PM News –March 22, 2006 #2,538 Editor-Barry Block, DPM, JD
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-----------Debuting April 1: CodinglinePRINT
Online-----------
Codingline is pleased to announce the publishing of
CodinglinePRINT,
its monthly reimbursement, coding, and practice management
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---------PODIATRISTS IN THE NEWS--------
APMA Warns of Sandal Scandal: FL DPM Offers Advice
The American Podiatric Medical Association says that at this
time of
year, it's common to witness the "Sandal
Scandal," meaning the ill-
fitting shoes you're wearing may be making any existing
foot
problems a lot worse.
If you look at the styles that are out now -- super-high
wedge heels
with straps that go around your calf, wooden shoes -- you
can't help
but buy, buy, buy. I am guilty, too. Since I am a member of
the "height-challenged club," most of the shoes
in my closet teeter
toward the 3 inch mark. They are hard to give up, and
podiatrist
MICHELE SELSOR offers this advice:
Dr. Michele Selsor, Podiatrist: "Try to go shopping
around. If
you're able to wear a shoe (high heel) for a few hours (for
an
event, wedding), wear them, then take them off and put them
away.
Don't wear them for an extended period of time. Afterward,
check
your feet, look for blistering and redness."
Source: De Anna Sheffield, TV 10 Florida [3/20/06]
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-----------SPORTS MEDICINE NEWS---------
Warming Up and Stretching May Impair Performance in
Competition
Have you watched football players, sprinters and other
athletes
warming up and stretching before competitions? Two studies,
one from
Louisiana State University and one from Liverpool University
in
England, show that they may be harming their performance
(Journal of
Sports Science, May 2005).
In the first study, elite college sprinters were timed in 20
meter
sprints, with and without prior multiple 30-second stretches
of
their leg muscles. As was expected, both active and passive
stretching slowed them down. Many previous studies show that
you
cannot lift your maximum weight after a muscle is pulled and
stretched. Other studies have failed to show that stretching
prevents injuries. This study does not tell you to stop
stretching
completely because there is solid data to show that
stretching makes
you a better athlete. Stretching elongates tendons and the
longer
the tendon, the greater force a muscle can exert around a
joint to
make you stronger and faster. However, this study suggests
that
athletes should not stretch before competitions.
The English study shows that warming up limits how far you
can run.
Runners alternated 30 seconds of very fast runs on a
treadmill with
30 seconds of running very slowly until they were exhausted.
They
tired earlier after having their legs heated passively and
also
after taking a long warm up run before testing. At
temperatures of
about 70 degrees F., both active and passive heating raised
both
muscle and body temperatures, which uses up muscle glycogen
faster
and tires runners earlier. Since warming up has been shown
to help
prevent injuries, it may be good idea to warming up before
power
events of short duration, but not before competitions that
last for
several hours.
Source: DrMirkin.com [3/20/06]
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--------------MEDICAL EDUCATION NEWS-----------
Harvard Alters Docs' Training to Emphasize Patient View
Harvard Medical School is embarking on the most dramatic
changes to
its curriculum in 20 years, in an effort to better train
doctors to
understand illness from the patient's perspective and
appreciate how
patients' lives and the disjointed healthcare system
complicate
care. The biggest shift will occur in the third year, which
is the
first time that students leave the classroom to see
patients. At
present, students go from hospital to hospital for one- to
three-
month stints, a practice that gives them few opportunities
to get to
know patients or senior doctors. Under the new curriculum,
students
will stay in one hospital and follow some patients the
entire year.
Senior doctors would be able to better spot students'
strengths and
weaknesses, and they will hold twice-monthly conferences in
which
students will discuss not only their patients' medical
issues but
also ethical dilemmas, family problems, and health insurance
snafus.
Source: Boston Globe via Modern Healthcare [3/20/06]
-------- MEETING NOTICES/ COURSES --------------
AAPPM Spring Coding, Billing, Reimbursement and Practice
Management
Workshop. Sheraton Inner Harbor Baltimore. May 4-7, 2006
Two great meetings in one! Optional coding, billing and
reimbursement workshop all day Friday and an all-new, two
day
practice management workshop featuring an all-star lineup of
the
best practice management speakers in Podiatry, one half-day
sports
medicine track being put on by the American Academy of
Podiatric
Sports Medicine. Several all-new presentations and the
Academy's
trademark, highly interactive small group round tables.
DPMs,
podiatric assistants and office staff invited.
Contact AAPPM at 978-646-9091; e-mail officeaappm.org; or visit
http://www.aappm.org.
------------
For a list of all meetings go to:
www.podiatrym.com/meetings.pdf
-------- CODINGLINE CORNER --------------
Query: Physical Therapy Payment
If you perform bilateral foot surgery, and follow-up with
physical
therapy for both feet, how do you get paid for the physical
therapy
performed on both feet?
I have found that insurance companies usually only pay for
therapy
performed on foot no matter how we bill it. Is there a
modifier or
other method of billing to get paid for performing physical
therapy
on both feet?
Nicole D. Klueh Hancock, DPM, Houston, TX
Response: The CPT guideline for physical therapy modalities
requiring direct (one-on-one) patient contact by the
provider define
the therapy as including "...one or more areas, and
per 15
minutes..."
When billing physical therapy bilaterally you would need to
document
the site(s), and total time of therapy administered (per
site). You
bill the total number of 15 minute units of therapy
administration.
This is regardless of whether you administer the therapy
bilateral,
or multiple sites on one extremity, or to a single site on
the foot.
Paul Kesselman, DPM, Woodside, NY
Additional responses can be found at http://www.codingline.com
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-----RESPONSES / COMMENTS------------
RE: APMA to Hold 2009 Annual Scientific Meeting in Toronto
From: Bret M. Ribotsky, DPM
With all the political heat this profession faces each year,
having
our only national meeting in Canada will not look good to
our
elected officials.
Hold an additional meeting. Call it what ever you want. Keep
the
Annual APMA meeting in the USA.
Bret M. Ribotsky, DPM, Boca Raton, FL, ribotskygmail.com
---------------
RE: Tiny Piece of Needle Post-op (Allen Jacobs, DPM)
From: Howard R. Fox, DPM, Richard W. Boone, Sr
I agree with Dr. Jacobs in that a post-operative x-ray is
not
necessary following a 5th toe arthroplasty. I would be
interested to
know if there was an "incident" during the
procedure that would have
made the surgeon suspect a needle break, in which case, a
post-
operative x-ray would be prudent. If there were such an
incident, it
would be the standard of practice to closely inspect the
suture
needles after use. If it were the tip of the suture needle
that
broke off (as is almost always the case with these
scenarios), we
all know the feeling of trying to push a pointless needle
through
skin, which would incline a prudent surgeon to closely
inspect the
needle tip.
I would be particularly interested in speaking with all the
people
Present in the OR to try and obtain any feeling that such
an "incident" occurred.
Howard R. Fox, DPM, Staten Island, NY foxhryahoo.com
I would be extremely reluctant to file a third-party action
against
the suture manufacturer. In my experience, third-party
actions
usually don't work out very well for the defendant. What I
would do
is to "try the empty chair." In other words,
blame everything on
the suture manufacturer without naming it. With a little
luck, that
will force the plaintiff to add the suture manufacturer as
an
additional primary defendant which, quite frankly, is a
better place
for the doctor to be.
This is a case which begs for a trial and not a settlement.
Contrary
to popular opinion in medical circles, lay juries are NOT
stupid.
Whatever happened in this case is NOT the defendant
doctor's fault
and any moderately competent defense attorney ought to be
able to
make that point absolutely clear to the jury fairly easily.
Frankly, the plaintiff's attorney is hoping this case will
settle
because the potential verdict value is so low that the
plaintiff
attorney will probably lose money by going to trial, even if
the
jury gives the plaintiff a verdict. Settling cases like this
just
encourages more cases like this. Make this lawyer work real
hard for
every penny he or she gets (if they get any pennies at all)
and that
lawyer will be less likely to do it again in the future.
From the legal viewpoint, this case is a "no harm, no
foul" case.
Assuming that the defendant doctor had done the immediate
post-
operative x-ray. The second procedure to removed the needle
fragment
would still have been necessary anyway. Unless the plaintiff
expert
is going to say that earlier surgery would have resulted in
less
scarring (a preposterous position) nothing happened to the
patient
due to the delay in discovering the needle fragment which
wasn't
going to happen anyway. So, where are the damages?
Richard W. Boone, Sr., Health Care Attorney, Fairfax, VA,
RWBooneaol.com
----------
RE: CME Guidelines (Allen Jacobs, DPM)
From: Barry Mullen, DPM, Elliot Udell, DPM
While Dr Jacobs eloquently make his point regarding
lecturers
deriving income solely from honorariums accrued from their
appearances on the "lecture circuit", another
pertinent issue comes
to mind. Haven't we all listened to enough lecturers who
clearly
weren't qualified to discuss their particular chosen topic?
While
I'd gladly pay to listen and learn from an experienced,
proven,
podiatric retired veteran that's maintained his/her
expertise in a
given podiatric subspecialty, shouldn't CME organizers be
held
accountable to ensure that their chosen speakers are truly
worthy of
selection.
From one perspective, we all take time from our private
practices to
attend these meetings. This costs us money, as well as the
fees and
traveling expenses incurred attending these premier CME
programs. We
hope the income "lost" is replaced with the
knowledge gained for
self-improvement in some component of our specialty that
ultimately
earns the income back several times over. If podiatric
medicine is
going to evolve into the elitist specialty it ascribes to
be, then
the days of "seeing one, doing one and teaching
one" need to be
replaced in favor of hiring the most qualified subspecialty
experts
at these premier events.
Barry Mullen, DPM, Hackettstown, NJ, yazy630aol.com
Dr. Allen Jacobs has focused on another facet of why
seminars that
feature corporate sponsored speakers to the exclusion of
others are
cheating their participants. Many topics such as medical
ethics,
psychiatric medicine, research methods, non implant related
surgical
topics are just a few topics are important but lack anything
to sell
to participants. Such topics will not find a corporate
sponsor and
to exclude them is to deny our profession important post
doctoral
training. I do want to salute those conferences out there
that do
have lectures that don't fall into the category of topics
would be
subsidized by corporate sponsors. These groups deserve
credit for
enriching our postdoctoral educational system.
Elliot Udell, DPM, Hicksville, NY, Elliotuaol.com
-------
RE: Diabetic Ulcer Care (Mark Katz, DPM)
From: Paul Kesselman, DPM
I totally agree that my being a speaker for Wright Medical
is a
factor and should be divulged, and that's exactly why I
did. So that
someone else would not point this out! That however, does
not change
the fact (and is supported by many studies) that the
advanced tissue
engineered products offer many advantages to even the most
advanced
dressings, and certainly to saline and gauze. As I will
point out in
June's Podiatry Management, all advanced skin
tissue-engineered
products should not be used as a first-line treatment for
any wound.
One should certainly have the knowledge of sophisticated
dressings
and modern off loading techniques, and employ them prior to
the use
of any advanced tissue engineered product. This is no
different than
what I previously advocated and certainly agrees with Dr.
Katz'
position.
I do, however, feel certain products (dressings and graft
materials)
Offer certain advantages (both technically and efficacy) in
certain
situations over others. One certainly can use a collagen
based
dressing, or a less expensive graft product such as Oasis or
other
temporary porcine grafts, and Regranex which together will
provide a
wonderful scaffold and the growth factors lacking in many of
these
wounds. This certainly can be used prior to use the much
more costly
advanced tissue materials and may provide the same effects
at a much
lower cost. Of course comparing the costs at start up of
treatment
would be very difficult to estimate.
One should also note that a study published in January's
issue of
Wounds came to the conclusion chronic wounds treated with
Integra
vs. STSG healed faster and were less costly. So yes, as per
Dr. Katz
what makes the world go round and round here is not just the
number
of opinions, but the number of options. This is only likely
to
increase with more products and the emergence of gene
therapy as a
future tool for wound care.
Paul Kesselman, DPM, Woodside, NY, Pkesselmanpol.net
------------
RE: Nuisance Cases (Jay Grife, DPM, JD, MA)
Dr. Grife suggests that I set up a debate between us.
Unfortunately, I don't have the ability to do that.
However, if some
organization which does have the ability to organize and
sponsor
such a debate wishes to do so, I'll be there. Any time, any
place.
Richard W. Boone, Sr., Health Care Attorney, Fairfax, VA,
RWBooneaol.com
Editor's comment: We'd gladly pay to hear that debate.
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