PM News –April 20, 2006 #2,560 Editor-Barry Block, DPM, JD
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-------- PODIATRISTS IN THE NEWS --------
TN DPM Offers Sound Advice on Toenail Care
For some women, a fresh coat of paint can't seem to mask
the pain
associated with some types of nail problems. Blount Memorial
podiatrist DR. BRENT HARBIN explains that women are more
likely to
develop toenail problems, mainly because of the types of
shoes they
wear. "These problems are often made worse by the type
of shoes
women wear. For example, most women's dress shoes are
narrow in the
toe box, likely causing increased pressure on the nail
borders,"
Harbin explained. "This can make an existing condition
more painful."
A common toenail ailment found fairly often in women is
fungal
nails, which is an infection within the nail unit. The
condition
typically presents itself as a thickened, discolored, flaky
nail,
according to Harbin, who also says there sometimes is a
noticeable
odor associated with the condition. "It can be
difficult to cure,"
Harbin said, pointing out that oral and topical treatments
are
available. "Regardless of the chosen treatment,
typically at least
three months is needed to see improvement in the nail
unit."
Just as it's important to do with other personal hygiene
items, be
sure to disinfect instruments used to cut nails and home
pedicure
tools. "Of the biggest concern to women who have
pedicures and
manicures is the risk of infection, whether fungal or
otherwise,"
Harbin says, also noting that women who have services done
at a
local salon or nail parlor are at a limited risk.
"That risk (of
infection) certainly exists, however, as long as the
facility or
salon is following the appropriate guidelines for cleaning
their
instrument, the risk should be limited."
Source: Maryville Daily Times (TN) [4/17/06}
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------------HEALTHCARE NEWS -------------
Insurers Have Near Monopoly on Healthcare: AMA Study
Consolidation among health insurers has led to
near-monopolies and
oligarchies in most areas of the U.S., an American Medical
Association study finds. According to the study, based on
2005
data, 56% of 294 metropolitan areas have single health
insurers that
control more than 50% of business in HMO and PPO
underwriting. The
study also finds that 95% of metropolitan areas have
"high" market
concentration based on the Herfindahl-Hirschman Index, which
measures antitrust concerns. According to AMA, health
insurers have
not passed savings in personnel and administrative costs
that result
from consolidations to consumers. AMA has raised antitrust
issues
with the Department of Justice, but the department does not
have an
interest in the issue.
Source: American Health Line [4/18/06]
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-------------QUERIES--------------
Query: Latex Shields
Does anyone have a source for any companies who still makes
good
quality latex shields?
David E. Gurvis, DPM, Avon, IN, Deg1 comcast.net
Latex shields may be ordered from: Liquid Rubber Appliance
Laboratory, 45 Valley Way, West Orange, NJ 07052
(973-325-0174).
Previous PM News posts indicate that they do an excellent
job with a
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------- CODINGLINE CORNER --------------
Query: Distal Symes Amputation
Pre-Op Diagnosis: "painful chronic ingrown toenails of
digits 1-
5..."
Procedure: "distal Symes amputation of digits 1-5 of
right foot."
"...mapped area of incisions which were located at the
distal tuft
of all digits fish mouth-type incision made on all digits.
Removed
wedge of skin. Flushed the site. Using a power saw, a
partial
resection of the distal phalanges of each toe was performed.
The
sites were flushed again, and the surgical sites
closed...The
procedures took 1.25 hours..."
How should this really be coded?
Margie Scalley Vaught, CPC, CCS-P, Chehalis, WA
Response: I would recommend looking CPT 28153 (resection,
condyle,
distal end of phalanx, each toe) x 5 for this procedure.
Also bill
using the appropriate "T" modifiers.
Denise Paige, CPC, Long Beach, CA
Additional responses can be found at http://www.codingline.com
-----RESPONSES / COMMENTS------------
RE: Arrested For DWI (Barry Mullen, DPM)
From: Richard W. Boone, Sr, Esq., Brian Kashan, DPM
With all due respect to Dr. Mullen, I thought the commentary
and
advice provided by the Learned Editor was very appropriate.
Unfortunately for Dr. Name Withheld it really doesn't make
any
difference whether this was a first offense or not. Driving
while
under the influence of some chemical substance, especially
alcohol,
is a BIG DEAL, even for a first offense.
This Doctor needs some really good legal assistance and he
needs it
right now. Both his personal liberty and his right to
practice
medicine are in jeopardy. I suspect that any competent
attorney
retained by this Doctor would immediately refer the Doctor
for
evaluation by some specialist in substance abuse. The key
to
preserving Dr. Name Withheld's license will be to be able
to prove
that this offense was an aberration and not an ongoing
problem. The
best way to do that is by the testimony of specialists in
the field
who have evaluated and/or treated him. Further, the fact
that the
Doctor voluntarily sought out the services of a support
group will
weigh very heavily in his favor with any licensing
authorities who
may review this matter at some later date.
This Doctor needs to understand that he must be proactive in
developing evidence to prove that he's not an habitual
abuser. So,
if (heaven forbid) Dr. Name Withheld actually does have a
substance
abuse problem, then the Learned Editor's advice was
absolutely
correct. On the other hand, even if Dr. Name Withheld
doesn't have
an ongoing substance abuse problem, following the Learned
Editor's
advice is one major and beneficial step to establishing that
fact.
So I applaud Dr. Mullen's compassion. Unfortunately, the
prosecutor
in Dr. Name Withheld's hometown may not share in it. Dr.
Name
Withheld needs to understand that this problem isn't simply
going to
go away all by itself. He's going to have to make it go
away. The
Learned Editor's advice, ALL of it, is a giant step in that
direction.
Richard W. Boone, Sr., Health Care Attorney, Fairfax, VA
The question from Name Withheld, and the subsequent comments
compelled me to respond. Dr. Block, your advice was
excellent.
While some of us, without knowledge of substance abuse, may
offer
opinions based on personal views, they are speaking without
experience. Having had a person in my family with substance
abuse
issues, I can tell you first hand that even one DUI is a
major issue
that needs to be addressed. Having this person evaluated
after only
one incident can save lives.
Almost inevitably, the initial response to getting caught is
denial
by both the person and their family. There mindset is that
it was an
isolated event and bad luck in getting caught.
"Everyone drinks and
drives sometimes. Everyone smokes pot sometime in their
life. It is
only a social thing that allows me to relax and have
fun." Sound
familiar? However, my guess is that while this may have
been the
first time being caught, it was not the first time driving
intoxicated. So, are we defining a "problem" as
getting caught or
using?
This person should seek help immediately, and go for
counseling. Let
those who know determine if there is a problem. Who lets the
patient
make a determination as to their condition? Professionals
are able
to evaluate a person for addiction/abuse behaviors and this
can
ultimately be a life saving experience.
I can attest to the positive life changes that can be
achieved when
one gets the help they need and makes a determined effort to
recover. My family member has never been happier, more
productive,
and our relationship has never been better than after her
recovery.
Plus, I am now educated and informed as to the issues of
substance
abuse and have done away with the stigmas attached to these
diseases.
Brian Kashan, DPM, Baltimore, MD, drbkasatt.net
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