This week I want to be sure to include this "housekeeping" note up front.  On June 30th, all of us who have had internet service with AT&T Broadband will be changing to new email addresses with Comcast.  Comcast will provide forwarding of email addressed to "attbi" accounts for a while, but we will need to get used to new addresses.  I'll let you know what the new one is when it becomes definite, but in the meantime, the FootZine email and web site addresses should remain the same: gaylejohnson@footzine.com   www.FootZine.com

I want to remind you, too, that the FootZine web site is more than just an archive for past issues and previous Gems, Pearls, and Crystal-Clear Coding tips.  The "Networking" page is a place to share your search for the perfect job or perfect staff person in our field, as well as other information and contacts.  "Links" is a page of active links to useful web sites, including connections for OSHA, HIPAA, APMA, AAPPM, UFP, OUM, PICA, as well as other informational web sites for podiatry.  There is also a search engine, accessed via the "FootZine Archive" and "Gem Archive" pages, that can help you find past issues or articles relevant to a specific topic.

The "Calendar" page gives dates and places of seminars and programs, particularly those for podiatric assistants, as well as related information when available.  This page is only as current as the information that is sent to me, so I welcome details about upcoming meetings.  The more of this information we provide, the more options FootZine readers are aware of for educational opportunities.

If you haven't visited the site in a while, why not drop by and explore a little?   And feel free to share your information, too, with email to  gaylejohnson@footzine.com .

~ Gayle

From:  Heather Schafer, PMAC
re:      MediSoft (Volume 31, Sharon Hockinson)

Hi, I saw your posting on FootZine and just wanted to let you know that we are in the process of purchasing MediSoft and connecting our three offices together using it. We have researched Milbrook and Horizon and are currently using Wisdom and VERY unhappy....with both the support (or lack thereof) and the excessive fees etc.

Two other offices in our building use MediSoft and are very happy with it and I've played a bit around with it and it is very user friendly.  I know that Gayle's employer (Alan Woodle) uses MediSoft and when I spoke to Roslyn (the office manager) they have used it for years and they seem to be happy with it.

Anyway, sorry I can't be more helpful but I will definitely keep you posted when we are up and running.

Heather Schafer, PMAC
Island Foot & Ankle Care - Anacortes, WA
Heatherpmac@aol.com    (360) 293-4502

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From:  Liz H.
re:      Thank You

Dear Gayle,

I just want to say thank you for all your hard work to keep this going.
Thanks a million to all your contributors. I'm in a pretty remote site and have no opportunity to network with others in this very specialized field.

You keep me going!!! You provide valuable information and ideas that I would not otherwise be privy to. God bless you all!!!!!

Liz H.

MEDICAL INSURANCE BILLING CLERK - Experienced, Full-Time.  Some experience with A/P A/R desirable. Edmonds, WA.
Fax resume to (425) 775-9078

Notices of positions wanted or positions available, as well as other "classified" information, are welcome. They are posted at the FootZine web site's Networking page. Have a look at http://www.footzine.com/FZ_6.htm

Osteomyelitis Coding

The Question:

What is the correct way to code for an inpatient consult that results in a surgery, for example seeing a patient with osteomyelitis on consultation and doing a bone resection on the same day.

The Answer:

For a Medicare patient you can bill the consultation code based on the level of E/M documentation in the chart (9925X) and add a 57 modifier reflecting that the decision to do the surgery was based on that E/M service and that the surgery was done within 24 hours of the E/M service.

The surgical procedure would be coded as the surgical procedure you actually performed (for example 28820 amputation toe at MTPJ).  This would have a 90-day global. The follow-up inpatient visit and office visits related to the surgery would be covered but not separately billable for 90 days.  Post-op radiographs would be billable.  If the patient developed any other problems during the post op period they could be billed with an E/M-24 indicating a non-related problem during the post-op period.

Crystal-Clear Coding tips by Dr. Ward are posted on the FootZine web site on this page:
http://www.footzine.com/FZ_C.htm


*_*   "Learning is not attained by chance, it must be sought for with ardor and attended to with diligence."   -  Abigail Adams (1744 - 1818), 1780   *_*

One of the most overlooked security flaws in a practice is the waste-paper basket.  If your office is not currently using a shredder, then please, by all means, at the end of the day take a look through your waste paper baskets, especially at the front desk.  You may find an abundance of PHI in there.  You may think that this is a bit paranoid, to go through the trash, or “who wants my trash anyway?”.  Case in point, last month in Philadelphia there was a crew that was working with insiders in an HMO and they were sending patient PHI out the door in the trash.  Their accomplices would then go through the trash and remove the PHI.  Their next step was to take the papers back to an apartment that was set up with some very elaborate devices for making forged credit cards and documents.  This crew would then open charge cards, make mortgages and even purchase automobiles all with the forged documents.

The bottom line is that the HMO is going to see serious liability on this because they have an obligation to have policies and procedures in place to prevent this kind of activity.

Putting a shredder in the office is an inexpensive way to protect discarded PHI.  When purchasing a shredder always look for a cross-cut or chip style.  The straight strip type of shredders just don’t provide enough security -  you would be surprised how easily a strip-cut document could be reassembled.  Shredders also have a duty cycle rating in pages.  Look for one that is at least 50% greater than the amount of paper you currently generate.  Shredders have a relatively long life so you want one that will be able to handle long-term growth in your office.  One model that I have found to work well is the Fellowes PS80C.  It is a real workhorse and ideal for a small-to-medium office. There are some very high-end commercial units out there, but they would just be overkill for most offices.

Another solution is the use of a shredding service.  There are several national companies that provide this service.  They provide a trash can inside a locked cabinet.  The papers get deposited through a slot in the top and stay secure until pick up.  The shredder companies send a truck to your location and shred everything right there and give you a certificate stating that everything was shredded.

When you first implement a shredding policy in the office, a good idea to help break old habits of just throwing PHI in the regular trash is to remove all trash cans from the immediate work areas and relocate them in a back area. The idea is to just make it more difficult to get to the trash so that the employees will make a point of going to the shredder first and dispose of all their paperwork.  Once this becomes the new habit, you can then reintroduce the regular trash cans.  Also make sure that violations of your shredding policy carry consequences.  It is important that everyone in the office take shredding seriously because lapses can come back to haunt you.

By: Raymond F. Posa, MBA
Technology Advisor to the American Academy of Podiatric Practice Management
President, R. Francis Associates

Any questions or comments can be addressed to Mr. Posa by E-mail: Rposa@Rfrancis.com
Or visit WWW.NJHIPAA.COM

You can review previous installments from Mr. Posa at
http://www.footzine.com/FZ_H.htm

As schools start to wind down for the summer, vacation plans shape up, and we shift to that sunny-weather mode and attitude, I hope you'll take time to stay in touch.  Let us hear what's going on where you are, or what billing, coding, HIPAA, OSHA (etc.) issues are eluding a solution in your office.

 ~ Gayle

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