PM News –January 18, 2006 #2,487 Editor-Barry Block, DPM, JD
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--QUESTIONS ABOUT BILLING, CODING OR REIMBURSEMENT?-------
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this newsletter.
---------PODIATRISTS IN THE NEWS--------
Be Proactive With Diabetic Neuropathy: NJ DPM's
The highest rates of diabetic neuropathy are among those who
have
had diabetes for 25 years or more, according to the CDC, and
people
whose blood sugar levels are not well-controlled. Symptoms
of the
condition vary depending on the type of neuropathy a person
has.
Often, because the nerves leading to the feet are so long,
the toes
are affected first, said DR. JOHN BRANDEISKY, who has a
podiatric
practice in Freehold and is affiliated with CentraState.
Numbness and tingling in the feet are among the first signs.
"You'll
know when you have it," said Little Egg Harbor resident
Kenneth
Davis, who was diagnosed with diabetes 15 years ago.
"It's like
little bugs biting at you."
The key to fighting neuropathy, DR. MATTHEW ROGALSKI said,
is
vigilance. "You got to be proactive," he said.
"You got to keep
surveillance on your body." Rogalski, a podiatrist with
offices in
Lacey and Toms River, NJ, said it's important to keep the
feet
moisturized, though diabetics should never put lotion or oil
between
their toes because too much moisture can lead to fungus
build-up.
Davis makes a point to dry his feet thoroughly after washing
them. "You got to be very careful and (check your feet)
daily," he
said. Though some advise patients to use a pumice stone on
their
feet to file away dead skin, Rogalski said people should
have a
professional podiatrist do that. If they press too hard, he
said,
they could break the skin.
Source: Brian Prince, Asbury Park Press [1/17/06]
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----------- COMPONENT NEWS---------
Fix Feet First For Weight Loss Success: ACFAS
Today, the American College of Foot and Ankle Surgeons
(ACFAS) urged
obese adults to seek immediate treatment for chronic,
activity-
limiting foot and ankle problems to foster compliance with
physician-
directed exercise programs.
"It's unfortunate obese adults get caught up in the
vicious cycle of
avoiding physical activity due to foot or ankle pain,
thereby
permitting cardiovascular disease and other life-threatening
conditions to worsen as a result," said Milwaukee-based
foot and
ankle surgeon Sean Wilson, DPM, FACFAS. "For example,
in many
cases, chronic heel pain occurs from carrying too much
weight. Left
untreated, it becomes an impediment to physical activity and
meaningful weight loss."
For those moderately to severely overweight, Wilson said a
thorough
physical examination is mandatory before beginning an
exercise
program. "Once cleared by your physician to begin
exercising, don't
try to do too much too soon. Follow a gradual routine until
your
body adjusts to the stress of regular physical
activity," Wilson
advised. "For example, I counsel overweight patients
to avoid
working out on treadmills or elliptical machines to minimize
pounding and stress on their joints."
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-------------QUERIES--------------
Query: Silver From X-Rays
I have a large number of old radiographs that I must
destroy. Are
there any companies still around that will reimburse for the
silver
which can be extracted from the old films, particularly in
the Los
Angeles/Southern California area.
Harry E. Confer, DPM, West Covina, CA, drhecaol.com
Editor's comment: PM News does not provide legal advice.
Because x-
rays contain PHI, HIPAA regulations mandate that you either
destroy
the name part of the x-ray or have the purchaser sign a
business
associate agreement.
Query: Source for DP701 Nail Nippers
Our office just added two new physicians and we are looking
for more
instruments. We have all agreed we prefer DP707 nail
nippers.
Unfortunately, these are no longer being made, and we have
been
unable to locate any sets. Does anyone have an idea where we
could
purchase some?
Laura Schweger, DPM, Bend, OR
--------- CODINGLINE CORNER --------------
Query: Arthrodiatasis Hardware Removal
The doctor performed an arthrodiatasis articulated joint
distraction) on a patient. Six and a half weeks post-op the
external
fixation device was removed.
Can we bill for the removal of the external fixation, or is
that
included in the procedure? If the removal is billable what
will be
the proper diagnosis and CPT codes?
Lisa Maynard, New York, NY
Codingline Response: If the removal required a trip to the
operating
room, performance of the procedure under anesthesia, and was
a
planned procedure, I would bill for the removal using a
"-58"
modifier using CPT 20694 (removal, under anesthesia, of
external
fixation system).
If the hardware had to be removed due to some other problem,
then
use a "-78" modifier using the same CPT code. I
would also refer to
the original diagnosis code that prompted the surgery,
and/or V54.89
(other orthopedic aftercare).
If the removal was done in the office, many would consider
it part
of the global care and not separately billable (depending on
the
insurance plan policies).
Denise Paige, CPC, Long Beach, CA
Additional responses are posted on http://www.codingline.com
-----RESPONSES / COMMENTS------------
RE: Wherefore Art Thou Biomechanics?
From: Elliot Udell, DPM
I have the great honor of attending and lecturing at many
great
podiatric seminars. At a recent world class seminar a
colleague
and I lamented that it appears that over the past few years
our post
doctoral educational system seems to be veering away from an
area of
podiatry that truly is our own - biomechanics and orthotics.
When I
finished my residency 25 years ago, and attended seminars
the
majority of lectures were either totally focused on
biomechanics or
as with most surgical presentations, had a strong
biomechanical
component associated with it. A good lecturer would not give
a
presentation on surgery without throwing in something about
post-
operative orthotic control.
This seems to no longer be the case and I wonder why? Was it
pure
economics on the part of labs and practitioners that might
have been
the driving force behind the lectures of the past or have
the
biomechanical sages of yesteryear passed on with no students
to
replace them? Lastly should we do anything about or just
lament?
Elliot Udell, DPM, Hicksville, NY, Elliotuaol.com
------------
RE: Comprehensive Diabetic Foot Exam Billing (John E
Morehead, DPM)
From: Ken Malkin, DPM
The question regarding Medicare insurance reimbursement was
posed to
me privately by others in addition to your excellent post. I
am
aware that a few states, North Carolina and Oklahoma, do not
allow
podiatrists to bill an E/M with a diagnosis of diabetes. I
disagree
with your assertion that you do not treat diabetes. As I a
podiatrist, just like a nephrologist, ophthalmologist, and
neurologist, among others we are involved in the overall
management
of diabetics. We are responsible for the early detection of
known
pedal complication of diabetes. By early detection and
treatment, we
are one more reason for the diabetic to control their blood
glucose.
Once a single serious complication of diabetes develops, the
patient
becomes more and more depressed and discouraged and less
likely to
be a partner in the control of their disease.
Federal statutes written into the original Medicare program
excluded
routine foot care. Routine foot care was defined to include
the
treatment of corns, calluses, and nails, and general
hygienic
maintenance of the feet, along with the management of other
asymptomatic structural conditions of the feet. Exceptions
were than
made to allow coverage for certain procedures for the
at-risk
patient provided they meet class findings. At-risk foot
care, as
covered by Medicare, is payment for a select group of
procedures -
11719, 11055 series. Documentation of class findings, which
are
required for coverage in most states are not reimbursable
separately
even though some of the elements consist an E/M service.
This is
consistent with other Medicare rules. For example, Medicare
requires
photos to cover blepharoplasty, but does not a physician to
obtain
them.
A comprehensive diabetic foot exam (CDFE) does not involve
any minor
surgical procedures. It is strictly a cognitive service
consisting
of an interim history, interim exam, decision-making, and
patient
counseling. It is recommended by the ACFS Guidelines on the
diabetic
foot and is considered a standard by the ADA Foot
Guidelines. My two
articles from Podiatry Management discuss this in detail and
explain
the purpose and nature of the exam. I suggest that this exam
be
performed on a day in which NO at-risk foot care is
performed due
to the nature and time involved in the exam. In cooperation
with
Footlogic (footlogic.info) I have created a sample form
which is
tailored to this exam and part of "kit" to get
physicians thinking
in this manner. Footlogic will be at the NY Clinical
Conference for
those of you that are attending.
I strongly suggest you ask your CAC representative and state
society
to challenge Medicare in this area, citing coverage for an
ophthalmologist's retinal exam every six months as an
example.
Ken Malkin, DPM, Caldwell, NJ, drmedicareaol.com
------------
RE: Sterilization of Dremel Burrs (Kyle Kinmon, DPM)
In my practice all burrs get autoclaved after each use. My
nail pack
includes a nail nipper, scalpel handle, curette, and two
Dremel
burrs, and gets sterilized after each use. The question of
autoclaving instruments has been exhausted in this forum and
I
believe every patient deserves sterile instruments every
visit.
Bryant A. Tarr DPM, Brytarraol.com
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----------
Seeking to Share Your Office Space - Los Angeles Area
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----------
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-------------
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Established practitioner or new practitioner OK. Base,
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-----------
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