July brought new email and web addresses for those whose internet service used to be with AT&T (attbi).  The "mirror" web site for FootZine is still in place, with a new address:    http://home.comcast.net/~gaylesjohnson/GSJ-web_1.htm

My "back-up" email address for FootZine is:  footzine@comcast.net
The "FootZine.com" email and web addresses are still valid, but we've learned the hard way that having backup is a really good idea!

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"Spam" has been the topic of much discussion recently, and most of us would prefer to have less of it in our inboxes.  A story from IDG News Service on 6-27-03 reported that Network Associates will be giving away free copies of their "McAfee SpamKiller" both online and in retail stores.  The giveaway will take place tomorrow, on July 4th, which they have declared to be "Independence from Spam Day".  If you're lucky enough to receive a free copy of the "Spamkiller", remember to tell it that FootZine is "friendly" email.  Details can be found at this link:
http://www.infoworld.com/article/03/06/27/HNmcafeespam_1.html

  ~ Gayle

From:  Joan A. Cox
re:      The New Organization and X-ray Manual/Video

Hi Gayle,

I really appreciate reading your FootZine information even tho I am now a retired podiatric medical assistant.  I miss it very much, so with reading the many articles from assistants I still "feel" a part of it.  Thank you for allowing a "retired me" to continue to feel this way.

I am very proud of the accomplishments you have made as you have grown with your dream & knowledge of how to assist others in their careers as podiatric medical assistants, with dedicated PMAs & DPMs by your side.  I am sure the new organization will grow & benefit greatly as it is supposed to for the members.  Best wishes for all as you focus on the future; may you form friendships that last a lifetime.

With many Docs, students & assistants looking for ways to save time & money, as well as being well-informed, I would like to suggest my X-ray manual & video "Basic X-Ray Techniques for Podiatry".  It shows how to take Podiatric X-rays consistently, thus reducing costly errors & time for retakes.  Great for cross-training office staff or new assistants.

It can be ordered direct from me via e-mail joancox@nwlink.com .  However, I no longer accept credit cards, & charge S/H of $6.  The order is shipped via Priority Mail.
For more information here is the link:  http://www.ulti-media.com/stevfoot.htm

I would like to assist your new organization by donating $5 on each order I receive.

Have a great day,

 Joan
Joan A. Cox
Anacortes, WA

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You can also find more information about Joan's X-ray Manual and Video via the "Links" page of the FootZine web site:  http://www.footzine.com/FZ_3.htm


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From:  Renee Gross, PMAC
re:      Creating a "Welcome" Brochure

My doctor has given be the task of creating a "Welcome to our Office" brochure.  I have not seen any and have no idea where to start.  Is there anyone who would be willing to show me theirs so I would have a starting place?  It would be greatly appreciated.
Please email me at lrgross@hotmail.com

Thank you -

Renee Gross, PMAC
Spokane, WA

How can one ever forget the captivating moment when Dorothy opened her front door after her journey through the tornado to see the vivid colors of Munchkin Land?  She felt that her life in Kansas was tragically gray and now had a dream come true.  She was set free and brought somewhere over the rainbow to this colorful world she envisioned to lead to her happiness.

The Munchkins were quite scared of Dorothy and were quick to find out if she was a good witch or a bad witch.  Their false fears were forged through past experiences and, in a sense, tunnel vision.  This same way of thinking frequently keeps us in a gray world within our offices.  We look at things such as managed care, insurance companies, HIPAA and increased paperwork as the Bad Witches and often complain how this leads to considerable frustration. 

The Munchkins had Glinda the Good Witch to comfort them that Dorothy was harmless, but where is our Good Witch to help us through our days with the layers of additional work caused by the forces mentioned above?  The answer is right in our own backyard.  The forces that appear as wicked as the Bad Witch in our office can melt, as easily as she did with a pail of water, by simply understanding that we can only change something we have control over.

There is no logic in complaining about managed care, but it makes a lot of sense to learn how to bill correctly to maximize reimbursement for the plans you participate in.  This is where raises in your pay and benefits are derived.  Instead of whining about governmental control such as HIPAA and OSHA regulations, create simple systems to follow their guidelines and they will quickly become a simple part of your daily routine.  Rather than focus on that one patient on your schedule that continually aggravates the doctor and staff, think of the other 95% of the patients that appreciate your good service and remind us of our devotion to our profession.  After all, it is the patient who does write our paychecks.

So take that first step along the Yellow Brick Road and begin your journey understanding that your friend Glinda is always watching to keep your glass half full instead of half empty.  In next week’s FootZine we’ll meet the Scarecrow and his wits.  Happy 4^th and EVERYDAY.

Previous "Gems" can be found on their own pages of the FootZine.com web site, at
http://www.footzine.com/FZ_90.htm

Often in podiatry we encounter a situation similar to the following:
A patient was seen in the office and it was determined that he had an ulcer which probed to bone.  Radiographs indicated bony degeneration and a diagnosis of osteomyelitis was made.  The podiatrist contacted the patient’s PCP and later that day the patient was then admitted to the hospital by their PCP and a podiatry consult ordered.  The consult was done and the patient was booked for an amputation.  The amputation was performed the next day.  Inpatient follow-up care was rendered until discharge.  Thereafter the patient is followed in the office by the podiatrist until the surgery site is completely healed.  How should the podiatric services be coded?

1. The initial office contact with the patient would be coded as a 9920X new patient or 9921X established patient, depending on the level of history, exam and medical decision making.  736XX would be billed for the radiographs.

2. The inpatient consult would be coded as a 9925X-57, depending on the level of history, exam and medical decision making.  The 57 indicates the decision to do the surgery was made as a result of the consult.

3. The surgery would be coded with the appropriate CPT code.  Let’s assume it was a digital amputation at the MTPJ.  This would be coded 28820.

5. The professional component of the radiographs taken in the hospital will probably be billed for and paid to the radiologist at the hospital unless the podiatrists reads the films first in which case the podiatrist would bill 736XX-26 where the 26 indicates only the professional component is being billed.  The hospital would bill the technical component for the radiographs.  This includes any intraoperative radiographs.

6. The follow-up visits in the hospital and in the office would be included in the global for the surgery and are not separately billable unless some other problem exists, in which case the appropriate code would be 9921X-24.  Here the 24 indicates that a separate unrelated problem was addressed during the post-op period.

7. Radiographs taken in the office post-op are separately billable and would be billed as 736XX.

The Question:

What would be appropriate coding for the custom fabrication of a toe crest
from a silicone based compound such as Berkoplast or Accumold? I have
considered L3030, L3100 and also L3003. Thank you.

Robert D. Phillips, DPM

The Answer:

There is no specific code for a custom crest pad.
L3100 is not appropriate because it describes a hallux splint
L3003 is not appropriate because it specifically states silicone gel
L3040-L3090 are not appropriate because they specify arch
L3030 may be appropriate as nothing in the descriptor would eliminate it's use however
We use the CPT code CASH for this device in my office


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

Anti-Virus software is essential in today’s computer environment, so much so that I tell clients to not even bother running their PCs if they are not running up-to-date virus software.  Why?  Because viruses are so prolific that in a very short time you WILL get one.  Anti-virus vendor watchdog groups are reporting that new virus activity was up 17.5 percent over the past six months, and viruses getting are more sophisticated, with more sophisticated targeting.

Just to demonstrate this fact for my clients, my anti-virus program has an audible alert option that I can switch on for demonstration purposes; it goes off every time a virus attempts to enter my system.  When activated, it will beep every 5 to 10 seconds all day every day, that’s how bad things are.

Some users believe it won’t happen to them or they can’t afford the software or the update subscriptions.  My response is, you can’t afford not to have it.  The cost of repairing a system after being infected will cost much more than even the most expensive anti-virus software; plus you can’t even put a monetary value on the cost of lost data.  I consider the money paid for anti-virus software to be part of the operating expense of a computer, just like electricity is.

In just the last two weeks we have had some real nasty viruses make their presence felt.  We had the Backdoor.Prorat which is a backdoor Trojan Horse that gives its creator full control over your computer, by opening port 58343.  Due to the high number of infections, this virus has been upgraded to a Category 4 from a Category 3 threat.

Another one we just had to deal with is W32.Bugbear.  It is a mass-mailing worm that also spreads through network shares.  It is polymorphic and also infects executable files.  It also possesses keystroke-logging and backdoor capabilities and attempts to terminate the processes of various antivirus and firewall programs.

Under HIPAA security requirements you are required to safeguard your systems from outside intrusion, and failing to do so is a violation.  Virus attacks and outside hacks are considered “common knowledge” and you are responsible to implement procedures to prevent intrusions.  Just installing anti-virus software is not enough.  You must configure it so that it will quarantine the virus and /or delete it.  You need to also make sure the virus patterns that the manufacturer provides are up to date. You also need to know how and when the manufacturer updates its virus tables.  For example, Norton has an auto-update capability built into its software.  The thing to know about Norton is that even though you are doing an update every day, Norton only updates its server every Wednesday; so the rest of the days of the week you are not getting anything new.  In order to get the new daily update you have to go manually to the Norton site and manually download the daily update. This is important because the Backdoor virus was deployed to exploit this fact and it came out on Thursday and infected many systems, before users were able to get the new updates.

The key is to know your anti-virus software and very specifically how it functions and any limitations it may have.
 
Once you have your anti-virus software installed and configured and getting its updates, you’re done, right?  Wrong.  There is another key component that must also be done: that is updating your operating system.  Microsoft Windows from 95 on has a Windows update feature that goes out to the Microsoft web site and gets all of the latest patches for your version of Windows. This is critical because many viruses are written to exploit vulnerabilities in Windows.  Even though you have anti-virus software, if you have critical holes in Windows you are still subject to getting a virus. The anti-virus software also depends upon the Operating system being secure.

You should be checking for Windows updates on a daily basis.  In Windows 98 and later, Windows has a scheduler feature whereby Windows will automatically go to the Microsoft update site and find any new critical updates and download them for you.  It will then have a little pop-up alert letting you know that the updates are downloaded and ready to be installed.

Be safe: stay current with your Windows updates and anti-virus updates.

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

Here's hoping you all have an enjoyable holiday (conveniently attached to a weekend!).  Do be careful with those firecrackers, though - you have to take good care of your fingers so that you can still write!  :)

~  Gayle

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