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12/23/2009    

CODINGLINE CORNER

Query: Hallux Valgus Repair


We are trying to the locate the appropriate code(s) for a hallux varus repair by capsulotomy and Mini-TightRope.


Joy Constanzo, Billing Supervisor, Office of Kirk Koepsel, DPM,

Houston, TX


Response: There is no specific code for this service. You should bill for the actual procedure(s) performed. It this case, your options could include CPT 28270 which is capsulotomy metatarsal-phalangeal joint, or CPT 28313 (reconstruction angular deformity of toes, soft tissue procedure only).


There is no code for the TightRope use. It is a product used in the primary repair procedure. If you feel the work done was significant enough, append a "-22" modifier. The op report should clearly document that work. Be sure to include a letter of explanation.


Tony Poggio, DPM, Alameda, CA


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Other messages in this thread:


04/18/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1A



From: Bryan C. Markinson, DPM


 



I have worked with one or two musculoskeletal oncologists continuously for the past 15 years. Procedure code CPT 20206 is used for most soft tissue mass (not skin and not bone) core needle biopsies. Although the code descriptor states that the biopsy is for muscle, the utilization of the code is not limited just to muscle, as lesions other than in muscle (except for those organs that have dedicated codes), have no assigned code. In view of the rule to be as "close as possible," code CPT 20206 fits. This would not apply to aspiration of a cystic mass which yields fluid. That would be most applicable to the CPT 10021 code.


 


Attempts should be made before the aspiration to define the mass as cystic or solid, or both. A simple and relatively cheap musculoskeletal ultrasound is usually sufficient. I agree with Dr. Bakotic that it is downright foolish for any coding expert to support the notion that malignancy be the primary concern to justify a biopsy. There are functional issues, pain, etc. that may be germane. After that, biopsy of a mass to learn its biology BEFORE it is excised is critical!



 


Bryan C. Markinson, DPM, NY, NY, bryan.markinson@mountsinai.org

04/18/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1B



From: Kathleen Toepp Neuhoff, DPM


 



I was astonished to read that fine needle aspirates are not considered appropriate for podiatrists to perform. I have been in practice more than 20 years and perform 3 to 5 FNAs/year. Frankly, I have no idea if I have been reimbursed for them - I have done them because they are indicated and are in the best interest of the patient. The most common reason I have done an FNA is that I have aspirated a growth that I assumed to be a ganglion cyst and did not obtain the typical fluid. When I submitted the aspirate for cytology, the results have been varied - sometimes it is a ganglion or an inclusion cyst. I have found lipomas, fibromas, and a fibrosarcoma (the fibromas and fibrosarcoma required an incisional biopsy to confirm).


 


I have also diagnosed an amelanotic melanoma with an FNA.  This patient was referred to me for treatment of a "wart" which the PCP had been treating for more than one year. The patient died from the melanoma less than a year after I diagnosed it. I am not aware of ANY diagnostic technique other than incisional or excisional biopsy that will diagnose these lesions, and I prefer not to be cutting holes in patients'  feet if it is not necessary. 


 


If FNAs are not considered appropriate for podiatrists, our APMA needs to be working to change this. I could not live with myself if one of my patients died because I failed to perform this simple and inexpensive procedure!


 


Kathleen Toepp Neuhoff, DPM, South Bend, IN,  vetpod@aol.com


04/17/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Bradley Bakotic, DPM, DO


 


It is a fact that CPT 10021 is the appropriate code for percutaneous fine needle aspiration of a superficial soft tissue mass. Though in the vast majority of cases, there are no issues with reimbursement, I have also seen exceptional payors deny payment for podiatrists on the grounds that they are not covered. This might require a letter from you and/or your state association to educate the payor’s medical director. 


 


Although this procedure is clearly within the podiatric scope of practice, it seems that in a few instances, because podiatrists...


 


Editor's note: Dr. Bakotic's extended-length letter can be read here.

04/16/2014    

CODINGLINE CORNER


Query: Needle Aspiration Biopsy


 


I performed a needle biopsy as described by Dr. Bakotic. It was not paid as the insurer wrote, "not covered for podiatry." I used code CPT 10021, as directed by Bako. Interestingly, I cannot find the code in the APMA Coding Resource Center. Any ideas? 


 


Donald Carlson, DPM, Hermiston, OR


 


Response: You are correct that CPT 10021 - fine needle aspiration; without imaging guidance - is not included in the APMA Coding Resource Center. The data does not support - with exception of very few circumstances - the medical necessity for a foot and ankle specialist to perform a fine needle aspiration. Obviously, if presented with compelling studies evidencing medical necessity (over other existing diagnostic means) for performance of fine needle aspiration/biopsy on the foot or ankle, the code could be included. 


 


Just so we are all on the same page, a fine-needle aspiration (FNA) is a diagnostic procedure using a thin, hollow needle to percutaneously obtain a sampling of cells for cytology exam or a sample of tissue for histological examination that could not otherwise be obtained using standard diagnostic techniques (for a foot and ankle specialist performing procedures defined by injection/aspiration codes: CPT 20612, CPT 20600, and CPT 20605). 


 


Typical examples of fine needle aspiration use include masses or nodules of the thyroid, breast, lung, and kidney. FNA is used in the diagnosis of cancer and inflammatory conditions. You didn't mention what the pathology was that you needed to perform a fine needle aspiration. Was it a suspected malignancy? 


 


Harry Goldsmith, DPM, Cerritos, CA 


 



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04/12/2014    

CODINGLINE CORNER


Query: Removal of Painful Hardware Denial 


 


I did a Lapidus-type bunionectomy procedure along with an osteotomy of the proximal hallux phalanx. Within the 90-day global period, the hardware in the hallux was reported by the patient to be painful. Under aseptic technique, I removed that hardware in the office using local anesthesia proximal to the site. I billed for removal of hardware (adding a "-78" modifier) and was paid. Now, Anthem Blue Cross states that they will not pay for removal of the hardware even though it was painful because it was in the 90-day global period. I definitely was not going to wait until the 90 days to take out painful hardware. Should I have submitted the claim with some other modifier? How should I appeal? 


 


Corey Wesner, DPM , Neenah, WI


 


Response: You did the right thing for your patient by removing the painful hardware. However, with very few exceptions, related services performed during that post-operative period, especially in an office setting, are included in the fee you were paid for the original surgery. This is most likely spelled out in the contract definition of global services you agreed to when you signed your insurance contract (or, with Medicare, when you became a provider). In this case, the "-78" modifier says, "unplanned return to operating room/procedure room by the same physician following initial procedure for a related procedure during the post-operative period." There is no other modifier, in my opinion, available for you to use. 


 


While you may have correctly removed the painful hardware which was not planned either at the time of surgery or in the follow-up care, the payer will see place-of-service code, 11 (office), and not consider a "return to the operating room or procedure room." 


 


Paul Kinberg, DPM, Dallas, TX 


 




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04/09/2014    

CODINGLINE CORNER


Query: Denial Modifier Needed


 


What modifier would I use on a Medicare claim when I bill L3000 (custom foot orthotics) to get a denial so I can send the claim to the secondary which will pay the claim? 


 


Barry Rosen, DPM, Bayside, NY 


 


Response: The "GY" modifier indicates that the service provided is statutorily excluded. 


 


This will result in a PR (patient responsibility) rejection by Medicare and forwarding of the claim to the patient's secondary insurance plan (if there is one). If the patient did not have secondary coverage, he/she would be responsible for payment. 


 


Paul Kesselman, DPM, Woodside, NY


 



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04/05/2014    

CODINGLINE CORNER


Query: Hallux Varus Deformity Repair Coding


 


We have a patient who will be having a correction of hallux varus deformity with a metatarsal-phalangeal joint implant arthroplasty. I have done some research, and most sources are suggesting to code the procedure as unlisted (CPT 28899) or CPT 28293 (correction hallux valgus with resection of joint with implant). We feel that CPT 28293 is incorrect as this is for valgus repair versus varus repair. We are looking at billing the following: 


 


CPT 28306 - metatarsal osteotomy 


CPT 28270 - capsulotomy (metatarsal-phalangeal joint) 


CPT 28310 - osteotomy proximal phalanx 


CPT 26536 - arthroplasty, interphalangeal joint, prosthetic .....implant [which is not really correct since it is not the MPJ] 


 


Can you provide any other thoughts or suggestions? 


 


Kerstin, Office of Kelly Malinoski, DPM,Naples, FL


 


Response: I believe you are overthinking this surgery. The procedure code is not dependent on the diagnosis, but rather should reflect the work being done.In this case, an arthroplasty with prosthesis of the first metatarsal-phalangeal joint is what is being done. The most accurate code is CPT 28293.  I''m not sure how you could justify the codes suggested since no osteotomy of the first metatarsal is mentioned. The other codes suggested are fragmentation of the code I recommend. 


 


Howard Zlotoff, DPM,Camp Hill, NJ


 



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04/02/2014    

CODINGLINE CORNER


Query: New CMS-1500 Forms


 


Since the ICD-10 codes have been delayed, does this affect the April 1st deadline to use the new CMS-1500 Forms? I would like to know what the guidelines are for the new forms. Are commercial insurances accepting them, as we have not really received any written notice whether they are now mandatory? One insurance carrier actually said they would continue to accept both. The new format does not seem to affect Medicare electronic billing, only paper claims sent to Medicare (RailRoad) and DMERC claims. Please clarify.


 


Jack Ressler, DPM, Tamarac, FL


 


Response: CMS confirms that providers who currently submit paper claims to Medicare must use the new CMS-1500 form (02/12) for paper claim submissions RECEIVED on or after April 1, 2014. The grace period for submitting the "old" CMS-1500 forms ended midnight March 31, 2014. 


 


Harry Goldsmith, DPM, Cerritos, CA


 



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03/29/2014    

CODINGLINE CORNER


Query: Follow-Up to Debridement


 


Last week, a patient came to my office to have a debridement on the 4th toe left foot of a small ulceration and was advised to come back in one week. He came back and the ulcer does not require debridement, although it is still open. I cleansed the wound, medicated it, and re-bandaged. Can I bill Medicare for this follow-up visit? 


 


Amy Dunetz, DPM, Aventura, FL


 


Response: If you re-evaluated the patient and made some type of recommendation, in my opinion, this sounds like it would an E/M service. Bill CPT 9921x, and make sure you performed and documented the appropriate history, exam, and/or decision-making (two out of three) information to match the level E/M code you chose. 


 


Jeffrey Lehrman, DPM, Springfield, PA 


 



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03/26/2014    

CODINGLINE CORNER


Query: Medicare & Ankle Braces


 


For the Medicare patient who presents with ankle sprain, what DME products are typically payable by Medicare? 


 


Craig Sapenoff, DPM, West Palm Beach, FL


 


Response: There are a myriad of devices which may be used. The AFO LCD does not provide diagnostic limitations. If you read the LCD, you will see there are specific requirements for the products. Listing specific products here would be inappropriate. The use of these products would be subject to medical necessity. Your documentation should meet the standards of care in addition to any requirements of your carrier. 


 


Paul Kesselman, DPM, Woodside, NY


 



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03/22/2014    

CODINGLINE CORNER


Query: Custodial Care Facility Billing


 


We recently saw a few patients in what we originally thought was a nursing home. Afterwards, we determined that they were actually residing in a custodial care facility. I got the correct CPT codes from the APMA Coding Resource Center, and did the billing. My question is: Are there things we cannot do there, for example, wound care or dispensing DME? Is the place of service code "33"? 


 


Erica, Office of James Hirt, DPM, Fenton MI


 


Responses: A custodial care facility is defined by Medicare as "a facility which provides room, board, and other personal assistance services, generally on a long-term basis, and which does not include a medical component." Unlike a skilled nursing facility, there are no restrictions in services you can perform. You should bill the services to your Medicare Part B contractor. 


 


Tony Poggio, DPM, Alameda, CA 


 



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03/15/2014    

CODINGLINE CORNER


Certification of Diabetes & *Q* Modifiers


 


How often does a patient for covered foot care have to be re-certified by their primary care physician, vascular doctor, or endocrinologist for covered routine care? I know that they have to have been seen within 6 months of their visit for covered routine foot care by a podiatrist. 


 


Arnold Beresh, DPM, Hampton, VA


 


Response: There is no requirement to have the primary care physician "certify" the diabetic status of the patient (with exception within the therapeutic shoe program for persons with diabetes). 


 


If there is an active management requirement with an asterisk (*) systemic condition qualifier of routine foot care services, the MD/DO managing the patient's diabetes - for example - must be listed on the claim, their NPI, and date last seen by that doctor for the management of the systemic condition (they must have evaluated, managed the patient within the past six months). There is no "certification" required to qualify these services. 


 


Tony Poggio, DPM, Alameda, CA 


 



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03/12/2014    

CODINGLINE CORNER


Query: Co-pay During 90-Day Global Period


 


I am having a dispute with a colleague about collecting a co-pay during a global period.  When a patient visits your office post-op and you are evaluating the surgical site, taking x-rays, or removing sutures, is it okay to collect a co-pay from a patient who is still in a post-op global period? 


 


Furthermore, is it okay to collect this co-pay as a non-covered service and not submit it to their insurance? I am pretty sure that this is incorrect, please weigh in. 


 


Marc Katz, DPM, Tampa, FL


 


Response: I agree with you, this would be incorrect. If you are a contracted provider with a payer, you are obligated to abide by the contract. If a patient is seen for a related visit in a global period, a co-pay should not be collected from the patient since it's non-payable due to the visit being part of the global period. 


 


Collecting a co-pay and not billing the carrier would be looked at negatively, and it would be a breach of your contract with the payer. 


 


Response: Angela K. Gomes, RMC, CMBA, Office of Gary McClernan, DPM, Tampa, FL  


 



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03/08/2014    

CODINGLINE CORNER


Query: Performing Dressing Changes in the Office


 


How often can you have a patient come to the office for treatment of foot ulcers and dressing changes if the patient can't change the dressing himself at home? What would be the correct billing codes (can you bill an E/M service code for each visit?) for the visits if you are having the patient come to the office two times per week? 


 


Naftoli Weingarten, DPM, Long Beach CA


 


Response: A patient who is unable to perform dressing changes (or doesn't have any family members or friends to help) needs to consider whether the home is the appropriate place to recover. If the patient is scheduled multiple times per week to come to your office for dressing changes, it is doubtful he would meeting the criteria for billing an E/M service. It is not the standard of care for the doctor's office to perform this service. And if it were, the supplies used in the office to clean and dress the would not be. 


 


I recommend contacting a home health agency which in turn can contact the patient regarding providing the service and its costs (and whether it is reimbursable by the patient's insurance plan). Most insurances have home health care benefits. Lastly, a local wound care center may have more options available to help you and the patient. 


 


Tony Poggio, DPM, Alameda, CA 


 



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03/05/2014    

CODINGLINE CORNER


Query: CAM Walker Modifier 


 


I have placed a diabetic patient with a calcaneal fracture in a CAM walker type boot (L4382) which was then denied by DMERC stating "procedure code is inconsistent with the modifier used or a required modifier is missing."  We submitted this with these codes and modifiers "RT" and "Q9".  ICD-9 825.0 (calcaneal fracture); ICD-9 250.60 (diabetes mellitus with neuropathy); and ICD-9 729.5 (pain).  Place of service 12 (home).  Any idea why this was denied, and what modifier are we missing? 


 


Mark Ray, DPM, Latrobe, PA


 


Response: The "Q" modifier is ONLY to be used when qualifying vascular-based at-risk status for routine foot care. It is not to be used for other services or DME coding. Using a modifier incorrectly could result in a claim denial. You are missing the "KX" modifier which indicates that the requirements of the policy have been met regarding the walking boot. 


 


Tony Poggio, DPM, Alameda, CA 


 



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03/01/2014    

CODINGLINE CORNER


Query: Tibialis Anterior Repair Coding


 


I performed a tibialis anterior repair with excision of damaged tendon, slide graft, and reattachment to the cuneiform. What is the appropriate CPT coding for this procedure? 


 


Carl Ganio, DPM, Vero Beach, FL


 


Response: A tendon repair is a tendon repair no matter what steps are required to repair it. I suggest CPT 27665 (repair of extensor tendon of the leg). 


 


Tony Poggio, DPM, Alameda, CA 


 



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02/26/2014    

CODINGLINE CORNER


Query:  LOPS Claim Rejection


 


On our Medicare diabetic patients with LOPS (loss of protective sensation) and good vascular status, we submit codes G0245 or G0246, as necessary, for the visit along with G0247 for the foot care every 6 months with the appropriate diagnosis codes for diabetes and neuropathy. Recently, our claims for G0247 are being rejected. The reason is "related or qualifying claim/service was not identified." We bill codes ICD-9 250.00, ICD-9 357.2 (polyneuropathy in diabetes), and ICD-9 703.8 which have paid previously. 


 


John Dahdah, DPM, Pottstown, PA


 


Response: I tried looking in the Novitas JL Routine Foot Care LCD for the LOPS materials and could not find anything. So, I went to the Novitas JH Routine Foot Care LCD and was able to, I believe, find your problem. The JH document states that only ICD-9 250.60-250.63 and ICD-9 357.2 diagnoses codes will be accepted for the LOPS codes G0245, G0246 and G0247. Since I am aware that Novitas is trying to merge the LCDs for these two jurisdictions, that most likely is your problem. 


 


I suggest contacting your Pennsylvania podiatry CAC representative just to be sure. You may want to ask why the JL Routine Foot Care LCD does not have any references to the LOPS policy. 


 


Paul Kinberg, DPM, Dallas, TX


 


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02/22/2014    

CODINGLINE CORNER


Query: Tibialis Anterior Repair Coding


 


I performed a tibialis anterior repair with excision of damaged tendon, slide graft, and re-attachment to the cuneiform. What is the appropriate CPT coding for this procedure? 


 


Carl Ganio, DPM, Vero Beach, FL


 


Response: A tendon repair is a tendon repair no matter what steps are required to repair it. I suggest CPT 27665 (repair of extensor tendon of the leg). 


 


Tony Poggio, DPM, Alameda, CA


 



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02/19/2014    

CODINGLINE CORNER


Query: Foot/Ankle X-Rays for the Same Extremity


 


At times, there are patients with conditions that warrant the taking of both foot and ankle x-ray studies on the same extremity. My standard billing for this is CPT 73630 (foot, 3 views) and CPT 73610 (ankle, 3 views).  However, the lateral ankle film is the same as the lateral foot film. There are 5 films total in the patient's chart.


 


My question is which is correct: billing one of the x-ray codes indicating 2 views and the other 3 views so the total amount of billed views is 5; or billing two 3-view codes?  If an insurance company requests records, can I print the lateral films twice; once for foot, once for ankle? 


 


Kelly Malinoski, DPM, Naples, FL


 


Response: My standard billing for this is CPT 73630 (foot, 3 views) and CPT 73610 (ankle, 3 views). However, the lateral ankle film is the same as the lateral foot film. There are 5 films total in the patient's chart. Pick one of the series and that will be your lateral. 


 


My recommendation is to use CPT 73610 (complete ankle study) and CPT 73620 (limited foot) when you bill foot and ankle, especially knowing you have only taken 5 total views. 


 


David J. Freedman, DPM, CPC, Silver Spring, MD


 



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02/15/2014    

CODINGLINE CORNER


Query: DMERC License Renewal 


 


A DMERC license must be renewed every 3 years. Is there a way to find out when our DMERC license renewal is due? 


 


Saera Arain-Saleem DPM, Elmhurst, IL


 


Response: I do not recommend that you contact NSC regarding this. They likely won't appreciate you calling them either, as they are inundated with many other issues. 


 


While they are supposed to be performing these renewals every three years, it often does not exactly come out to that. I will forward this question to someone at the NSC who may be able to provide a website link where this information may be posted. When/if I have more info on this, I'll post it here. 


 


Paul Kesselman, DPM, Woodside, NY 


 



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02/12/2014    

CODINGLINE CORNER


Query: Laser Wound Debridement


 


Does anyone know if there is a specific separate and payable CPT code for the use of a laser post-debridement of a wound? If not, what is the CPT code that one would bill for when a laser is used in conjunction with debridement? 


 


David Zuckerman, DPM, Cherry Hill, NJ 


 


Response: The use of the laser after or during wound debridement would be bundled into the code for the debridement itself. Just use the wound debridement code, presuming you are performing a wound debridement, CPT 97597 or CPT 1104x. 


 


Jeffrey Lehrman, DPM, Springfield, PA 


 



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02/11/2014    

CODINGLINE CORNER























ASSOCIATE POSITION - CALIFORNIA (SANTA CRUZ COUNTY)





 


The Foot Doctors of Santa Cruz County is a multi-office podiatric group looking for a self-motivated, committed podiatrist with a CA license.  Offices are up-to-date with EMR, digital x-ray, and laser. Duties include all aspects of podiatry including wound care, surgical cases and nursing homes. There is great surgical growth potential. Must intend to reside locally. Send CV to: srfctysc@gmail.com




 


ASSOCIATE POSITION - KENTUCKY


 


Immediate opening for palliative/general podiatric care provider in established clinics, nursing home and assistive living settings in beautiful Southern Kentucky. Travel involved, but transportation provided along with ability to provide a wide range of clinical care including DME. Board certification not mandatory, but must be eligible for KY state license. Base salary with incredible bonus opportunity/full benefits. Join Kentucky’s largest and most respected podiatric group. Email CV and letter of interest to:jonkim12000@yahoo.com



 


ASSOCIATE POSITION - PUERTO RICO 








 


Looking for a well-motivated surgically trained podiatrist for a 20 year-old hospital-based multi-office practice. WILL BE INTERVIEWING PERSONALLY AT 2014 ACFAS MEETING IN ORLANDO Candidate must be personable, ambitious, and knowledge of SPANISH language a must. Hospital surgical privileges available with heavy load of high-risk diabetic foot patients. This position leads to PARTNERSHIP, and eventually ownership. Offices located near San Juan Metro area nearbBeaches, great schools, and major shopping malls. Please send CV to medicopodiatra@aol.com.



 


ASSOCIATE POSITION - CENTRAL PA 


 


Looking for an associate with strong surgical training. Personal and energetic a must. The physician will provide all aspects of podiatric practice, including sports medicine, wound care, and foot and ankle surgery. Competitive compensation package. Partnership opportunity for right person. To apply, please email, letter of intent and CV to premierfootpa@outlook.com



 




ASSOCIATE POSITION- MANHATTAN AND BROOKLYN




 


Podiatrist wanted for busy, expanding group practice which covers all aspects of podiatry including surgery. Must be able to work in both Manhattan and Brooklyn locations. Position available asap. Please send resume and references to yfrierson@starrettpodiatry.com.





 



ASSOCIATE POSITION – SW FLORIDA 



 


Immediate position available in SW Florida. Podiatrist to join a small group. Must be Florida licensed, surgical privileges pending experience. Board Certification or Qualified preferred but not necessary. Some nursing home care and limited travel. Excellent pay and lifestyle. Send CV to: 1foot.ankle@G-Mail.com


 


ASSOCIATE POSITION – CHICAGO, IL




 


Podiatrist in Chicago. Independent, energetic Dr. needed to do house calls; schedule will be accommodated due to Dr.'s preferences; both full- and part-time will be considered. Send your inquiries to: dpms2@hotmail.com







 


ASSOCIATE POSITION - SOUTHEAST GEORGIA STATESBORO & SURROUNDING AREAS  



 


Beautiful weather year round. Seeking experienced, Family-oriented, podiatrist looking to build a career & long-term relationship. Must be PSR-24/36 trained. Multiple locations. Full range of services with access to Surgical Center. Willing to live in a College town with rural settings. E-mail cover letter & CV to melissafoot@atlanticfeet.com.


 




ASSOCIATE POSITION – CHICAGO, IL




 


Podiatrist in Chicago. Independent, energetic Dr. needed to do house calls; schedule will be accommodated due to Dr.'s preferences; both full- and part-time will be considered. Send your inquiries to: dpms2@hotmail.com





 



ASSOCIATE POSITION – SW FLORIDA 


 


Immediate position available in SW Florida. Podiatrist to join a small group. Must be Florida licensed, surgical privileges pending experience. Board Certification or Qualified preferred but not necessary. Some nursing home care and limited travel. Excellent pay and lifestyle. Send CV to: 1foot.ankle@G-Mail.com


 






ASSOCIATE POSITION - UPSTATE NEW YORK


 


Mmulti-specialty, busy practice looking for highly motivated Podiatrist. Outstanding opportunity, excellent salary and benefits, working with three Podiatrists as well as residents, high volume of surgical cases, advance wound care, broad based referrals, and Electronic medical records. Opportunity for partnership. Please submit CV to  associateinfoot@yahoo.com or fax 607-723-1567.


 



ASSOCIATE POSITION - MISSOURI


 


Midwest practice opportunity for candidate with practice experience, PSR 24/36 trained, BQ/BC. Associateship leading to ownership. Surgical and general podiatric practice with high volume foot surgery, wound care and hospital affiliations. Email:  stcpod@att.net


 




ASSOCIATE POSITION - TENNESSEE  


 


Opportunity for fully credentialed podiatrist(s) needed to join or purchase a high-volume practice with enormous growth. Located on the largest medical center/hospital campus in East Tennessee. Please email CV, letter of intent, and references to PodiatryFootAnkle@gmail.com



 




ASSOCIATE POSITION - NY (ROSLYN AND HUNTINGTON) 




 


Join one of the largest podiatry groups on the East Coast. Well established and progressive  offices, including EMR, digital x-ray, PVR and NCV studies, PinPointe laser, and Microvas therapy. For more info, www.GreatFootCare.com. Send resume to:  Dr.Kassaris@yahoo.com.



 



ASSOCIATE POSITION – CONNECTICUT



 


High volume practice seeking a hard-working, motivated, Connecticut licensed podiatrist. Duties to include diabetic foot care, wound care and minor office procedures. Please submit CV to: podiatrypeople@gmail.com






 


PODIATRY OFFICE FOR RENT - STATEN ISLAND, NY 










 


1000 square foot (approximate) office in large modern medical center. Good parking, public transportation, 36 years as a podiatry office. 5 exam rooms, business office, lab, reception room, bathroom, central air. Great layout. Designed for Podiatry/medical. Call 212 794 0089.


 



PRACTICE FOR SALE - SOUTHWEST FL 


 


Multilocation multidoctor practice in beautiful Southwest Florida. Practice has grossed over seven figures consistently and currently shows 10-15% growth in revenues with increase in new patients and patient visits. EHR is already implemented with meaningful use criteria met. Practice has been professionally evaluated by Provider Resources. Only serious inquiries to this email address. This is a great practice in Paradise and a good opportunity for the right doctor or doctors. Email to: practiceforsaleswfla@gmail.com



 



PRACTICE FOR SALE - SAN DIEGO


 


Doctor Disabled. Must sell. $16,000 for small well-equipped office. Low overhead. Professional bldg with views. Great weather. Practice focus: Biomechanics, Fungal nail laser (diode), CO2 laser, General Podiatric Medicine. Very good Yelp reviews. Low cost opportunity. Fax your contact info: 858-408-9434







 


PRACTICE FOR SALE - NORTHERN NEW JERSEY 


 


Suburban part-time(2 days a week) practice. established for over 30 years. Relatively young patient base. About 20% Medicare. No Medicaid. contact kaymullen18@gmail.com.


 







PRACTICE FOR SALE - CONNECTICUT 


 


Well-established, 35-year-old reputable practice/condo with approx 2,500 Square ft. Grossing approximately $450,000. Outside Hartford area. All phases of podiatry. Contact drsch52@hotmail.com






 


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Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 15,500 DPMs. for details, click here or write to: bblock@podiatrym.com or call (718) 897-9700 for details. For commercial or display ads contact David Kagan at (800) 284-5451

02/08/2014    

CODINGLINE CORNER


Query: Excision of Os Trigonum


 


How would I code an excision of os trigonum? 


 


Donald Sheller, DPM, Peoria, IL


 


Response: CPT 28120 [partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (e.g., osteomyelitis or bossing); talus or calcaneus] is the appropriate code to bill for an excision of talus bone. The os trigonum is considered part of the talus. 


 


Walter Pedowitz, MD, Linden, NJ


 



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02/05/2014    

CODINGLINE CORNER


Query: Laser Treatments of Warts


 


My doctor performed a CO2 laser treatment for warts. Is CPT 17106 (destruction of cutaneous vascular proliferative lesions [e.g., laser technique]) the appropriate code to use to bill this procedure? If not, what would be an appropriate treatment code? 


 


The claim has been denied due to ICD-9 078.10 (verrucae, unspecified) and ICD-9 216.7 (benign neoplasm, lower extremity) being invalid diagnosis codes for this procedure. 


 


Doni James, Billing Specialist, Office of Thomas Vail, DPM, Finley, OH


 


Response: Yes, you can use a laser in the treatment of this condition. The problem is that a wart is not a cutaneous vascular proliferative lesion. Clinically, it never has been. An example of a cutaneous vascular proliferative lesion is a hemangioma. 


 


If you are treating a wart by destruction - regardless of the recognized technique - you would code the procedure as CPT 17110 (up to 14 warts destroyed). Presuming the doctor is treating plantar warts, the code is ICD-9 078.12; mosaic wart, ICD-9 078.19; other (vulgaris) wart, ICD-9 078.10. 


 


Tony Poggio, DPM, Alameda, CA 


 



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02/04/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)


RE: Blood Thinner Qualifier (Robert Bijak, DPM)


From: Richard A. Simmons, DPM


 


Dr. Bijak correctly notes that the use of medication describes a drug-induced, purposeful anti-coagulation, not a true defect. Even so, the Florida LCD for Routine Foot Care states: “The following diagnosis related to anti-coagulation therapy does not require a Q modifier: 286.9* | OTHER AND UNSPECIFIED COAGULATION DEFECTS.” 


 


I still find it best to have a signed statement from the treating MD or DO that says this is the correct diagnosis for this patient.


 


Richard A. Simmons, DPM  Rockledge, FL  RASDPM32955@gmail.com
Sigvaris