so if
there is no talar
fracture present, do not include that ICD-9 code in your
billing; if
there is no Achilles tendinitis present, do not code for it,
etc.
Harry Goldsmith, DPM, Cerritos, CA
-----RESPONSES / COMMENTS------------
RE: Height a Factor For Amputation Among Patients With
Diabetes
From: Kevin A. Kirby, DPM
Excessive magnitudes of plantar pressure are the likely
cause of
skin ulceration in patients with diabetic neuropathy. Since
pressure is defined as force divided by surface area then,
either
an increase in force acting on the plantar foot or a
decrease in
surface area upon which that force acts will increase the
plantar
pressure, and possibly lead to plantar ulceration.
Individuals with increased height will tend to have longer
legs,
longer feet and increased body mass, compared to those
individuals
with decreased height. If the increase in body mass is
proportionally greater than the increase in surface area of
the
plantar foot, as one compares a tall person to a short
person, then
one would expect the plantar pressures to increase. Also,
if the
tall person has a higher medial and/or lateral arch height
(which I
commonly see in my patients) then, due to the decreased
plantar
surface area of contact, the plantar pressures would be
expected to
increase in magnitude during weight-bearing activities.
However, the longer leg length in a tall person would not
cause an
increased dorsiflexion rotational velocity of the ankle but
would,
in fact, cause a decreased dorsiflexion rotational velocity,
if
speeds of walking were kept equal when comparing a tall
person to a
shorter person. To move the center of mass (CoM) of the body
a
given speed during midstance, the person with longer legs
will
require less dorsiflexion rotational velocity of the ankle
joint
than a person with shorter legs would require. In effect,
the
longer legs of the taller person act as longer lever arms
around
their center of rotation at the ankle joint. Leg length will
also
greatly affect the stride frequency during walking, with the
shorter
person taking more strides per minute at a given speed than
a taller
person.
Kevin A. Kirby, DPM, Director of Clinical Biomechanics,
Precision
Intricast, Inc., kevinakirby comcast.net
--------
RE: Topaz Microdebrider Radiofrequency Coblation (J.
Petrinitz, DPM)
From: Michael DiGiacomo, DPM
I performed an open surgical excision of a fibrosis on the
distal
Achilles of a competitive bicycle rider in 2004. In late
2005 I used
the topaz unit on a similar mass on his contralateral side
(similar
size). He voiced a preference for the later procedure, had a
similar
clinical result and was back on his bike two weeks sooner
with the
topaz treatment.
Michael DiGiacomo, DPM, Oakland, CA, mddpmhotmail.com
------------YOU CAN'T MAKE THESE THINGS
UP--------------------
I practice at Johns Hopkins in Baltimore. We are about 150
miles
from the ocean and at Hopkins, we accept all medical
assistance
plans. A patient from the Eastern shore of Maryland had an
ingrown
toenail. There are no podiatrists there who accept Medicaid.
If you
think the state would therefore pay someone from the Eastern
shore
UCR fees to have their patients taken of, you'd be wrong.
This
patient was placed into a taxi for a round trip to Baltimore
at the
cost of $500. By the way, the patient showed up without a
referral,
so we were not paid anything.
Bruce Lebowitz, DPM, Baltimore, MD
-----------CLASSIFIED ADS--------
Podiatry Practice for Sale - NYC
Nassau/Queens Border, 40 year old Practice, General Care -
Net $300K
Good practice for Partnership, 1 Partner in place, Small
Down
Payment, with Pay Out All information to be emailed
Serious Inquiries Only!!!! Email: DPM1111optonline.net
----------------
Associate Position- Indianapolis and Suburbs
Group practice with multi-office, multi-hospital locations
looking
for "good fit" associates to grow and develop
into partners. We
offer diverse practice environments from pediatrics to
geriatrics,
nail surgery to rearfoot surgery, and diabetic foot care to
sports
medicine. New grads with surgical residencies a plus, but
mentoring
is available for others.
More important than your training and experience is your
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be
proud of your life. Experience Hoosier hospitality...come
and
visit. You might like what you find.
Curriculum Vitae and References to: Lawrence E. Lloyd, DPM,
FACFAS
Dir., Indiana Podiatry Group, Inc. larrydpmaol.com
FAX 317-595-6296
---------
ASSOCIATE POSITION – TEXAS
Mature 3-DPM general podiatry and surgery practice in the
Rio Grande
Valley of Texas is seeking a DPM to fill an Associate
position,
partnership will be considered after a period of 2-3 years.
Applicants should have at least 2 years of residency
training and
enjoy diabetic foot and wound care. Diverse patient
populations.
(VA, Community Health Clinics, Hospitals and 3 offices)
Good
practice environment in hospitals and community. Salary,
bonus and
benefit package offered. Interested DPMs should send a
letter of
intent along with a current C.V. to Complete Family Foot
Care, 812
Lindberg Ave. McAllen, TX 78501. Fax 956 971-9109
-----------
ASSOCIATE POSITION- NEW ENGLAND
Associate wanted to start this summer. Routine care,
diabetics,
biomechanics, sports injuries and steady surgery. Buy-in
for
partnership and ownership of building a possibility.
PSR-24.
Office podiatry skills (residency experience, office
observation or
work) important. Surgical training with focus on core skills
(bunions, met. osteotomies, neuromas/neurolysis, tendon
repairs,
some rearfoot) is important. facne11aol.com, give evening
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-----------
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