PM News –January 31, 2006 #2,497 Editor-Barry Block, DPM, JD
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--QUESTIONS ABOUT BILLING, CODING OR REIMBURSEMENT?-------
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---------PODIATRISTS IN THE NEWS--------
DPM's View Diabetes Through Eyes of Complications: Tredwell
Dr. Jeff Tredwell, doctor of Podiatric Medicine, discussed
the
problems caused by diabetes. "We view diabetes through
the eyes of
the complications," said Tredwell. "We need to
prevent the disease
before it starts."
Amputations, surgeries and hospitalization caused by
diabetes are
some of the reasons healthcare is on the rise, according to
research
conducted by Tredwell. As a result, he established various
methods
that have decreased diabetic complications before
individuals are
diagnosed with the disease.
Tredwell recommended diet, exercise and lifestyle
modification to
ensure to prevent long-term health issues.
Source: Rhonda Simmons, Culpeper Star Exponent, [1/29/06]
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-------APMA COMPONENT NEWS --------------
APMWA Announces 20th Annual Student Writing Competition
APMWA Announces 20th Annual Student Writing Competition
The American Podiatric Medical Writers Association Has
announced its
20th Annual Student Writing Competition.
1. All papers MUST be Non-technical in nature. Appropriate
subjects
include ethics, practice management, or any topic that would
be
suitable for a lay publication.
2. There is no word limitation. Papers will be graded for
content,
style, grammar, neatness, and overall impact.
3. First prize will be five hundred ($500) and recognition
in the
APMA NEWS and the APMWA Newsletter. Honorable Mention
Certificates
may also be awarded.
4. This competition is open to ANY enrolled podiatric
student.
5. To enter, submit must be received by 4/1/06 via e-mail to
bblock prodigy.net
6. Entries become the property of APMWA, which may arrange
publication of the entry. All royalties from such
publication shall
be forwarded to the entrant.
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-------------DIABETES NEWS --------------
FDA Approves First Inhaled Version Insulin For Diabetics
The first inhalable version of insulin won federal approval
Friday,
giving millions of adult diabetics an alternative to some of
the
regular injections they now endure. The Food and Drug
Administration
said the Pfizer Inc. insulin, to be marketed as
"Exubera," is the
first new way of delivering insulin since the discovery of
the
hormone in the 1920s. Pfizer jointly developed the drug and
dispenser with Sanofi-Aventis and Nektar Therapeutics.
Scientists were working on the inhaled insulin project for
more than
decade before Pfizer researchers in Groton, Conn., developed
the
Exubera system as an alternative to needle injections. Use
of rapid-
acting inhaled insulin will not replace the need to
occasionally
inject the hormone, according to the FDA. And diabetics
would have
to continue pricking their fingers to test blood sugar
levels.
The FDA delayed its decision by three months so it could
review
chemistry data on the diabetes treatment. The European
Commission
approved Exubera for use in adults on Thursday.
Source: Associated Press [1/27/06]
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-------------QUERIES--------------
Query: Semmes-Weinstein Monofilament Test Pens
Can someone tell me where I can purchase Semmes-Weinstein
monofilament test pens at a reasonable price.
Frank DiPalma DPM, Athens GA , fivetoes1946aol.com
--------- CODINGLINE CORNER --------------
Query: Old Vs. New CPT Codes
To bill an extracorporeal shockwave therapy performed in
December of
2005, should I use the "old" code, 0020T, or can I
use the new 2006
code, CPT 28890?
This question would apply to the old-new nursing home and
assisted
living E/M service code billings as well.
Hal Abrahamson, DPM
Plainview, NY
Response: Bill the code that was valid on the day the
service was
rendered. This is true of all billing.
You would bill the 2005 code, 0020T.
Richard Papperman, Jr., CHBME, Cape May Court House, NJ
-----RESPONSES / COMMENTS------------
RE: Cuboid Syndrome (Hai-En Peng, DPM)
From: Howard Bonenberger, DPM
I have found that a good chiropractor can often manipulate
the
cuboid back into place. If you don't know any that do
sports
medicine (actually do...not just advertise that they do) ask
a local
high school or college soccer coach for a recommendation as
this
injury is commonly seen in soccer. I believe that some of
our
podiatry literature also speaks about the
"whipping" maneuver that
re-locates the cuboid but it may better left to someone who
has had
some experience.
Howard Bonenberger, DPM , Nashua, NH, HOWARDBONaol.com
---------
RE: Kraus Receives Harry J. Casson Award
From: Allen Lazerson, DPM
Kudos to Dr. Kraus for receiving the distinguished Harry J.
Casson
award from his state's podiatric association. This comes as
no
surprise to the podiatrists of Tennessee.
His leadership capabilities and passion for the profession
does not
end at the state level. He has shown for many years his
unyielding
time and energy on the national level with the APMA. He has
served
on numerous committees as a valuable member for the
advancement of
our profession. Dr. Kraus is a big asset to our profession.
Allen Lazerson, DPM, Past President, GPMA, ALazersonaol.com
----------
RE: E/M Time Billing (Mark Schilansky, DPM)
From: Michael M. Rosenblatt, DPM
E & M time billing is never a substitute for non-covered
routine
foot care. This practice would most likely be considered
fraudulent
in an audit and open your records to a fraud examination,
which has
very different attributes than "ordinary" audits.
Among those
attributes is the fact that there are no statute of
limitations for
the audits.
When you bill for time properly, you should always record
the start
and stop time (by the clock) and record whom you spoke with
and gave
advice. For example, if you are counseling a family (and
patient)
about the risk of amputation of a diabetic you see who
accidentally
poured hot water over her foot, causing a burn, you should
record
the start and stop time and the people whom you counseled,
by name. A situation like this would stand up to audit quite
well and is an appropriate use of time billing.
Michael M. Rosenblatt, DPM, San Jose, CA, ROSEY1prodigy.net
---------
RE: Screw Vs. K-Wire Fixation of Austins (Lowell Weil, Sr.,
DPM)
From: Multiple Respondents
In the average healthy individual, a single buried K-wire is
my
personal fixation of choice. The suggestion that the failure
tom
utilize a screw for fixation is reflective of "old-time
medicine" is
disingenuous at best. Perhaps Dr. Weil could provide some
evidence
based study to support his contention that healing of an
Austin type
bunionectomy is superior to other forms of fixation (or non-
fixation). The fact is that I have had the opportunity to
review
numerous malpractice cases in which very poor results
followed the
utilization of screw fixation for an Austin type procedure.
Giving
someone a Louisville slugger does not guarantee hitting a
home run.
Allen Jacobs, DPM, St. Louis, MO, allenthepodsbcglobal.net
I have gone from no fixation (30 yrs ago), to K-wires, to
Orthosorbs, to one 2.7 screw and finally to two 2.0 screws
for
almost all Austin's. I use Synthese
"non-cannulated" screws. The
cost is very minimal. (I believe 10-15 dollars a screw). I
find they
hold better than the cannulated screws after you get
comfortable
using them. I have never had a patient that refused surgery
because
of the buried hardware. Once you explain to them the
increased
stability, patients are fine. The head of the 2.0 screws are
so
small they almost never have to be removed.
Kenneth Meisler, DPM., NY, NY, Kenmeisleraol.com
Before all my colleagues go "screw crazy", yes,
internal fixation
with a screw can provide rigid internal fixation. But what
happens
when the patient begins to bear weight? The Austin or
Chevron type
osteotomy should be inherently stable and why most of us
allow
weightbearing in a surgical shoe. But, depending on the
directional
placement of that screw and its pitch, any force along the
threads
can result in bone breakdown and loss of screw stability. I
have
been using smooth .045 K-wire fixation on these osteotomies
for some
time. I place it dorsal-medial to plantar-lateral and bury
the wire
in the fashion recently described by another colleague in
this
post.
I also bend it with the suction tip and turn it into the
bone and
close periosteum over it. Since it is smooth, any
compression and
motion along the pin should not cause any bone damage. The
osteotomy
can easily compress without that "sawing" effect.
I find the K-wire
satisfactory fixation, economical, technically easy and cost
efficient. Lastly, for those rare instances the wire
becomes some
problem, it is easily retrieved in the office under local
anesthetic. For this type of osteotomy, I personally find
it
extremely effective.
Carlos Montes, Jr., DPM, MS, W. Melbourne, FL,
Cimontesjraol.com
There may not be a standard of care to fixate an Austin
osteotomy,
but read any journal, text, etc and one will quickly note
that
screws provide interfragmental compression. K-wires,
Orthosorb pins,
capital fragment impaction do not. Even though all of the
above are
accepted methods of fixation for an Austin bunionectomy,
only the
screw provides proper interfragmental compression via AO
fixation
techniques. The others merely provide stabilization (and
resistance
against rotation when more than one pin or wire is used).
Results ultimately depend upon patient compliance,
bandage/splinting, post-op meds, etc seeing how the
osteotomy is
inherently stable and should heal nevertheless.
Rahul Patel, DPM, docrahulpatelgmail.com
K-wires can be left inserted subcutaneously. If you want to
continue
using wires, they need not exit the skin. I drive my wires
from
proximal dorsal to plantar distal shy of the plantar joint
space.
When I am satisfied with position and stability of fixation
the wire
is bent cut and rotated flush with the dorsal cortex. This
allows
for early ROM, early bathing and with two crossing wires
rigid
fixation. My patients love not being screwed.
Jeffrey Petrinitz, DPM, Greensboro, NC, jproxtriad.rr.com
I have been following the debate of Austin fixation and
wanted to
point out that some screws are very cost effective. For
instance, an
old fashioned SS alloy 2.7mm screw from a Synthes mini-frag
set
costs about $12.00. I realize that there are many high-tech
screws
out there but that does not mean it is necessary to use
them. I
would also expect to see more cases of primary bone healing
vs.
secondary bone healing when rigid, internal fixation is
employed.
Craig Breslauer, DPM, Palm City, FL, drbreslauerfootanklegroup.com
Let me make a quick point about screws vs K-wires, there is
evidence
that both are successful. I am new practitioner and have
read
articles on both. They are both acceptable forms of
fixation. I
actually have used both forms of fixation on Austin
bunionectomies
in residency and practice and have noticed very little
difference
between the two. Basically people who want to see
differences and
know that their way is superior; keep looking, so to those
people I
say whatever makes you feel better about yourself. But at
the end
of the day 95% practitioners if injected with truth serum
would say
there is no difference.
Seth Stinehour, DPM, Huntington WV, sjstinehouryahoo.com
As they say; there are many ways to skin a cat. I originally
trained
circa 1987-1989 with some attendings that used no fixation
(as the
original Austin treatise described). I also trained with
screws,
absorbable pins and K-wires. Today, I almost exclusively
use K-
wires.
Gentle early ROM can be initiated with pins. Rarely do I see
secondary bone healing. I prefer seeing all Austin's
regardless of
how they are fixated (athlete and non-athlete) stay in a
Darco shoe
for a minimum of 3 weeks. Admittedly, an early return to
bathing is
a nice benefit to screw fixation.
All of the above; no matter what the form of fixation is
influenced
by other factors: how much the met head is transposed,
patients
weight, pain tolerance, proclivity to swell, whether
concomitant
procedures were done-akin etc. If using a K-wire, bend the
pin
twice, right angle to the skin and right angle to the wire
bender
instrument (this will prevent skin irritation) As far as
what the
patient's want -- they want what you tell them and a good
outcome.
This is best achieved by surgeons preference formed by a
track
record of success and a proficiency with a particular
technique.
Joe Boylan, DPM , Ridgefield, NJ, Drb0327aol.com
Editor's Note: This topic is now closed.
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