PM News –March 9, 2006 #2,528 Editor-Barry Block, DPM, JD
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--QUESTIONS ABOUT BILLING, CODING OR REIMBURSEMENT?-------
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---------PODIATRISTS IN THE NEWS--------
IL DPM Becomes First Chief of Surgery at Local Hospital
DR. MICHAEL WESSELS has been elected the Surgical Division
Chair at
Katherine Shaw Hospital in Dixon, Illinois. Wessels is the
first
podiatrist to hold the designation at KSB and will serve
until
January 2008.
The road to being designated chief of surgery at any
hospital is
often a long and circuitous one. When Wessels began practice
in
1977, podiatrists were often granted allied health
professional
status at hospitals, if they were granted any privileges at
all.
Even today, it is not difficult to find hospitals that only
grant
podiatrists this quasi-professional status. Since allied
health
professionals were not actually considered medical staff,
they were
not allowed to vote on medical staff concerns. Wessels
worked to get
a by-laws change to allow podiatrists to be members of the
medical
staff at various hospitals with which he was affiliated in
Northwestern Illinois. While podiatrists were then
admitted to
medical staffs at these hospitals, they were still not
allowed to
vote.
Wessels successfully changed the by-laws to allow podiatrist
voting
privileges, but holding an office on the medical staff was
still not
allowed. Wessels volunteered to serve on various hospital
committees, beginning with the Performance Improvement
Committee,
which he has chaired for the past 6 years, and the Physician
Performance Review Committee. Service on hospital committees
led
Wessels to lobby to change the by-laws to allow podiatrists
to serve
as an officer of the medical staff. He argued that all
other
specialties could aspire to hold an office, so podiatric
medicine
should not be excluded. When an opening for a
Member-at-Large on
the Executive Committee came available, Wessels ran for the
office,
and was unanimously elected. After serving two years as
Member-at-
Large, Wessels was slated by the nominating committee for
the Chief
of Surgery position.
Wessels says," It is all about inclusion. To be
respected as an
equal partner in the healing arts we must have full
inclusion on
hospital medical staffs. Each generation of podiatrists
must help
pave the road for the next generation until the day will
come when
the hills my generation had to climb will just appear to
have been
distant bumps along the road to the next
practitioners."
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----------------PROFESSIONAL MUSCONDUCT--------------
FL DPM Charged with 1.5 Million Medicare/Medicaid Fraud
A podiatrist with offices in Orange Park and Green Cove
Springs, FL
is charged with stealing Medicaid and Medicare funds for
work he did
not perform.
BRUCE FRIEDMAN also is charged of obstructing an Internal
Revenue
Service investigation of his finances by creating false and
fraudulent receipts for various items and services. Court
records
show he also submitted claims for work at nursing homes and
assisted
living facilities. Friedman remains free pending court
action
scheduled next week.
Court documents allege Friedman defrauded the government by
billing
for services he did not perform at sites away from his
office;
billing for services he claimed to have done when they were
performed by an unlicensed employee; having employees submit
claims
for a service than had a greater reimbursement rate than the
work
performed. The government seeks forfeiture of $1.5 million
related
to the fraud.
Source: Associated Press [3/8/06]
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--------------APMA STATE COMPONENT NEWS -----------------
New NJ Podiatric Medical Practice Act Signed Into Law
A-2024 (Biondi/Prieto) was signed into law on January 5,
2006 by
Acting Governor Codey and became effective immediately. In
addition
to modernizing and clarifying the current practice statute,
the new
law deleted all archaic references to
"chiropody" and replaced it
with "podiatric medicine" throughout all the
pertinent sections of
law, including insurance law, and emphasized that
"ankle" is within
the scope of podiatric medicine.
The new practice statute clearly reflects the current state
of
professional education and terminology. As a result of
NJPMS'
advocacy, NJSPS membership may point to the new statute as a
clear
representation requiring no further interpretation when
questioned
as to the extent of the scope of podiatric medicine in New
Jersey.
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-------------QUERIES--------------
Query: Dak Sterilizer Replacement Parts
Does anyone know where to purchase a replacement inner tub
for a Dak
sterilizer?
Jay Kerner, DPM, Baldwin, NY, aikiman44 aol.com
-------- CODINGLINE CORNER --------------
Query: Cartilaginous Surface Drilling Code
Is there a code to use for fenestration or subchondral
drilling of a
cartilaginous surface such as in an OCD lesion of the 1st
met head?
Nicole Hancock, DPM, Houston TX
Response: Yes, there is a code you can use: Unlisted
foot/toe
procedure, CPT 28899.
No, there current exists no regular CPT code that defines
a "fenestration or subchondral drilling of a
cartilaginous surface
on a 1st met head.
Be aware that payers may request, prior to reimbursement,
you
provide them with published peer-to-peer articles
establishing this
treatment as 1) effective and 2) standard of care for
degenerative
pathology of the metatarsal-phalangeal joint. You may want
to
attempt to pre-authorize the procedure/reimbursement.
Harry Goldsmith, DPM, Cerritos, CA
-----RESPONSES / COMMENTS------------
RE: Semi-Customizable Hallux Limitus/Ridgus Orthotic (W
Godfrey ,DPM)
From: Larry Huppin, DPM
The Instep Prefab from ProLab Orthotics is a semi-rigid
polypropylene prefab that incorporates 3 degrees of forefoot
valgus
correction. The valgus correction encourages the first ray
to
plantar-flex and thus helps to enhance first MPJ motion in
patients
with functional hallux limitus.
To further enhance first MPJ motion, the Instep Prefab
allows for
easily adding a first metatarsal cut-out. If patients still
continue
to have hallux limitus symptoms, then a reverse Morton's
extension
can be applied. If the patient still has symptoms, it's
time for a
custom orthosis.
Larry Huppin, DPM, Medical Director, ProLab Orthotics, Napa,
CA
Lhuppinprolab-usa.com
-----------
RE: Pedalign Digital Scanning System (Howard Bonenberger,
DPM)
From: J Rose, DPM
Our office decided to evaluate the Pedalign Digital Scanning
System
on a trial basis. They offered a very reasonable incentive
program
to use the system. It was installed in our office on January
13,
2006. We have definitely found the system to be
user-friendly and
the podiatric assistants were able to quickly learn how to
use the
scanner. I am now in the process of teaching them the basis
for
deciding which orthotic style and features to order for
certain
conditions.
I have been quite excited about our new system despite
limited
feedback to date. If one considers an approximate two-week
turn
around on orthotic delivery and our standard three week
follow-up
appointment, we are just beginning to see patients again for
follow-
up. But the early results have been quite good and better
than our
previous lab results.
Likewise, I have found patient acceptance of the scanner and
its
computer technology to be much higher than the traditional
plaster
casting techniques. Patients actually come into the
treatment room
with the Pedalign brochure that they read in the reception
area and
inquire whether this will help their problem. I no longer
feel that
I have to "sell" the orthotic therapy.
On the "down side", I still believe such
computerized systems are
limited with regards to orthotic choices and available
options based
on the included templates. For example, one can not order a
device
with medial and/or lateral flanges or deep heel cups for
some
orthoses. A Richie Brace is out of the question. However, I
believe
that Pedalign has been continuously working to improve and
expand
its product range. Hopefully, we will see increased options
in the
near future.
I hope that Dr Bonenberger gives the system a closer look as
I
believe that it will be quite beneficial to his practice and
patients alike.
J Rose, DPM, docrosebellsouth.net
Editor's Note: This topic is now closed
---------
RE: Intra-articular Steroid Injections (Barry Mullen, DPM)
From: Bryan C. Markinson, DPM, Art Hatfield, DPM
Regarding my post that a joint does not have to be tapped
prior to
instillation of steroids if there is no effusion present,
the recent
wonderful voice of reason on PM News, Dr. Barry Mullen,
asked the
following : "if the joint is not effused in the first
place, why
would anyone want to inject a steroid into it?"
This is a fair question but experience tells us that there
is an
inflammatory component involved even in non-effused joints,
such as
hallux limitus/rigidus, and Freiberg's disease. Certainly,
anti-
inflammatory agents are used in ostearthritis, which
classically is
viewed as "non-inflammatory." From a
rheumatology standpoint,
a "joint" includes the ligaments, synovium,
capsule, and even the
tendon attachments going into it. I can only conclude that
in
painful joints within which there is no effusion that
respond to
intra-articular injection, there must be some inflammatory
component
that is addressed.
Lastly, in most pedal joints we are dealing with very small
amounts
of fluid normally to begin with. In inter-phalangeal joints
and
lesser metatarso-phalangeal joints, we may indeed have an
increased
amount of fluid which is not appreciated clinically as in
the first
metatarso-phalangeal joint. So in conclusion, the
inflammatory
component may not be known OR the presence of an effusion in
certain
small joints may not be clinically appreciable.
Technique-wise, we
need only get the needle under the capsule to be
"intra-articular."
Poking the needle around to try to get into the space (that
does not
really exist) is what in my view causes damage and may
induce
further reaction.
Bryan C. Markinson, DPM, NY, NY, profpodaol.com
In podiatry school I must have missed the lecture,
"Stay out of
joints." I am sure glad I did. If I had, I would have
had a hard
time justifying bunion surgery, arthroplasties and a whole
host of
other common procedures that I learned during my residency.
I do
remember hearing anecdotal stories about prepping the skin
before an
arthrocentesis with Betadine, benzine, alcohol, and other
noxious
agents to prevent infections. Personally I have relied on a
good
alcohol prep for 30 years without any problems.
Finally what has a greater chance of causing a wound
infection, an
injection of a sterile fluid with a sterile needle into a
non
infected joint, or an open procedure in an operating room
that has
been exposed to the most virulent microorganisms imaginable
surrounded by the surgeon, assistant surgeon, two residents,
a
medial student, anesthetist, circulating nurse, scrub nurse,
x-ray
tech, and all of the bugs they carry? It seems to me that if
you
have ethical concerns about injecting joints and possibly
causing an
infection, you should probably stop doing surgery.
Art Hatfield, DPM, afootjobjuno.com
Editor's note: This topic is now closed.
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