PM News –January 23, 2006 #2,490 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
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explore Codingline (www.codingline.com), and register for
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focusing on
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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--------
AZ DPM's Provide Advice For Heel Pain
Heel pain is one of the most common foot ailments seen by
podiatrists. Besides holiday shopping and parties, anything
done to
excess, like exercising, can prompt the condition.
Podiatrist RANDY
GUBLER of Las Vegas said he treats 15 to 20 people a week
for the
condition. Besides the winter holidays increase, the number
of cases
spikes in summer, too. That's when people become more active
and
begin playing sports.
Gubler said the worse case he's seen was two years ago when
a man in
his 40s came to his office. "The whole bottom of his
foot was
inflamed," he said. "He couldn't even walk on it.
He arrived at my
office in a wheelchair he borrowed from a friend." For
those with
less severe symptoms, Gubler said, an easy way to relieve
the pain
is to place a frozen bottle of water on the floor, then sit
down and
roll it back and forth under the foot. Hot foot baths are
not
advised.
Summerlin podiatrist LAWRENCE M. RUBIN, acting director of
the
AStepSafely FootCare Network, a group of health
professionals
networking to provide specialized preventive foot health
services in
the Las Vegas area, suggested a few simple measures to help
relieve
plantar fasciitis. Use the weekend to give your feet
continual rest
by restricting walking as much as possible, he said. Do not
engage
in hiking or sports. This gives injured plantar fascia a
chance to
begin healing. "If simple measures do not help, do not
put off
seeing a podiatrist," Rubin said. "Continuing to
limp along with
plantar fasciitis for a long time almost always makes
treatment more
difficult when you do decide to seek help."
Source: Jan Hogan, Summerlin South View [1/21/06]
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----------- PROFESSIONAL MISCONDUCT---------
NJ DPM Gets 4 Year Sentence For Botox Injections Without
License
A former podiatrist who gave Botox injections to women at
their
homes was sentenced to four years in prison for practicing
medicine
without a license, which he had lost due to drug use.
"All I wanted to do was have a chance to practice
medicine again,
and being hasty I made a mistake," Stephen Saul said
Thursday at his
sentencing. "Unfortunately, I won't have my license to
practice
medicine again."
Saul, 34, had been awaiting reinstatement after surrendering
his
license in 2001 and completing drug treatment. While working
at two
spas doing laser hair removal last year, he began writing
prescriptions and arranging to meet women in their homes to
inject
the Botox wrinkle remover.
Saul pleaded guilty in December to practicing medicine
without a
license and health care claims fraud.
Source: Associated Press [1/20/06]
-------- MEETING NOTICES/ COURSES --------------
January 28, 29, 2006 -- Codingline 2006 Expo & Seminar
in Los
Angeles, CA. Coding, reimbursement, and practice management
tracks
will be offered along with clinical update tracks on wound
care,
surgery, and medicine. See link below for speakers and
topics. An
assistants' program will be presented by S.O.S. Healthcare
Management Solutions. Noridian Medicare discussions will be
hosted
be Rick Horsman, DPM, former CAC rep from Washington State.
For
information, go to http://www.c
odingline.com/events-ca.htm.
------------
For a list of all meetings go to:
www.podiatrym.com/meetings.pdf
-------------QUERIES--------------
Query: Orthovisc
I was recently detailed by DePuy for their new Orthovisc
product. I
am curious if anyone has experience using this off-label for
the
ankle or any of the foot joints? I am also curious if the
payers
have been allowing the J codes (3490 and/or 3590) as
recommended.
Depuy is recommending the large joint injection code 20610
which
would not work for the ankle or other foot joints.. which
raises
another issue.
Lloyd S. Smith, DPM, Immediate Past President,
APMA,lssmithapma.org
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--------- CODINGLINE CORNER --------------
Query: Nail Avulsion in a Post-op Period
If a patient in 90-day global period for a right foot bunion
surgery
requires a nail avulsion on right great toe, how can this be
billed?
Adrienne Sabin, DPM, San Jose, CA
Codingline Response: The nail avulsion has no relationship
to the
bunion surgery performed even if it is on the same foot. The
billing
for the nail avulsion would be: CPT 11730-T5-79
Harry Goldsmith, DPM, Cerritos, CA
-----RESPONSES / COMMENTS------------
RE: Sinus Tarsi Pain (Stuart Goldman, DPM)
From: Multiple Respondents
If your patient responds to injections, I feel your source
of pain
has likely been identified, the subtalar joint. Have you
exhausted
foot orthoses with a deep heel cup, appropriate extrinsic
postings,
heel lift, flanges, medial heel skive if necessary? Have had
a
pedorthist modify her shoes with a Thomas heel?
Based on your description and failure with non-surgical
means, she
may respond well to a subtalar joint arthroeresis. This is a
short,
outpatient procedure performed under local with minimal
post-op
recuperation. Address any equinus at the time of
arthroeresis.
If you feel she truly needs a triple arthrodesis, you can
consider
incorporating an external fixator with a foot plate to allow
early,
post-op weight-bearing. You may also be able to arrange
admission to
an extended care facility early on.
Craig Breslauer, DPM, Palm City, FL, cbdpmbellsouth.net
In rheumatoid patients in the absence of trauma, chronic
sinus tarsi
syndrome is likely due to hypertrophic synovial
proliferation with
subsequent impingement. I have had excellent results with
subtalar
arthroscopy and debridement for this condition. The surgeon
needs
to be a competent arthroscopist and possess a working
knowledge of
the surrounding anatomy. The post-operative course consists
of a 1
week period of non-weight bearing, followed by advancement
to a
functional brace and referral for physical therapy.
Open "debulking" of the sinus tarsi has fallen out
of favor due to
the significant morbidity associated with the procedure, and
the
disturbance of normal anatomy with simply removing the sinus
tarsi
contents.
Daniel J. Tucker, DPM, Rockville Centre, NY, reekataol.com
If your patient w/ rheumatoid arthritis has pain focused at
the
sinus tarsi, I am not sure what you would accomplish by
performing "blunt dissection of soft tissue" in
the sinus tarsi. It
would in all likelihood make her symptoms worse than they
are now.
As you said she probably "needs" a triple
arthrodesis, but why not
consider an isolated subtalar fusion with internal fixation.
And If
she can't tolerate immobilization, let her ambulate with a
walker
and post-op surgical shoe. The subtalar joint generally
fuses
nicely, particularly with the excellent fixation we can
obtain
today. Sometimes the individual needs of our patients
require that
we veer away, albeit, slightly from our esoteric academic
background.
Thomas A. Graziano, DPM, Clifton, NJ, TGrazi6236aol.com
------------
RE: Wherefore Art Thou Biomechanics? (Lowell Scott Weil,
Sr., DPM)
From: Lloyd S. Smith, DPM, Doug Richie DPM, Kevin Kirby, DPM
Dr. Weil is on target with the need for evidence based
research on
everything we do. One irony of his suggestion - the need for
an
award - is that APMA currently has a largely unused
endowment
available for research. It has gone unused for years because
of the
paucity of quality requests being submitted.
It would be wonderful if we could point to quality studies
that
orthotics control bunion pain, eliminate neuroma symptoms or
solve
chronic cases of plantar fasciitis.
Lloyd S. Smith, DPM, Immediate Past President, APMA,
lssmithapma.org
The American Academy of Podiatric Sports Medicine has
provided over
$50,000 in research grants studying various aspects of lower
extremity biomechanics. In the past 2 years, the Cleveland
Clinic
and the University of Calgary have been recipients of these
grants.
The Cleveland Clinic is studying the effects of shoe shank
design on
the incidence of plantar heel pain syndrome in runners. The
University of Calgary, in a study conducted by Neil Humble
D.P.M.
and Yukiko Toyoda have already completed and submitted their
study
on the effects of foot orthoses on patellofemoral pain in
runners.
The problem, as proposed by Dr. Weil, is not a lack a of
evidence
based papers in the field of lower extremity biomechanics.
Most
major scientific symposia in the podiatric profession
continue to
ignore topics related to biomechanics and podiatric sports
medicine. Dr. Weil is well aware that topics related to
biomechanics and pathomechanics of lower extremity disease
are
routinely included into the programs at orthopedic meetings.
The
disappearance of these topics from our own meetings has
multiple
reasons, and will undoubtedly cause future harm to our
profession.
The American Academy of Podiatric Sports Medicine has
received
tremendous support from the APMA with inclusion into the
Scientific
Program at the Annual Meeting the past 6 years We are
working with
PFOLA , Podiatry Institute and AAPPM to incorporate topics
related
to sports medicine into their programs as well. We salute
these
fine organizations who realize that what has always been
unique to
our profession, must be taught and passed on, or it may
simply fade
away.
Doug Richie DPM, Immediate Past President, American Academy
of
Podiatric Sports Medicine, DRichieJraol.com
In response to Dr. Weil's comment "As soon as we get
some evidence-
based science into the biomechanics lectures, the rooms will
be
filled", it is obvious that Dr. Weil has not recently
been attending
the lectures offered at the Prescription Foot Orthosis
Laboratory
(PFOLA) annual meetings. At these meetings, the lecture
halls are
filled with over 300 interested clinicians and biomechanics
researchers from multiple disciplines representing many
nations.
Two research grants of $25,000.00 from PFOLA have been
distributed
on foot orthosis research that have now repeatedly
demonstrated that
foot orthoses not only alter the kinetics but also the
kinematics of
the foot and lower extremity. Here is a partial list of the
research papers for those more surgically oriented
podiatrists who
do not follow biomechanics research:
MacLean CL, Hamill J: Short and long-term influence of a
custom
foot orthotic intervention on lower extremity dynamics in
injured
runners. Annual ISB Meeting, Cleveland, September 2005.
Mundermann A, Nigg BM, Humble RN, Stefanyshyn DJ. Foot
orthoses
affect lower extremity kinematics and kinetics during
running. Clin
Biomech, 18:254-262, 2003.
Nawoczenski DA, Cook TM, Saltzman CL: The effect of foot
orthotics
on three-dimensional kinematics of the leg and rearfoot
during
running. J Ortho Sp Phys Ther, 21:317-327, 1995.
Nester CJ, Hutchins S, Bowker P: Effect of foot orthoses on
rearfoot complex kinematics during walking gait. Foot Ankle
Intl,
22:133-139, 2001.
Williams DS, McClay-Davis I, Baitch SP: Effect of inverted
orthoses
on lower extremity mechanics in runners. Med. Sci. Sports
Exerc.
35:2060-2068, 2003.
Woodburn J, Helliwell PS, Barker S: Changes in 3D joint
kinematics
support the continuous use of orthoses in the management of
painful
rearfoot deformity in rheumatoid arthritis. J Rheum,
30:2356-2364,
2003.
It would be my great pleasure to have such an esteemed
colleague as
Dr. Weil attend the 9th Annual International Conference on
Foot
Biomechanics and Orthotic Therapy in Chicago on December
1-3, 2006.
I think that he will find that the research being presented
in this
meeting would be of great educational value at any podiatric
seminar.
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirbycomcast.net
------------
RE: Prophylactic Antibiotics (Mark A. Aldrich, DPM)
From: Robson Araujo, DPM
Some hospitals may not allow you to use Vancomycin in this
manner
due to increasing prevalence of Vancomycin resistant
enterococcus
(VRE).
Clindamycin may be a good alternative.
Robson Araujo, DPM, Cullman, AL, robsonabellsouth.net
------------
RE: Source for DP701 Nail Nippers (Laura Schwege, DPM)
From: Marc Klein, DPM
Dentronix made the DP701, the best nipper I ever used. They
discontinued it and eventually brought it back to market but
the
instrument was changed; it was bigger. The closest to this
is
probably the Miltex 40-225A model, narrow jaw--but you might
want to
check the number. Contact Dentronix in Pennsylvania if you
are
interested: http://www.dentronix.com/
Marc Klein, DPM, Methuen, MA, MAILKleinaol.com
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-----------
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