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FootZine,
Volume 90 |
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I spent most of Saturday at the
Washington State Podiatric Medical Assistants Fall
Seminar. This day-long program is an annual
event which is free to our members. WSPMAA's
Vice President, Jamie Ancich, put together a varied
program with speakers covering Peripheral Vascular
Disease; Anatomy of the Foot and Ankle; many aspects
of Dementia and how best to communicate with our
patients who have some form of dementia; Patient
Transferring Techniques; and an "Open
Forum" in which all present exchanged ideas and
information that have been helpful in our work.
We also had a casting and strapping workshop with
all present participating. Many of these topics are included in seminars for podiatric assistants every year around the country. Even so, I found that every presenter today had something new for me - new information, a new technique, a new perspective or understanding. Thanks to those who took the time to prepare their slides and handouts and presentations, giving up part of their Saturday to share their expertise with us. And thanks also to the members who came to listen and learn, thus improving their personal understanding and bringing greater benefit to their employers and their patients. ~ Gayle *_* "All we know is still infinitely less than all that remains unknown." - William Harvey (1578-1657), English Physician *_*
*_* Letters
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From: Mark A. Dickensre: Job Descriptions for Podiatric Medical Offices (Volume 86) Gayle, The final product is almost done and will be presented at the ASPE meeting in October which is the week prior to the AAPPM/MPMA meeting in the second week of October. It’s a wonderful piece of work. The Michigan Dental Association spent over $100,000 putting it together. Mark A. Dickens Executive Director, Michigan Podiatric Medical Association 1003 North Washington Lansing, MI 48906-4840 517.484.4593 FAX 517.484.1930 mdickens@mpma.org *_* Editor's Note *_* In his August letter to FootZine, Mr. Dickens described a Human Resources Manual that MPMA and the Michigan Dental Association were compiling, and asked for input that would help make it podiatry-specific. *_* *_* *_* From: Ingrid Aderhold (Edited) re: Product Search (Volumes 88 & 89) Thanks to Debbie for the reply. I tried Jan-L. The lady I spoke with told me that their bags are only for their units (the bags with the clamp attachment setup).......[the bags for Ingrid's unit have elastic tops, as her unit does not have the groove for the clamp] ...... Still looking. Ingrid *_* Editor's Note *_* This made us curious and started us searching the web for something that might work, even thought we didn't know what Ingrid's unit looked like. Among the sites we explored, we found that Universal Footcare Products has some other dust extractors that use bags, although they didn't show pictures of the bags ("BAGS FOR DV-1 VACUUM -25- 14434"). I sent Ingrid this link to the Universal web site: http://www.universalfootcare.com/subcatmfgprod.asp?0=206&1=208&2=-1&6=3 She wrote back: Good Job! The picture at the Universal site is our exact MTI unit. I think we have a match. Thanks a bunch. Ingrid *_* "In the end we retain from our studies only that which we practically apply." - Johann Wolfgang Von Goethe *_*
*_* FootZine
Feeture Article
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The Question:Crystal-Clear Coding Q & A by Rick Horsman, DPM, and Scott Schroeder, DPM I am looking for a diagnosis code for Piezogenic Papule - Thank you for your help. Deb Siverhus The Answer: A piezogenic papule is a (typically asymptomatic) herniation of fat through the deep fascia. It produces non-tender lumps on the marginal sides of the heel, typically only evident with weightbearing. They usually only hurt if they extrude a fragment of nerve with them. There does not appear to be any specific diagnosis code. If symptomatic, I would suggest: ICD-9 782.9 Skin Lesion, Irritated Rick Horsman, DPM Olympia, WA The Question: Is there a code for the refurbishment of orthotics(L3010)? Thank You, Cindy The Answer: It's not stated if she's looking for a diagnosis code, or a procedural code. I typically use an E/M code, based upon time, materials, and complexity. Many would consider this a non-covered service, and code accordingly. Rick Horsman, DPM The Question: Thanks so much for getting back to us so quickly, I have another case I would like an opinion on. Here is a portion of our dictation: Removed dressings and Iodoform packing and flushed with sterile saline. Applied saline soaked Iodoform into the wound, although did not fully fill up the wound as will let it try to begin to granulate in, but keep the skin incision open for drainage. Applied dry sterile dressing after it was repacked. Pt is to continue with non-weight-bearing, although she may put some weight on the heel. Fit and dispensed removable cast to allow more protection and some ambulation, particularly on the heel. Reevaluate in 4 days. Patient is 12 days post-op for right foot abscess. We are seeing her about every 3-4 days for this sterile dressing change. How would you bill this, some say an office visit with modifier. I would like your opinion. This is taking several minutes and does not qualify under an E&M code, the patient is not in the global period for an I&D. Thanks, Deb The Answer: (A Compilation of two emails from Dr. Horsman) This is a longer and more complex problem If the patient is clearly out of the global period...I don't see anything here other than an E/M.O other services are billable... at least, not based upon this documentation If it IS within the global, and the patient is Medicare, it's all free. I will base my answer on Medicare-- other carriers may have different policies. First...The primary assumption is that this patient is NOT subject to a global period. Assuming 12 days post op, and how the original services were billed, the patient is either just out of the global, or still in it. (They mention leaving skin incision open for drainage...that sounds like a 90 day global to me.) Removal of dressing, packing, irrigation, and repacking. That is NOT wound debridement as billable by a physician. It's basically a dressing change. Depending upon medical necessity, quality of documentation, etc., you could bill it as an E/M (CPT 9.9212 or 99213.). you would have trouble supporting billing for this- especially every 3-4 days For Medicare, the removable brace would likely also be a non-covered item (fractures only). I would look VERY closely at the global period, and seriously consider (if appropriate and medically necessary) sharp debridement of the wound. Hope that clarifies (don't shoot the messenger). Rick Horsman, DPM Crystal-Clear Coding tips are posted on the FootZine web site on this page: http://www.footzine.com/FZ_C.htm
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Patients often ask "How
long have you been doing this work?" or
"Don't you get tired of looking at feet every
day?" Whether done in small groups
face-to-face, or among dozens or even hundreds of
people in a larger forum such as this, the learning
opportunities and exchange of information that we
participate in keep our livelihood interesting and
fresh. I look forward to including your
questions and solutions in future issues of FootZine!~ Gayle
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Copyright
2004 Gayle S. Johnson. All Rights Reserved. or click
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