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From: Don R Blum, DPM, JD


The Social Security number is not a necessary requirement for treatment nor is it a necessary requirement for billing for a patient. The only reason, I can think of, you "might" need the Social Security number is for the purpose of sending a patient's account to a collection service. 


I do think it is important to have enough identification to confirm that the person you are treating and the insurance being used are for the appropriate person. I further believe you need enough correct information in order to contact the patient as might be necessary for their medical care. I do not believe the SS# is necessary for these purposes.  


Don R Blum, DPM, JD, Dallas, TX

Other messages in this thread:



From: Kim Antol


What makes an image storing App HIPAA-compliant is the requirement of an additional password or PIN to open and view images. (This would be in addition to your normal log-in procedure to your device). The one I use and recommend is called “Vaulty”. Once a medical image is received, you can transfer it in from your normal photo App…as well as the ability to delete or transfer it out.


Kim Antol, Sigma Digital X-Ray



From: Linda McSmith, RN


At PICA, we recommend that medical record retention policies and procedures should include guidelines that specify what information should be kept, the time period for which it should be kept, and the storage medium (electronic, paper, X-rays, etc.). Applicable federal health record retention requirements, state laws, or regulations pertaining to retention of health information, and accreditation agency retention standards, if applicable, should be followed. It is recommended that a local attorney, familiar with such matters, be consulted when developing medical record retention policies.


Unless longer periods of time are required by state or federal law, records of adult patients should be retained for a minimum of 10 years after the most recent encounter, and records of minor patients should be retained to the age of majority plus the state statute of limitations or 10 years after the most recent encounter, whichever is longest. CMS requires Medicare managed care program providers to retain records for 10 years. This includes books, records, documents, and other evidence of accounting procedures. This requirement is available at 42 CFR 422.504 [d][2][iii] on the Internet.


Linda McSmith, RN, Risk Manager PICA



From: Vincent Marino, DPM


While I  agree with Dr. Blum for private insurers - in California, the patient’s Social Security number is a requirement when billing California Workers Compensation Insurance. Many if not all of the CA Workers Compensation Insurance Companies may not process your bill if the patient’s Social Security number is not on the claim since this information is matched to the employer’s employment records.


For those people who actually do not have a Social Security number, you are required to use 999-99-9999. But you cannot use it if the injured worker simply does not give you their SS# or forgot it. The insurance company will electronically compare the Social Security number on your bill (whether e-bill or paper billed) with the records of the employer. If they do not match, you will get a rejection notice.


Vincent Marino, DPM, San Francisco, CA



From: Linda McSmith


Providers may or may not charge for copies and supplies necessary to copy, depending upon the stipulations in the contract with payors. PICA recommends that you check your contract with the payor to determine if you can charge for charts being requested for audits.  


Linda McSmith, Manager of Risk Management, PICA



From: Steven Finer, DPM


Solution to DEA number. A limited number excluding schedule 2 drugs would solve it. The DEA can then charge a reasonable fee. Of course, we would be trusting a government agency to do something simplistic.    


Steven Finer, DPM, Philadelphia, PA 



From: Christopher Orlando, DPM


This is a conversation that should not be happening. The DEA license should be retained until the doctor is fully retired and out of practice. The cost in New York is $731.00 for 3 years (243.67 per year). This is nominal. The cost of membership in ABPM, ABPS, etc. is three times the cost. Why cheap out on a small number? Historically, we as a profession worked very hard to earn the right to have the DEA license. This was a long hard battle that was finally won in 1971. Prior to that, we could not write any prescriptions at all. Our profession has been climbing a steep hill (and gaining) for the past 100 years. Let's not give it back.  


While we are on the subject of prescriptions, our DEA license allows for schedule 2, 2N, 3, 3N, 4, 5 medications. Therefore, if doctors are allowed by their DEA license to prescribe medical marijuana, each doctor would then make an individual decision as to whether to prescribe it or not. I would not want that decision taken away from me by those who would elect to decline to prescribe it.


Christopher Orlando, DPM, Hartsdale, NY



From: Paul Kesselman, DPM


A little bit over a year ago, I had the same experience, where I received a shock of a bill for my DEA number renewal. Being part time clinical, not doing much surgery, and with the surgery I did perform being well managed with high potency NSAIDs, I also felt it was absurd to renew my DEA number. I called the NYS Board of Pharmacy and they told me I absolutely did not require a DEA number to prescribe non-narcotic or non-scheduled meds. To be clear, certain non-narcotics such as Lyrica and Ultram are scheduled in NY


With those facts in mind, I did not renew my DEA license and then the fun started. Every insurance company I was contracted with hounded me for...


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



From: Richard A. Simmons, DPM 


Jack, I faced the same dilemma about eight years ago. I contacted our State of Florida Podiatric Licensing Board and was told it was not necessary. I contacted my professional liability insurance carrier and they were more than enthusiastic that it was not necessary.  So, I have not had an active DEA for about 8 years. I could not tell you the last time prior to then that I wrote for a narcotic, but I do know that since I discontinued my DEA license that I have no longer been called by patients in acute pain that could “only be resolved by Oxycontin, etc.” Save yourself time and money, but for peace of mind call the Licensing Board and your insurance carrier to get their 2019 opinion.


Richard A. Simmons, DPM  Rockledge, FL



From: Joel Lang, DPM


This actually happened to me and one of my staff members many years ago. There was this elderly man who engaged in inappropriate touching with a female assistant, particularly in a small whirlpool room where she offered him assistance removing his shoes and socks. She came to me after a number of incidents and while it made her uncomfortable, she tolerated it because she did not want to lose a patient for me. I was pleased that she brought it to my attention and I told her so. My immediate response was "I have many patients, but good assistants are hard to find. So, if one of you has to go, it has to be him."


I gave her two options: 1) Since she was mature enough and self-confident enough to speak for herself, I would allow her to speak to him directly and let him know that his behavior was unacceptable and would no longer be tolerated. 2) Alternatively, if she wanted me to speak with him, I would do so and transmit the same message.


In either case, if the patient was lost, so be it. My memory is that she chose the first option and I don't accurately remember whether the patient remained in the practice, but I think he did.


Joel Lang, DPM (retired), Cheverly, MD



From: Howard R. Fox, DPM


I assume you do not practice as part of a large group or hospital. If you do, your group or hospital would have a sexual harassment policy in place. It would detail what your exact steps would be.


If you’re not part of a large group or hospital and do not have a sexual harassment policy in place for your office (I assume you don’t or you wouldn’t be asking), your employee can call the police and file charges. You should memorialize your conversation with her in writing and also note the day, time, location and any witnesses. Different states have different reporting requirements. In New York, we have the Division of Human Rights. On a federal level, the 1964 Federal Civil Rights Act (codified as 42 U.S.C. § 2000e et seq.) covers this, but you must have at least 15 employees to be covered by the EEOC.


As far as your patient is concerned, I’d speak first with your attorney (many malpractice carries will allow you legal advice to protect you and advise on your actions) before discharging the patient based upon the allegation of sexual harassment. On the smallest level possible, a frank conversation with your patient letting him know his behavior will not be tolerated would be in order, and your patient’s response should also be incorporated on the written memo of the event. Chances are he won’t feel comfortable returning after that and you would avoid having to discharge him from your practice.


Howard R. Fox, DPM, Staten Island, NY



From: Timothy P. Shea, DPM


One of your primary responsibilities as a professional business owner is the safety of your employees. Inappropriate behavior, such as language, physical activities, or any actions by patients, or anyone else, which you or your staff deem inappropriate is immediate cause for dismissal from the practice. My office manager is an ex-ER nurse and she does not tolerate anything, even over the phone, that falls into this category.


There is a fine template available from PICA Insurance for dismissing patients. We use the term "inappropriate action" in the letter to explain the reason for being let go. There is no second chance, and I have had a few call backs to request an opportunity to make amends to no avail. Your staff must feel safe in your work environment. Fortunately, this does not happen that often. I recommend you take immediate action in this matter.


Timothy P. Shea, DPM, Concord, CA



From: Elliot Udell, DPM


If a podiatrist (or any physician) sells his or her practice, do patients have a say so on who will then have access to their medical records? Take this scenario. Let’s say Mr. Jones has been treated by his trusted family doctor for a condition that he wants kept confidential. Let’s say his physician sells his practice to a large group, corporate practice, or hospital-based practice where many people will have access to his medical records. How does he protect his privacy? Will his next door neighbor, friend, or "nephew who is a resident" be able to see his potentially embarrassing medical records?


Elliot Udell, DPM, Hicksville, NY


Editor's Comment: PM News does not provide legal advice. "HIPAA allows for the exchange of PHI without a written authorization between current and prior practitioners or contemporaneously treating practitioners (including practitioners who are treating the patient at the same time, such as consultants). However, when a practice is being sold, HIPAA does not permit the transfer of PHI from one provider to another without the patient’s written authorization. Although transferring the records to the purchasing practitioner or corporate entity might seem to be the most expedient solution, it is not permissible under HIPAA. 


State statutes and administrative rules may further complicate the process. For example, states can require practitioners to maintain patients’ health records for specified periods, dating from the last treatment date. Many states impose a 7-year or longer record maintenance requirement, and many states impose separate — and often more rigorous — requirements for retaining pediatric records. HIPAA does not diminish the authority of these laws."


Source: Medpro Group



RE: The Danger of Downcoding

From: Michael Forman, DPM


A colleague of ours, an immigrant from Russia, was used to working in an onerous medical system and strived to do the best to avoid any problems with Medicare. This doctor downcoded all  I&Ds in order to avoid having to justify the higher code. As a result, the podiatrist’s number of 10060s was much higher than average. CPT 10061 was never billed, thereby saving the government money. The doctor was charged and found guilty for improper billing. Now, I am not sure there were other factors involved; nonetheless, the downcoding was held to be a fraudulent act.  


I have never seen an actual description of the difference between 10060 and 10061, except that one is considered greater in nature than the other. Lesson to be learned - 1. the government is not here to help you and 2. Don’t downcode.


Michael Forman, DPM, Cleveland, OH



RE: Requests to Trim Fingernails

From: Brian Kiel, DPM, John Fricker, DPM


One of the responders asked why as podiatrists we cannot trim fingernails. 60 years ago, we were chiropodists and treated the hand and foot (chiro-hand, pod-foot). We fought to change the name to podiatrist and now we are struggling to change the degree to MD. Going back to treating fingernails seems quite illogical.


Brian Kiel, DPM, Memphis, TN


I once had a patient who requested that I cut his fingernails. I replied that due to my scope of practice in Kentucky, everything I work on has to be below the knee. As he sat in the treatment chair, he thought for a second and then extended his hand down to his ankle and said, "How about now?"  We had a great laugh together. Clever guy.


John Fricker, DPM, Frankfort, KY



RE: Requests to Trim Fingernails

From: Bryce Karulak, DPM, Charles Morelli, DPM


I truly think we are hyper-focusing with respect to trimming patients' fingernails. I am willing to bet that if anyone of us cut a patient's fingernails and went to the majority of the PCPs in our respective areas, they would not care and even say, "Great!" 


Where this conversation should really focus on is enhancing our scope. I work in Texas and the law for podiatry basically reads, "A podiatrist may treat...


Editor's Note: Dr. Karulak's extended-length letter can be read here.


My question is very simple and I look forward to hearing from our legal scholars. Why is it that anyone can trim a fingernail but a podiatrist cannot? Why was my wife able to trim our daughter's nails? Why is a granddaughter not placed in peril if she cuts the nails of her grandmother in a nursing home? These examples are endless. Why might this not be covered under the Good Samaritan law which "provides basic legal protection for those who assist a person who is injured or in danger." I once had to pry open the hand of a patient in severe contracture, only to find a nail that was on the verge of puncturing his palm. Does that qualify him as being in "danger"? I submit to you that it does. 


Charles Morelli, DPM, Mamaroneck, NY



RE: Requests to Trim Fingernails

From: Daniel Chaskin, DPM


Trimming or debridement of fingernails might be interpreted as part of good podiatric care concerning a comprehensive podiatric exam in conjunction with podiatric treatment. The purpose  of such an exam is to ultimately treat the foot so that its condition remains as healthy as possible.


Look how far we came. In NYS, for example, podiatrists can cut above the malleolus to perform epidermal nerve fiber density (EFND) testing so long as the purpose of the exam is to treat a foot condition. The law says that we cannot cut above the malleolus, but I believe this refers to... 


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



RE: Requests to Trim Fingernails (Michael Lawrence, DPM)

From: Michael Forman, DPM


I agree with Dr. Michael Lawrence that there are times when we can further help an aged or infirm patient by cutting their fingernails. I understand why my colleagues have second thoughts about this because of malpractice issues, however to refuse this simple request would be horrid. I wish I could offer better advice. I admit that we have a few patients who have their fingernails trimmed in our office. I admit that I have a few dermatologists who referred patients to me for surgical correction of nail deformities. I performed these procedures although it may have been a foolish decision. And one more shameful admission, as a podiatrist who has an interest in the law and has studied law - I don’t even know if the state of Ohio allows us to work on fingernails.


Michael Forman, DPM, Cleveland, OH


Editor's note: PM News does not provide legal advice. The State Medical Board of Ohio has determined that an Ohio podiatric physician who has successfully completed appropriate training may, as medically appropriate, provide treatment of fingernail fungus in podiatric patients and for treatment of scars on the hand when the etiology is not associated with trauma.





From: Lawrence Kobak, DPM, JD, Todd Lamster, DPM


Dr. Morelli has a kind heart. He is a fine example of what a podiatrist and human being should be! Unfortunately, treating a wart on a finger is clearly out of scope in most states. More than one podiatrist has lost his license to practice in more than one state for doing this. 


Lawrence Kobak, DPM, JD, Uniondale, NY


I must admit that I am surprised by the number of my colleagues who perform this service. I, too, have elderly patients who ask me to trim their fingernails. I tell all of them that it is against the law because it is out of my scope of practice, and doing something out of my scope could put my license in jeopardy. Just because I am capable of doing something doesn't mean I have the right to do it. Every single patient completely understood and respected the answer.


To my colleagues who trim fingernails: Would you incise and drain an abscess on a hand or finger? Would you perform a biopsy of a suspicious lesion? Would you inject a symptomatic palmar fibromatosis?


Todd Lamster, DPM, Scottsdale, AZ



From: Paul Busman, DPM, RN


Like Dr. Morelli, I would very occasionally trim a patient's fingernails. These were generally patients that I had treated for a long time, had fingernails that were already pressing into their skin, and had severe disabilities. This made them unable to go to a nail salon. Some had such severe finger contractions that a nail salon would not likely want to treat them. Yeah, I know, scope of practice, liability, blah, blah, blah. I just didn't have it in me to refuse such a simple request which I was eminently qualified to fulfill. I never once had a problem doing this, just very grateful patients. Not that it legally meant anything, but I always told patients that their podiatry treatment was over, but I was cutting their nails as a friend might do. They got the message.


I never did treat warts on a patient's finger or any other area but the foot. However, I did tell them that if the warts on their feet were cured, there was a good chance that the warts would all go away. Know what? In a fair number of cases, that actually happened. Also, if I was treating a patient with some home applied remedy, e.g. Sal acid under occlusion, I'd point out to them that if they went to a dermatologist for their other warts, he/she might well prescribe a similar treatment for their other warts, wink, wink.


Paul Busman, DPM, RN, Frederick, MD



RE: Requests to Trim Fingernails (Maryann Trivlis, DPM)

From:  Brian Kiel, DPM, Tom Silver, DPM,


Sorry folks.. I am not a manicurist. Debridement of toenails is a valid medical issue but the fingernails do not (qualify). People can go to a manicurist for their fingernails. Are you going to file and buff them as well? 


Brian Kiel, DPM, Memphis, TN


Periodically, we get a request to trim a patient's fingernail that's split, thick, deformed/mycotic and if it just needs trimming, we take care of this as part of their visit-at no additional charge. When we notice that a patient's fingernails need trimming, as they are very long and they can't do it themselves-again we will do this at no additional charge. When we see a patient with dirty glasses...we clean them. If they need to have their shoes and socks taken off and put back on-no problem.  


We are in the business of helping people and we need to think of these things as just part of taking care of our patients. They appreciate it and this goes a long way towards creating happy, trusting patients who would never think of going anywhere else or referring friends/family to anyone else for their foot care.


Tom Silver, DPM, Golden Valley, MN



RE: Requests to Trim Fingernails (Maryann Trivlis, DPM)

From: Charles Morelli, DPM


While I completely appreciate and understand Dr. Block's measured and legal response to this query, part of me is in complete agreement with him but the other part is rolling my eyes at this. While a podiatrist is limited in scope (which does not include the trimming of fingernails), and medical malpractice does not cover these treatments, please don't tell me that a medically trained podiatrist who went through 3 years of medical and surgical training who is now a doctor and/or a surgeon would say no to an incapacitated and frail senior citizen who asks you to help them cut their fingernails.


Back when I made home visits, I did it whenever I was asked. In my heart I could never say no. In my private practice, I have stroke patients, or patient afflicted with Dupuytren's who are unable to do it and have nails that are on the verge of breaking the skin of their hand and their wife or husband would ask (sometimes plead) for it to be done. How could you possible say no. At least I could never and still don't. Anyone ever treat a wart on one of your patient’s fingers? 


Was I out of scope and was I opening myself up to the possibility of a malpractice case when they could have gone on to a massive fingernail infection and lose their finger or arm? Yes, I was, but my odds of hitting lotto or being struck by lightning were better than that. If you fear this, then just don't do it. 


Charles Morelli, DPM, Mamaroneck, NY



From: Stephen Doms, DPM, Martin S. Lynn, DPM


Five states do include the medical and surgical treatment of hands in podiatric statutes: Alaska, Minnesota, Michigan, Ohio, and West Virginia. Source: ACFAS state scope of practice provisions. I practice in Minnesota, and while I could trim fingernails and be within my scope of practice, I choose not to.


Stephen Doms, DPM, Hopkins, MN


I treat patients exclusively in SNFs and will only debride/I&D fingernails if they are dystrophic, mycotic, or have a paronychia. The durable power of attorney (DPOA) or patient is then informed that they should follow up with a dermatologist.


Martin S. Lynn, DPM, Snohomish, WA



From: Elliot Udell, DPM


Yes, hardly a month goes by when a patient does not ask me to cut his or her fingernails. On Friday, another tenant in our medical building came in an asked me to cut one of his fingernails. I refused. I still remember one of my professors at NYCPM, over thirty years ago, boasting to the class at what a good deed he did for an indigent patient by cutting her fingernails. The problem is that in most states, it’s against the law. Dr. Block said it well when he said that such an action could subject a podiatrist to professional discipline. 


I see no reason why our local state societies should not push for legislation which would allow podiatrists to cut fingernails but until this happens, we need to refuse.


Elliot Udell, DPM, Hicksville, NY



From: Tip Sullivan, DPM


In my home state, we do not have an independent podiatry board (yet). I have been involved in podiatry issues at the medical board level for many years. There are some issues when dealing with the board that are not fair - like the fact that you are not allowed to know the accuser or allowed to look at their record on you. That takes a court order and the court will most likely side with the board. 


Since the board investigators found no fault in your actions, I advise you to either have your attorney or you yourself contact the attorney for the board and discuss the matter. Perhaps bring it up at the next board meeting so the board may be able to find a way to prevent future issues in the way they handle complaints such as yours and maybe even correct your problem. Take an active part.


On a personal level, anytime I have a valid complaint, it bothers me-- board or no board! To have one that is frivolous would make me very mad, and I might try to petition the court to find out the nature of the complaint as well as the complainant.


Tip Sullivan, DPM, Jackson, MS



From: Richard Willner, DPM, Jeffrey Kass, DPM


While the reality is that the Data Bank reports to the NPDB are not meant to ever be removed except for a very limited number of occasions, based on the few facts that I have read in your publication of this date, I think that this podiatrist may fall into that area.


To begin to understand the NPDB, I suggest reading my latest article published on the NPDB.  It was published in BC Magazine (originally called Billing and Coding Magazine).


Richard Willner, DPM, New Orleans, LA


Name Withheld asks a valid question. If the complaint against him was found as “without merit,” then I agree with name withheld that nothing should be put on their record. If something is then [reported], the accuser effectively “wins”. This is outright wrong! This is something that should be corrected and changed. Why is the doctor always wrong, even when innocent? I say it time after time - why do doctors take this constant abuse? When issues arise that we may previously were unaware of, why doesn’t leadership attempt to evoke change before history repeats itself? I empathize with the poster. 


Jeffrey Kass, DPM, Forest Hills, NY

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