Another interesting web site was brought to my attention recently.  The site is called "Virtual Hospital" and is a digital health sciences library created by The University of Iowa.  They have compiled an "Atlas of Human Anatomy", and have very detailed drawings of the bones, the musculature and the nerves.  The section at the upper right of the page, Plate 6,  has the bones of the lower limb.  A click on that box brings up an enlarged set of illustrations of the femur, tibia, fibula, and 4 different views of the foot.  A click on one of the foot images magnifies that view and identifies the bones from that particular angle.  Other "plates" show enlarged views of the lower extremity nerves and muscles.  This could be a great study aid for students or assistants.  Have a look at:
http://www.vh.org/adult/provider/anatomy/atlasofanatomy/

  ~ Gayle

*_*  Editor's Note  *_*

The following was received in March, and I regret to say that I overlooked it in the emails that arrived that day.  I just discovered it in my email folders and think it is still probably very much wanted information.  My apologies to Dr. Block and to those who use Kidde systems for overlooking this.  ~ Gayle

From:  Barry Block, DPM, JD
re:      Kidde Refill Cannisters  (Volume 69)

Regarding the Kidde refills. A source is: Medical Products
Resource 800/524-5194 Ext 129;  952/882-1289.
E-Zine subscribers can find resource material such as this by typing
the name of the product in the search engine at www.podiatrym.com.

Barry H. Block, DPM, JD
Editor, PM News

*_*     *_*     *_*

From:  Cathi Harding
re:      SAS Shoemakers

Hi there,

I hope you can help me. I’m trying to get hold of Sas shoemakers (Siesta Valley, Texas) but can’t seem to find a web-site for them. Do you know if they have such a thing or even just an email address and contact would be helpful.

Thank you,

Cathi Harding

*_*  Editor's Reply  *_*

Hi Cathi,

Thanks for writing.  SAS Shoemakers are actually based in San Antonio, Texas, so that may have affected your search for them.  (There is a ranch at Siesta Valley, however.)

I inquired at the San Antonio offices and was told that SAS does not have a web site, but you can email Bill Armwood in their Marketing department:
barmwood@sas-shoes.net

Bill will be sure that your inquiry gets to the right person to give you the help you need.

Thanks again for writing, and let me know if I can help you further.

~ Gayle

The Question:

We see several diabetic patients twice a year for neuropathy but with no other symptoms. What should we code this? Any suggestions. Thanks

Linda Casella
Dr. James Dolan
Exeter, NH

The Answer:

The answer to the question is not as self-evident as it might seem...and depends upon the reason for the patient's presentation, and their underlying health insurer.
 
If the patient is non-Medicare, and presents without any symptoms (ulceration, infection, unrecognized injury, painful dyesesthesia, poor balance and stability...i.e. there's a LOT of latitude here), some payers would consider this screening care, and a non-covered service. Correspondingly, the documentation must be quite complete so as to support medical necessity.
 
In my own experience, such nebulous presentations are the exception, not the rule. I would bill it as an appropriate level E/M service.
 
If the patient is Medicare, the same issue applies... with the added complexity of the LOPS provisions. In my own opinion, the level of care provided in accordance with LOPS is a lesser standard of care than my patients are expected to receive, and I would avoid its use.
 
With an understanding regarding appropriate reasons for patient presentation, I would carefully document and support the appropriate E/M. Remember, neuropathic patients may not "hurt", but have abundant reason and medical necessity for evaluation, medical management, and education. Particularly in the presence of significant neuropathy, the patient may be in the worst position to determine when to seek medical care...But it will all fall to the quality of your medical documentation.
 
Rick Horsman DPM


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



*_*

"Change is not made without inconvenience, even from worse to better."  -  Richard Hooker, British theologian (1554-1600)

*_*

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.

Logo: Many labs now offer the ability to print a customized logo on the top covers of the orthotics you order. At first I thought this was a silly idea, as I did not want my patients stepping on my name and phone number in their shoes. I did not realize the power of the satisfied patient! Many of the patients that come to my office, referred by previous patients, have told me that they first saw my name and phone number when the other person took off their shoe to show them their orthotics. I would urge each of you to speak with the orthotic lab that you are currently using to add a simple imprint of your name and telephone number to the top covers of your orthotics.


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

This Memorial Day weekend signals not only that holiday of remembrance, but also the "graduation season" and in many areas, the beginning of summer vacation for those with school children.   Add in the "wedding season" and all that goes with it, and we have a really  busy time!   That often means there is less time for email, but if you take the time to write it, we'll be sure to share it.

  ~ 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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