First things first - Congratulations go to Dr. Barry Block, a member of the FootZine Advisory Board, and to Dr. Phill Ward, who until last week was a regular FootZine contributor!
Dr. Ward is now serving his first term as a Trustee of the APMA after winning election this week.  Dr. Block was named 2004 Podiatric Physician of the Year by The Fund for Podiatric Medical Education.  We are in good company here!

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I was recently (belatedly) reading the March 2004 issue of the APMA News and the "Insurance Advisor" (see page 17) caught my attention.  The question had to do with the unfortunate mistake of operating on the wrong foot, and how to prevent that kind of error.  While we hear stories about similar situations in the news from time to time, we think they would never happen in our office or to our patients.  In his response, Dr. William Munsey described a "universal protocol and procedures" adopted by the Joint  Commission on Accreditation of Health Care Organizations (JCAHO) to help avoid such problems. 

There are several steps that will become mandatory in July (only 2 months away), and they will apply to all hospitals, surgery centers, and office-based surgery centers that are accredited by JCAHO.  That means that certainly any of our doctors who perform surgery at an accredited facility must be aware of these new protocols.  It also means that any of us who work in an office-based surgery center, or accompany the doctor to surgery in another facility, will also need to be familiar and compliant with them.  Dr. Munsey reviewed some of the steps involved, and gave the web site address for JCAHO.  From there you can click on the "Universal Protocol" link, which will take you to a page offering three documents (in Adobe PDF format) about this new protocol, as well as patient information brochures and posters that can be downloaded or ordered by calling the toll-free phone number given on the page. 

Thanks to Dr. Munsey for making us aware of these new policies and also this helpful resource.  I'll be checking back often to this JCAHO web site:  http://www.jcaho.org/

  ~ Gayle

From:  Debra K. Latta, DPM
re:      Podiatric Assisting Books  (Volume 74)

Gayle,

Podiatric Medical Assisting by Levy and Thompson is still available at Amazon.com.  The book is out of print but they have limited availability.  I believe that you can purchase this book used as well.  Cost of the book is around $60.

Thanks,
Deb

Debra K. Latta, DPM
Columbus, OH

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From:  Sandra Lohrentz, PMAC
re:       Podiatric Assisting Books  (Volume 74)

Reply to Monica Thomas:

There are two very good books available from the ASPMA that can be used for training in Podiatric Medical Assisting.  The Comprehensive Guide to Podiatric Medical Assisting is a rewrite of the old Podiatric Assisting book by Donick.  When Dr. Donick retired, he turned the copyright of his book over to ASPMA.  A committee updated and rewrote some portions of the book and it is now for sale.

Another good book for the Administrative Training is Saunders Textbook of Medical Office Management.

Either or both of these books are available from Joan Gordon, PMAC, Qualifying and Examining Chairman of ASPMA. Joan can be reach at jgordon@cub.kcnet.org or by phone at 570-726-3215.  The forms for ordering these books can also be downloaded from the ASPMA website which is aspma.org.

Sandra Lohrentz, PMAC
Cicero, IL


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"Always do right. This will gratify some people and astonish the rest."  -  Mark Twain

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Opening Available for experienced "back office assistant who can multi-task".  Interviewing now for position to start on May 10, 2004, in Northgate area of Seattle.

Call Rex Nilson, DPM
(206) 525-0306

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

This is another in the series of “Mini-Gems”, taken from the extensive DME and IOD writings by the late Rich Levin, DPM.   Thanks to Dr. Ornstein for making them available for us to share with you.


Follow Up Visits: It is important to stress to patients that the orthotics alone cannot treat all their foot maladies, but they require periodic follow up exams to assure optimum function of their orthotic devices. I use the analogy of prescription eye-wear that requires eye examination at regular intervals to disclose any changes in their vision, [similar to] the need for regular follow up foot examinations to detect any changes in the biomechanics of their feet, which may relate to changes to their orthotics. I have my patients who have been dispensed orthotics return at 3 weeks, 2 months, 6 months and 1 year intervals. My office will also perform a 2-year follow up recall, from our billing software program, to all orthotic patients. In the letter sent to them we urge them to make an appointment to see if their orthotics need any adjustment or new top covers. I have been pleasantly surprised by the numbers of patients, who have not been seen in 2 years plus, who respond to the re-call letter and want to have new devices made.


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


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"I've learned.... That to ignore the facts does not change the facts".  -  Andy Rooney

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The Question:

Hi Gayle,
I am returning to practice after a 6 year absence.  I am absolutely mystified as to get a handle on correct coding.  Can you recommend a way to get up to speed quickly on the myriad of modifiers and codes we need to know?  Thanks for your great work!

Dr. Mike Prado

The Answer:

Scott Schroeder, DPM:

I would recommend you spend some time with a local Podiatrist's billing person.  It is going to be very important for a practitioner to understand how to code correctly (not just the office staff!).  It will eliminate much frustration for a practice and speed up payments.  McVey has coding seminars around the country.  I know Dr. Ward has spoken for them in the past and it would be great finding one of the seminars that is put on by a Podiatrist.  Codingline is another source of great information.  To get up to speed the fastest I would first visit a local Podiatrist's office and meet with their staff.

The Question:

Question.  I am still learning the electronic claims billing and would like to know how to code for hammertoes.  Two were done on one foot and one on the other.  Thankyou.
 
Debbie McGovern
David McGovern D.P.M.
 
The Answers:

Rick Horsman, DPM:

Each toe operated is separately billable, but you must indicate to the insurance plan that they are indeed separate. This is done via digit-specific T modifiers:
 
T1 for the left 2nd
T2 left 3rd
T3 for left 4th
T4 for left 5th
 
T6 for right 2nd
T7 for right 3rd
T8 for right 4th
T9 for right 5th
 
So, if the doctor operated upon the left 2nd and 3rd, and the right 3rd and 5th, coding would be:
 
28285-T1
28285-T2
28285-T7
28285-T9
 

Scott Schroeder, DPM:

In billing hammertoes the T modifiers should be used to indicate which toe has been operated on.  TA= the left hallux, T1=2nd left, T2=3rd left, T3=4th left, T4=5th left T5=Right hallux, T6= 2nd right, T7=3rd right, T8=4th right and T9 5th right.
 
If you were billing the second and third left toes and the fourth right one ideally you should be able to bill 28285-T1, 28285-T2, and 28285-T8 with your ICD-9 code being 735.4 for a hammertoe.  Unfortunately, some insurance companies still want the -59 modifier on the second and third procedures, so you would bill 28285-T2, 28285-T3-59, and 28285-T8-59.  This is the way we do it in our office and we have had very few problems.


Coding Questions and answers will continue to be posted on the FootZine web site on this page: http://www.footzine.com/FZ_C.htm

Thanks again to Drs. Horsman and Schroeder for providing the answers to your coding questions.  I always look forward to getting your letters and sharing them with the rest of the FootZine readers.

 ~ Gayle

Copyright 2004 Gayle S. Johnson.  All Rights Reserved.
DISCLAIMER: Acceptance and publication of any letter, article, news item or advertisement does not necessarily constitute or imply approval or endorsement by myself of the product, idea, or content therein. I reserve the right to edit or to not publish any material received. Any letters published are the property of FootZine. Any health- or legal- and financial- related information is for educational purposes only and should not be construed as medical, legal or financial advice, or a substitute for the advice of a healthcare professional, attorney, financial advisor or any other consultant or professional. Information pertaining to legal matters should not perceived as legal advice, nor should discussion about such issues as Medicare, coding, and billing be considered as definitive. All content is presented as being only the opinions of the contributors and is for educational purposes only.

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