PM News –February 3, 2006 #2,500 Editor-Barry Block, DPM, JD
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--QUESTIONS ABOUT BILLING, CODING OR REIMBURSEMENT?-------
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---------PODIATRISTS IN THE NEWS--------
PM News Marks 2,500th Issue
This issue, #2,500, marks another milestone for PM News.
"Over the
last 11 years we are proud to have become podiatry's
interactive
Internet newspaper. We believe that this publication has
served to
inform, educate, and unify the profession", said BARRY
H.BLOCK, DPM,
JD, PM News founder and editor.
PM News wishes to thank our many advertisers, as well as our
contributors for making this enterprise successful. We would
like to
single out Harry Goldsmith, DPM, editor of Codingline.com
and Al
Musella, DPM our talented webmaster, for their ongoing
efforts.
Additionally, we would like to thank all our devoted readers
for
their ongoing support.
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-----------MEDICARE NEWS ------------
Medicare Physician Payment Cuts Halted
A vote in the U.S. House Wednesday cleared the way for
restoration
of Medicare physician payments to 2005 levels, halting the
4.4
percent payment cut that took effect Jan. 1.
At the request of the AMA and other physician groups, the
Centers
for Medicare and Medicaid Services (CMS) has agreed to
retroactively
adjust claims to compensate physicians for the 4.4 percent
cut once
the one-year payment Freeze is signed into law. The freeze
came
after an aggressive AMA lobbying, Grassroots and media
campaign that
showed how the cut threatened seniors' access to doctors.
Source: AMA eVoice [2/1/06]
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-----------HEALTHCARE NEWS ---------
Healthcare-wise, State of the Union Disappoints
President Bush did not offer much in the way of plans for
addressing
major healthcare problems in his State of the Union address
Tuesday,
surprising industry executives, who had been led to expect
more by
prespeech hype. Bush devoted about five minutes of the
51-minute
address to healthcare, urging broader use of electronic
medical
records and health savings accounts -- both long-standing
pushes of
his administration. He reiterated a call for changes in
medical
liability and warned that an aging population would affect
future
spending. But he did not propose new initiatives for
expanding
health coverage or controlling costs, including a plan to
allow more
tax deductions for medical expenses, which administration
officials
had touted in the weeks preceding the speech. To a standing
ovation,
Bush said, "Keeping America competitive requires
affordable
healthcare." And he said, "Our government has a
responsibility to
help provide healthcare for the poor and the elderly, and we
are
meeting that responsibility."
Source: Matthew DoBias, Modern Healthcare [2/1/06]
-------- MEETING NOTICES/ COURSES --------------
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income?
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therapy at a
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For a list of all meetings go to:
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-------------QUERIES--------------
Query: Procedure for Hallux Rigidus with Short Proximal
Phalanx
I have a 39 y/o heavy set female patient with a painful
hallux
rigidus, stage III-IV. The proximal phalanx is congenitally
short
at 2cms and she has a mild 1st metatarsal elevatus. She is
a NIDDM
with documented periperal neuropathy but is under control.
She has
been told by another podiatrist she needed an implant and is
ready
for surgery. Any suggestions on a type of implant that
would be
better because of the short phalanx would be appreciated. I
have
thought about an arthrodesis but think this may shorten it
too
much. The 1st metatarsal protrusion is a -4 degrees.
Marten Lazar, DPM, Memphis, TN, footdoc234aol.com
---------------
Query: Ulcer of Distal Hallux in Diabetic
I was referred a 59-year-old uncontrolled insulin requiring
diabetic
male, 2 PPD smoker with anterior muscle weakness, flexor
stabilization, sensory neuropathy, adequate vascularity, who
chronically ulcerates his distal right hallux (no
radiographic
osteo) with hallux hammertoe deformity, flexible. He was
previously
wearing bilaminar heat-molded inserts with Brooks Addiction
walkers
that are not deep enough. After appropriate off-loading and
wound
care and eventual ulcer healing; other than deeper toe box
shoes
with custom total length inserts with metatarsal 1-5
accommodation
and metatarsal roller outsole are there any other
biomechanical
modifications to offload distal hammertoes in this patient?
Mark K. Johnson, DPM, West Plaines, MO, MarkkjohnsonAOL.com
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--------- CODINGLINE CORNER --------------
Query: Assistant Surgeon Procedures
I am looking for a source that would list the surgical
procedures
for which an assistant surgeon fee can be billed.
Sondra Berger, DPM, Albany, NY
Response: The APMA Coding Manual lists not only this
information,
but over 700 pages of other valuable information for
podiatrists.
It can be ordered by APMA-member podiatrists at
www.apma.org.
Phill Ward, DPM, APMA Trustee, Pinehurst, NC
Additional responses are posted on http://www.codingline.com
-----RESPONSES / COMMENTS------------
Clarification: In the January PM Jury Verdict Reporter, we
listed
Christopher Mason, DPM, JD as one of the plaintiff's experts
in a
Florida case. We have been notified by Dr. Mason that he was
merely
the attending physician, and was not paid a fee by the
plaintiff for
his testimony.
-----------
RE: Kenneth Brum, DPM
On a sad note, Kenny Brum was one of my classmates and was
one of
the nicest people you would ever want to meet. I was very
sorry to
hear of his passing.
Dennis Shaw, DPM, Dallas, TX, Dop352aol.com
----------
RE: Salary for Podiatric Assistant
From: Gary Hoberman, DPM
$600/week=$15.00/hr. This seems very fair to me, but when
you
mention she pays the health insurance, and there's no
mention of
dental, disability, or 401, sounds like you have a great
employee at
a bargain. While it's magnanimous of you to pay her for
hurricane
and Jewish holidays, neither are under her control. If you
can't
come to terms, ask her if she'll relocate to Chicago  !
Gary Hoberman, DPM, Chicago, IL, hobergcaol.com
----------
RE: Speaking to Family Members About a Patient's
Non-Compliance (E.
Udell, DPM)
From: Bryan C. Markinson, DPM, Barry Mullen, DPM
Dr. Udell's question regarding speaking to a family member
about a
patient's non-compliance is another example of how we are
increasingly becoming marionette puppets, tugged with
strings by the
legal and insurance industries. Is non-compliance, or the
allegation
of non-compliance an example of "protected health
information"? I do
not think so. I have reviewed many malpractice cases with
allegations of patient non-compliance by defendant doctors,
and when
the plaintiff's attorney is given undeniable proof of non-
compliance, it always begets the question "But did you
alert anyone
about it." So in the absence of what Dr. Block calls
"implied
authorization," (when the patient is present with a
family member) I
personally will continue to alert everyone possible to try
and get
the point across. I recommend that everyone else do the
same.
Bryan C. Markinson, DPM, New York City, NY, profpodaol.com
In addition to the exception noted by Dr. Block, it is
expressly
written in HIPAA guidelines (APMA HIPAA Manual- page 21
entitled,
Disclosures to Close Friends and Family Members and page 26
entitled, Disclosures to Prevent Serious Threats to Health
and
Safety) that exceptions exist when PHI may be revealed to
family
members without first obtaining authorization. When the
health and
well being of the patient, or those with whom they come in
contact
could be significantly compromised, in these occasional
circumstances, healthcare safety issues supercede privacy
issues.
Assuming one documents well, a healthcare provider may, in
those
circumstances, at his/her discretion, reveal PHI if he/she
feels it
is in the best interests of all parties concerned. Patient
PHI
authorization release is not needed. An example might be a
sexually
transmitted disease that a clinician recently discovers his
patient
tests positive for, and in the interests of protecting that
patient's spouse from exposure, the patient's PHI may be
revealed.
These are obviously very sticky situations, but the
provision for
PHI release without patient authorization most definitely
exists and
clinicians should be aware of this provision.
Barry Mullen, DPM, Hackettstown, NJ, Healthcare Compliance
Advisor,
AAPPM
-----------
RE: PM Jury Verdict Reporter - Alleged Wrong Bunionectomy
Performed
From: Multiple Respondents
There are mechanisms in place to challenge false or
unsupportable
expert testimony in many states. In fact, in one
southeastern state,
an MD expert who testified falsely was suspended by the
respective
state board of medicine. There is a trend in more and more
states by
the boards to make these "experts" accountable. I
myself am in the
process of taking a pediatric opthamologist to task for
false expert
testimony during a deposition I took here in Florida.
One should inquire specifically how their state handles
these
matters. It is our responsibility to report these instances
and
disarm hired guns. My medical colleagues often blame
attorneys for
too many medical malpractice lawsuits; yet I must remind
them
without a "hired gun" there is no case.....
Jack Heda, DPM, JD, Fort Lauderdale FL, jhedaaol.com
It seems to me that one of the first thing we were taught
was that
we treat the patient as a whole, and not X-rays. One has to
assess
the patient, their capabilities post-operatively, bone
stock,
expectations, and of course last but not least psychological
factors
as well.
It appears to me based solely on the verbiage of the report,
that
the podiatrist in question did exactly what he should have.
Obviously he could not be faulted for his choice of
procedure, and
the message sent to Dr. Boxer is strong enough. Performance
of a
closing base wedge, or similar on an independent 74 year old
women
amounts to little more than treating the x-ray alone.
Kudos to Dr. Mancuso (the defense expert), the defendant and
his/her
defense team!
Ira Weiner, DPM, Las Vegas, NV, vegasfootdoc2005yahoo.com
As a podiatrist who has acted as a defendant expert witness
in the
past, I am glad to see people such as Myron Boxer acting as
a
plaintiff expert witness. What a pleasure it would be to
beat him up
in court. I know nothing of the man personally, but was
astounded to
hear that he testified that a Keller/Austin procedure should
not be
used on an IM angle greater than 16 degrees while the
patient had an
IM angle of 17 degrees.
First of all, this is within the measuring margin of error,
and
secondly I don't recall ever seeing any published numbers
for this
combination of procedures. Although I rarely do the Austin
procedure, I have done many Kellers in the past 32 years.
Fenton and
McGlamry reported in APMA in 1982 that the Keller procedure
gives a
5.5 degrees average reduction of the IM angle. This in
addition to
the pseudo IM angle changes created by the Austin procedure
should
have easily "unloaded" the bunion and given
relief. If in fact the
patient did have continued pain, the real reason was never
revealed
in court. Was it truly unknown, or just missed by an
incompetent
expert who had an agenda.
Art Hatfield, DPM, afootjobjuno.com, Long Beach, CA
---------
Re: Orthotics for Skiing/Snowboarding (Multiple Respondents)
From: Robert Scott Steinberg, DPM
I have been fitting ski boots, and more recently, snowboard
boots,
and making prescription ski boot orthoses for 22 years. All
my boot
fitting and ski boot orthotic fabrication is done in a ski
shop. I
would like to point out the following:
1. Skiing requires medial column support.
2. Skiing biomechanics are not gait cycle biomechanics.
3. Where the center of knee mass is positioned over the ski
is more
important then placing a skier into perfect subtalar
neutral.
4. An impression taken while standing on positioning pillows
is far
more accurate then any non-weight baring impression - for
skiiing
and snowboarding orthotics.
5. Center of knee mass is controlled with proper forefoot
alignment,
taking into consideration, as well, the direction of knee
movement
to identify excessive internal or external rotation
6. The term "canting" is better left to describe
the placement of a
canting strip under the binding.
7. The grinding of boot soles is 99.5% unnecessary if the
orthotic
is properly posted and the boot cuff is properly aligned.
Orthotics for snowboard boot must be made taking into
account much
the same considerations as orthotics for ski boot. I have
two
articles posted at www.thebootdoctor.com that go into some
more
detail. I was member of the Vail Ski School for the 90/91
season and
continue to maintain my membership in the Professional Ski
Instructors of America (PSIA) - Rocky Mountain Division. My
patients
know that the real reason work is so I can pretend to be a
ski bum
in the Winter.
Robert Scott Steinberg, DPM, Hoffman Estates, IL,
docfootsportsdoc.com
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