PM News –January 16, 2006 #2,485 Editor-Barry Block, DPM, JD
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--QUESTIONS ABOUT BILLING, CODING OR REIMBURSEMENT?-------
Just send them to PM News by replying to this newsletter.
Your
questions will be forwarded to Codingline for responses
which will
then be posted on PM News. PM News subscribers are invited
to
explore Codingline (www.codingline.com), and register for
[Codingline-L], Codingline's free moderated listserv
focusing on
reimbursement and practice management issues: coding,
billing,
collections, appeals, and more. [Codingline-L] free
registration:
www.codingline.com/silver.htm ). For current Codingline
topics of
discussion and more information about [Codingline-L], see
the end of
this newsletter.
---------PODIATRISTS IN THE NEWS--------
IL DPM Provides Tips For Foot Health of Seniors
As we age, injuries and foot problems are common, says
ROBERT
PARKER, an Illinois podiatrist. After the age of 55, a lot
of fatty
tissue, or padding, deteriorates in the foot and the bones
are more
exposed, Parker says. The bones also tend to enlarge,
causing pain
in the ball of the foot or heel as more pressure is added to
the
bones, he says. The pressure causes deep calluses called
hyperkeratosis.
Arthritis and diabetes also add to the causes of sore,
aching feet,
Parker says. Cracking heels, dry skin and circulatory
problems are
common for diabetics, and constant medical attention is
needed for
diabetes patients.
Seniors who don't have chronic health problems also need to
pay
attention to their feet. "A big problem for older
patients is when
they lose foot and leg strength," Parker says.
Sometimes seniors
have difficulty getting in and out of the car. "Their
legs get
weaker, and they are more subject to falling and breaking a
hip," he
says.
Parker says he tells his patients to add some exercises to
their
daily routine to improve leg strength. The most important
exercise:
leg squats, he says. In a standing position, hold a 5-pound
weight
in each hand and hold it up to the shoulder. Then, bend the
knees to
a squat to the sitting level and stand back up. Repeat the
squat 15
times, three times a day. "You will see a difference in
a few days,"
he says.
Source: Theresa Grimaldi Olsen, Copley News Service,
[1/13/06]
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----------- PROFESSIONAL MISCONDUCT ---------
NJ DPM Accused on Medicare Fraud
Federal prosecutors say a Middlesex County podiatrist bilked
the
government of hundreds of thousands of Medicare dollars by
submitting claims for treatments that were little more than
massaging feet and clipping toenails. A civil complaint
filed in
federal court in Newark said MING TUNG, who lives in East
Brunswick
and has offices there and in Jersey City, ignored warnings
about
improper billings, instead filing more claims.
Two years ago, authorities say, Tung received $856,000 in
Medicare
payments, or nearly 24 times the average reimbursement for a
New
Jersey foot doctor. Last year his filings topped $1.6
million. In
many cases, Tung billed for visits to low-income apartment
complexes
in Middlesex and Hudson counties, where he allegedly gave
foot
massages in the lobbies. Prosecutors sought and received
from U.S.
District Judge Katharine Hayden a temporary restraining
order
Tuesday banning Tung from billing Medicare or Medicaid at
least
until a Jan. 30 hearing.
According to the affidavit, Tung collected more Medicare
reimbursements since 2003 than any podiatrist in the New
Jersey-New
York region -- and they say much of that was undeserved.
Between
January 2002 and June 2003, they contend, three-quarters of
Tung's
filings were fraudulent, leading to $530,000 in
overpayments. He is
accused of violating "numerous federal statutes"
including
healthcare fraud by performing "routine foot care"
but calling it
complex medical treatment.
Tung's attorney argued that government investigators weren't
equipped to evaluate patients' medical needs or the
treatment they
received. His attorney, Robert Conroy, said his client was
innocent
of any wrongdoing and that he looked forward to proving that
in
court. "We believe that the government just got its
facts wrong --
period," Conroy said. "And we believe their own
documents will
demonstrate that."
Source: John P. Martin, Star-Ledger [1/13/06]
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----------------------MEETING REPORT------------------------
Superbones + Superskin = Super Meeting
Each year Superbones/Superskin gets better. Following in
that
tradition, this year's event was arguably the best ever and
featured
the 1st annual Gerard Yu Memorial Lecture presented by
Podiatry Hall
of Famer Stanley Kalish, DPM. The unique morning only
lecture and
workshop format of this seminar allowed DPM's and their
families to
enjoy the beauty and ambience of the Atlantis Hotel &
Casino in
Paradise Island, The Bahamas. On Saturday night everyone
enjoyed the
festive and lavish Caribbean-themed gala affair sponsored by
Doak
Dematologics.
Superbones/Superskin 2007 (Jan 11-14) promises to be even
more
exciting with the debut of "Learn More, Earn More"
presented by
Barry Block, DPM and Podiatry Hall of Famer Harry Goldsmith,
DPM.
The 2nd Annual Gerard Yu Memorial Lecture will be given by
another
Podiatry Hall of Famer, Guido LaPorta, DPM.
-------- MEETING NOTICES/ COURSES --------------
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-----------
Codingline 2006 NY Seminar (Limited Seating-Register Now)
January 19, 2006 -- Codingline-NYSPMA "Strictly Coding
2006"
seminar ("Day Before the Clinical Conference") at
the New
York Marriott Marquis (Speakers: Mark Schilansky, DPM, Barry
Block,
DPM,JD, Ken Malkin, DPM, Paul Kesselman, DPM, Harry
Goldsmith,
DPM). For information, go to
www.codingline.com/events-ny.htm.
----------
For a list of all meetings go to:
www.podiatrym.com/meetings.pdf
-------------QUERIES--------------
Query: Loosening a Fixation Device
I performed a brachymet case with EBI external fix, I was
wondering
if some of my colleagues can give me some idea on when they
first
loosen the fixation device, and when they start the
lengthening
process. The procedure went great on this 42 yr old woman.
She is
coming back in six days for first dressing change. Do I
start to
lengthening on that visit, or wait?
Allan A. Wax, DPM, Chester, VA, Aswdpmaol.com
---------
Query: Sterilization of Dremel Burrs
What is the common procedure among high volume practices
regarding
the sterilization of Dremel burrs between patients? Is there
an OSHA
requirement related to this?
Kyle Kinmon, DPM, West Palm Beach, FL, kkinmonaol.com
--------- CODINGLINE CORNER --------------
Query: First MPJ Implant Removal
What is the appropriate diagnosis and procedure for removal
of a
painful, failed first metatarsal-phalangeal hemi-implant
(silastic)?
David Sands, DPM , Jamaica Estates, NY
Codingline Response: Assuming that the removal of the
implant was
essentially all you did, it would be billed as CPT 20680
(removal of
implant; deep [e.g., buried wire, pin, screw, metal band,
nail, rod
or plate]).
If you removed the implant in the course of doing other work
in the
area (e.g., exostectomy), then the removal would be
incidental to
the allowance for the other comprehensive procedure done.
Tony Poggio, DPM, Alameda, CA
Additional responses are posted on http://www.codingline.com
-----RESPONSES / COMMENTS------------
RE: Vicodin Before Surgery (David E. Gurvis, DPM)
From: Multiple Respondents
My first question would be does this patient truly have
plantar
fasciitis? In 20 years, have not seen anyone the required
narcotics
for the pain. There are some who thought they needed
narcotics. If
they are in that much pain, I would check my diagnosis and
send them
to a pain management clinic. This could be a disaster
waiting to
happen.
Patrick J. Nunan, DPM, West Chester, OH, PJNDPMRUNaol.com
If your patient isn't already an abuser of Vicodin you
certainly
will help her become one. Since when and who taught you that
Vicodin
is indicated in the treatment of plantar fasciitis There is
one
thing you should remember when you treat patients. The tail
doesn't
wag the dog. Just because your patient asks for something
and "she's a nice lady", you don't comply just to
be a nice guy I
guarantee you she won't be so nice sitting behind her
attorney in a
courtroom. If she can't afford the surgery right now, too
bad.
Don't feed her Vicodin which has no indication here.
Thomas A. Graziano, DPM, Clifton, NJ, TGrazi6236aol.com
Some of the worst abusers of narcotics are sweet little old
ladies.
The possibility that you are being used is too great and you
are
putting your professional life at stake. What are you going
to do in
February when she decides to reschedule her surgery. If she
is in
such pain then refer her to a pain management practice and
quit
supplying her with medication you really can't justify in a
legal
environment.
Brian Kiel, DPM, Memphis, TN, footdokaol.com
I want to take just a few moments to thank everyone who
replied to
me about my previous post. And just in case we forget that
we are
capable of helping each other, I had almost 20 personal
replies,
from podiatrists who took time from their busy day to be
helpful.
To me, that is the sine qua non of being a colleague.
David E. Gurvis, DPM, deg1comcast.net
Editor's comment: Of course the best way to share
information is to
reply to us at bblockpodiatrym.com so responses can be shared
with
the entire podiatric community.
------------
RE:Comprehensive Diabetic Foot Exam (NY Times Articles)
From: Ken Malkin, DPM
A few years ago I wrote an article that appeared in Podiatry
Management magazine about the comprehensive diabetic foot
examination (CDFE). It was followed up with a second article
a year
or so later. The purpose of these articles were to convince
my
colleagues that either we were not getting paid for the
cognitive
services we provide for diabetics beyond palliative foot
care or we
were not providing the level of care we are capable of and
that
diabetics deserved due to confusion over payment policy.
Medicare
has pages of rules delineating when statutorily excluded
routine
foot care may be covered. In no way do these rules preclude
medical
necessary evaluation and management services in addition to
the
procedure codes.
Some patients qualify for at risk foot care based only on
diminished
vascular status. I believe we should treat our diabetics
differently
than these other patients that qualify for at risk foot care
procedures. All diabetic patients require cognitive services
(evaluation and management) in addition to regular at risk
foot
care. This article proposed special patient encounters
during which
no at risk foot care was provided. These encounters would be
billed
as evaluation and management services. These encounters
would
document interim history and examination concentrating on
complaints
and issues relevant to diabetics and include a plantar
pressure
assessment, shoe evaluations, and involve counseling which
is so
important in the prevention of diabetic complications. As
the
guardians of diabetic foot heath we own these protocols. We
know
better than anyone the value of these services.
My analogy is the ophthalmologist's approach to diabetics.
Annually, a patient is refracted and receives a retinal
exam. Six
months later, the diabetic receives a retinal examination
alone.
Diabetics by virtue of their diagnosis are susceptible to
pedal
complication and deserve more than nail trimming and we can
be paid
for doing what is medically necessary according to ADA Foot
Care
Standards.
I challenge all of my colleagues to refresh their diagnostic
skills
and learn the new techniques such as semi-quantitative
plantar
pressure assessment that were not available when many of us
graduated podiatric medical school.
Ken Malkin, DPM, Caldwell, NJ, drmedicareaol.com
-----------CLASSIFIED ADS--------
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Position available Atlanta area . Excellent opportunity to
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----------
Seeking to Share Your Office Space - Los Angeles Area
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------------
Practice For Sale – Queens, NY
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-------------
Position Available – Naples, FL
Florida, Naples- Great opportunity for PSR- 24/36 BE/BC
podiatrist
with strong surgical skills. Hospital privileges available
at 548
bed hospital system and multiple surgical centers. Candidate
should
be able to and want to perform rearfoot surgery including
Charcot
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Established practitioner or new practitioner OK. Base,
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benefits including insurance and 401K. Fax CV to
(239)566-8778.
-----------
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Fax-773-
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