PM News –January 26, 2006 #2,493 Editor-Barry Block, DPM, JD
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--QUESTIONS ABOUT BILLING, CODING OR REIMBURSEMENT?-------
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which will
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---------PODIATRISTS IN THE NEWS--------
UT DPM Injured in Motocross Accident
DR. SHANE DRAPER is "improving and doing well"
after a motorcycle
accident Saturday evening at the Horse Palace in Spring
Creek,
according to fellow podiatrist DR. JOHN PATTEN. Draper was
practicing at the Ruby Mountain Motocross Winter Race
motocross
event when he was injured.
"We wish him the very best. There is no reason to
expect he won't
have a full recovery," said Patten, who is seeing
Draper's patients
for him while Draper is hospitalized. Patten said today he
thought
Draper would enjoy cards and letters. Draper is on the
neurosurgery
and spine floor at the University of Utah Hospital, Room
312.
The address for the University of Utah Hospital is 50 North
Medical
Drive, Salt lake City, Utah 84132.
Source: Elko Daily Free Press [1/25/06]
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-------APMA COMPONENT NEWS --------------
Frisch Named FL Podiatrist of the Year
At the recently concluded and highly successful SAM meeting,
the
Florida Podiatric Medical Association (FPMA) awarded
"Podiatrist of
the Year" recognition to Dr. Dennis R. Frisch of Boca
Raton, Florida.
Dr. Frisch has been a podiatric physician in his hometown
for 23
years. He is a leader within the FPMA and has served with
distinction in a variety of tasks throughout the years. This
award
recognizes his many achievements,
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-----------PHARMACEUTICAL NEWS ------------
Report Urges Strict Rules On Doc-Drug Company Relations
An article to be published in the Journal of the American
Medical
Association calls for rigid guidelines that would prohibit
drug
companies from providing physicians with gifts of any kind,
saying
that long-standing financial ties between the medical
profession and
pharmaceutical industry erode research integrity and hurt
patient
care. "No matter what you are told by any physician or
administrator, these gifts -- no matter how small --
influence
doctors' behavior," said David Rothman, president of
the Institute
on Medicine as a Profession in New York. The think tank at
the
Columbia University College of Physicians and Surgeons
helped fund
the report by a group of about a dozen medical experts.
The report urged academic medical centers to take the lead
in
abolishing gifts of any size, including meals and payment
for travel
or for participating in continuing medical-education
programs, and
to strictly regulate ties between doctors and drug
companies. Other
recommendations include: replacing direct drug samples with
a system
of vouchers for low-income patients and insulating
continuing
medical education from industry influence by requiring
companies to
contribute to a central academic office that would disperse
funds to
individual programs.
The Pharmaceutical Research and Manufacturers of America, a
trade
group, and the American Medical Association did not respond
to the
specific recommendations of the report. However, both said
they had
ethics codes meant to help ensure that interactions between
drug
companies and doctors worked to the advantage of patients.
PhRMA's 3-
year-old voluntary code warns drug company representatives
that "entertainment, expensive meals and gifts that are
for personal
use by the physician are not appropriate." "Only
practices that do
not compromise independent judgments of health providers,
such as
modest working meals, gifts of minimal value that support
the
medical practice and distribution of free samples, are
permitted,"
according to the code.
Source: Michael Romano, Modern Healthcare [1/24/06]
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-------------QUERIES--------------
Query: Screw Vs. K-Wire Fixation of Austins
During my schooling, it was almost ingrained in my head that
a screw
or screws were the best way to fixate an Austin
bunionectomy. During
my 3 year surgical residency, I was exposed to all sorts of
fixation
(screws, K-wires, Orthosorb, etc.) Each attending had their
reasons
for using a specific type of fixation; but as a resident I
was not
involved in the decision making of the pre-op,
peri-op, or post-op course. Now, six months into private
practice,
with a good amount of surgeries under my belt, I have found
things
out that no textbook will ever tell you. Most patients that
I have
talked to do not like the idea of a screw being put in their
foot.
I have noticed that patients are much more comfortable with
the non-
permanence of a K-wire that will be removed at a later date.
I
actually polled a group of friends and family who almost
unanimously
would opt for the K-wire. I have now used a .62 K-wire on my
last
couple of Austins, and have gotten, nice, rigid fixation
every
time. Due to its stable construct and its inherent
stability, I
feel the .62 K-wire is more than sufficient for Austin
fixation. I
was curious to see if anybody else who was more seasoned,
had
similar findings with their patients.
Daniel Tellem, DPM, Rochester, NY, liadant aol.com
---------------
Query: Medicare Statute of Limitations
What is the statute of limitations on an overpayment by
Medicare.
In 1997, I underwent an audit, and an overpayment was found.
It was
a coding error, and not fraud. I made many attempts to pay
this
back, and sent certified letters regarding this. They never
responded. The original auditor is now my compliance
officer, and
today 9 years later we received a call regarding this.
My healthcare attorney, well respected on the west coast,
has told
me the statute ran long ago, particularly if no fraud was
ever an
issue which it never was. What is your take on this?
Name Withheld
Editor's comment: PM News does not provide legal advice: The
statute
of limitations for non-fraud-related audits is five years.
In cases
of fraud, the government can (and often does) investigate as
far
back as they wish.
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--------- CODINGLINE CORNER --------------
Query: Billing For an Assistant Surgeon
Our practice has recently hired another podiatrist to
perform
surgery part time. Claims will be submitted under the
practice's
tax ID number. The practice owner/podiatrist will be
assisting the
part time podiatrist in an assistant surgeon-approved
surgery.
Can an assistant surgeon be billed if the same tax ID number
is used?
Shari Winkler, Nanuet, NY
Response: The assistant can be billed using the same tax ID
number.
If, however, the doctor isn't credentialed with the payers
that are
being billed, there may be payment problems and/or more
out-of-
pocket expenses for the patient.
Denise Paige, CPC, Long Beach, CA
-----RESPONSES / COMMENTS------------
RE: Implantation of Verrucae (Frank J. DiPalma, DPM)
From: Kevin A. Kirby, DPM, Larry Schuster, DPM
I was first introduced to the concept of treating verrucae
by
attempting to implant the virus into the body to initiate an
immune
response while reading a podiatry article back about 22
years ago
during my surgical residency. The podiatrist had written an
article
about treating plantar verrucae by taking a hypodermic
needle and
performing multiple punctures through the anesthetized
verrucae into
the subcutaneous fat to effectively push the virus into the
body and
stimulate an immune response. He even had fabricated a
special tool
from an electric toothbrush so he could perform multiple
needle
punctures in a rapid fashion.
Since then, I have treated about 20 verrucae plantaris
lesions using
this technique. I simply use a 22 gauge hypodermic needle to
puncture the verrucae about 100 times into the subcutaneous
fat
while under local anesthesia. I do not remember a single
lesion not
getting better within 3 months with this unique treatment.
Notably, ten years ago I treated a professional ballet
dancer that
had about 25% of her plantar foot covered with mosaic
verrucae that
had all of her plantar lesions resolve within two months of
having
the multiple puncture technique performed. More recently, I
performed the multiple puncture technique on a man that had
bilateral verruca, but I was only able to treat the one on
his left
foot due to fact that his worker's compensation insurance
would only
cover the affected foot. About two weeks after the left foot
verruca
was needled, the untreated lesion on the right foot turned
very dark
and spontaneously resolved within 8 weeks of treatment of
the lesion
on the opposite foot.
I would be interested if anyone remembers reading this
article since
the technique has been very helpful to a select few of my
patients.
Kevin A. Kirby, DPM, Sacramento, CA, kevinakirbycomcast.net
It wasn't implantation. The Dr. first anesthetized the area
under
one VP then used a 20 g needle and poked at the verruca
quite a bit.
It would Then theoretically form a scab and fall off along
with all
other VPs on both feet. As an immune response to the trauma
would
theoretically occur. It was supposed to be very effective
when a
patient had many warts you only had to inoculate one.
Topical acid
treatment has been used successfully for many years and also
should
cause the same immune response so I don't see any strong
reason
to "needle" a wart. As no papers are written to my
knowledge on
inoculation of VP I would advise patients that you are
experimenting
and list all risks and benefits that you expect. Acid
therapy
(trichlor, phenol, sal) works well if patient compliance and
consistency of treatment exists.
In non-compliant patients you may want to try nontraditional
off-
label therapies, but get consent after discussing risks and
benefits.
Larry Schuster, DPM, Parsippany, NJ, lschuscomcast.net
-----------CLASSIFIED ADS--------
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-------------
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--------------
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