FootZine Page 2

Many of you have noticed that FootZine's publication has been infrequent in the last year; in fact, there have been only five issues since last April. I have always felt that my role in publishing FootZine is to bring good information to the podiatric office community, and to prompt positive interaction and exchange of ideas between our subscribers. That would not usually include sharing the negatives or bad news that we all have to deal with. I do feel that I owe you all an explanation for my silence over the past six months, however.

Last November, my husband Michael passed away suddenly, the result of a heart condition that we did not know he had. We were days away from moving our home to be closer to my work, and in fact had already packed and moved many of our belongings. Thanks to my wonderful employers, friends and family members, I was still able to complete my move, but could not manage to send out the issue that I had just begun. Talking about it even with close friends and family has been very difficult, and to write about it publicly was just not possible.

Michael preferred staying in the background, but I could not have done all that you have seen as a part of FootZine without his help. He created the web site, the graphics and special effects, made sure that everything worked, and was my proof-reader. He found resources for new quotes and was usually the one who found the links to other interesting web sites that we shared with you. When it was time to broadcast a new issue, we each had portions of the subscriber list to send out, and when they were done, he was the one updating the web site. The photo pages, even photos submitted by others, benefited from his years as a photojournalist. In addition to his artistic side, he was also very logical and organized. The technical glitches that are part of the internet publishing territory are a big frustration to me, but to Michael were just challenges to overcome. I was very happy to leave those problems in his hands, and now I find myself at a loss for some of those answers.

When he was injured last April, Michael made me promise then that I would continue to publish FootZine. Of course I did promise, but I assured him then that we would do it together, as we did for a few more issues. It will be a slower process now, but I do plan for FootZine to continue. Michael wouldn't have it any other way - and really, neither would I.

~ Gayle

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"I am always doing things that I cannot do; that's how I get to do them." - Pablo Picasso

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*_* Letters *_*

From: Joan Cox
re:      Three Years of FootZine

Hi Gayle,

I enjoy reading your "FootZine" newsletter & I am so happy to see it grow & share information with so many people whether doctors, assistants in front or back office, and no certification required to receive answers to questions or learn of upcoming events as well as job opportunities.

I am so very proud to call you "Friend" & thankful of the many hours you have put in to make it a success & the tips you give to help people including myself over the years when your own life was full. I am glad you took the plunge... I KNEW you could do it!!

Thank You,

Joan

*_*     *_*     *_*

From: Janet Grace, PMAC
re:     Training Resources (Volume 109)

For Sam DeNunzio's question, ASPMA has developed an excellent "Coding Course" covering all the basics of ICD-9 and CPT coding including CCI edits and modifiers. Watch the ASPMA website -- www.aspma.org - for information. The course is available on CD for easy downloading which gives you an excellent manual to refer to.

Janet Grace, PMAC

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From: Rick E. Sevier, C. Ped, ABC ROPA
re:     Training Resources (Volume 109)

Sam,

CFS Allied Health Education has several CD/DVD's that are targeted
towards Pedorthists that may also be of use to Assistants. You can check
them out at www.LearnPedorthics.com .

Rick E. Sevier, C. Ped, ABC ROPA

*_*     *_*     *_*

From: Joan Cox
re:     Training Resources (Volume 109)

I would like to respond to a note from Sam De Nunzio re: Training Resourses in Volume 109
of FootZine.

I have a training manual & video, "Basic X-Ray Techniques for Podiatry".
The manual is a fully illustrated, 50 page spiral bound book with easy to understand instructions on taking x-rays in a podiatry office.
It has pictures of regular weight bearing partial & non-weight bearing foot & ankle views and other special views.

The manual is in outline-type format to help in memorizing each step to eliminate common errors & standardize podiatry x-rays for comparison studies.
The video is about 1 hour and shows the instructions of each view in high lighted detail.

For more information visit my web site: http://www.ulti-media.com/foot/joan/foot_index.htm

or you may e-mail me: joanie_cox@msn.com

Joan Cox
Anacortes, WA

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From: Michelle Bradshaw, PMAC
re:      Office Dispensing

Gayle,

We are looking to set up a display cabinet and sale more products in our office. I'm wondering if you have any suggestions on the best display cabinets. Looking at mostly digital pads, hammertoe splints?

Michelle Bradshaw, PMAC

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From: Loretta Allen
re:      Appointment Template

Gayle ,

I also am looking for an Appointment template to help me schedule patients more efficiently.   We use Office Hours by Medisoft. Would anyone know where I could find one?

Thanks,

Loretta

*_* Editor's Note: The coding question from Loretta's letter is answered in the Coding Q & A, below. ~ Gayle *_*

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From: Renee
re:      Ultrasound Imaging

Hello,

My employer just came back from a seminar. He and I are interested with anyone that has experience with Ultrasound Imaging.

He would possibly like to purchase one. Does anyone use one and if so can you give me some feedback on this. Also, since it is an expensive investment is the reimbursement back from the insurance company worth it?

Thank you,

Renee
Foot Health Center, LLC
Cheshire, CT

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From: Kathleen
re:      Podiatric Medical Assistant

Dear Gayle,

We are considering hiring a RN to train as a podiatric medical assistant. I understand that it is up to our state association to determine what the assistant can and cannot do to assist the doctor. My discussion with the state association led me to believe that there are a lot of grey areas. I am wondering how other offices utilize this person and what we can do to protect the doctor and assistant's liability if the state association does not have a firm stand on this particular position. For instance, can this person change dressings, dispense orthotics, remove sutures, debride and/or grind nails, and if so how does the office bill for these?

Any input would be appreciated!

Kathleen
Arkansas

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*_* Editor's Note: The two following messages include notes between Gail Bennett and Linda Windley of Noridian (Medicare), as well as Gail's notes to the readers. References to specific patients have been removed. As a reminder, Linda's responses are directed to those who submit their Medicare claims to Noridian.   ~ Gayle *_*

From: Gail Bennett
re:      Denied Claims

As most of you know if you have time to read Medicare's policies, Medicare in their infinite wisdom decided that 11305-11307 is the wrong code to use for painful lesions. Now remember that in March 2004 at our insurance seminar we were told to use it not 11040 which is strictly for ulcers. (If you read the policy it does state that), so as of December we are suppose to us the 11055-11057 codes for painful as well as callus with systemic. If you use pain as a diagnosis you do not need a Q modifier. Now if you do use a systemic such as 440.20 then yes you do need the Q modifier. If you use 357.2 (diabetic neuropathy) you do not need the Q modifier.

For those of us who have gone to the new way of billing painful lesions we have realized that Medicare is denying those claims (Big surprise HUH), just this morning I got a message from Linda Windley with Medicare:

"Just a follow-up on the claims that denied, based on the revised policies, that came out in Dec. You don't have to send me any claims, because we will do a mass adjustment, soon.

Thank You,
Linda Windley, CPC
AK/OR/WA Education Team Leader
Noridian Administrative Services
Phone-253 437 5414
Fax- 253 437 5300
E-mail- Linda.Windley@Noridian.Com"

Feel free to contact me if you have any questions or call Linda herself she is very helpful. I usually email her and she is johnny on the spot to get back to me.

Gail L. Bennett
Spokane, WA
Gailbpmac@aol.com

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From: Gail Bennett
re:      Pain Codes

Help!
Hi Linda, can you possibly help me. Date of service: 02-22-2006 11056 q8 with 700 440.20 diagnosis. It denied. I used the 25 on the 99212 for the 707.15 E&M. Why did this one deny? How much longer for the pain code 11055-11057 to be allowed? It's getting well into March and it went into effect in December right? That's a long time to go without pay.

Thank you.
Gail Bennett

"Regarding the pain codes. I received information yesterday that the edits are now complete, so new claims should go through correctly. Let me know if they don't . We are requesting a Mass adjustment, so you don't need to resubmit. I don't know when they will start the adjustments, because they have to finish up the fee schedule payments.

Thank You,
Linda Windley, CPC
AK/ OR/WA Education Team Leader
Noridian Administrative Services"

*_* Networking *_*

Position Available

Hi Gayle,

An ex-employer of mine in Pittsburgh, PA is in need of a podiatric biller. Can you put the word out that if anyone is interested they can call Trish, Dr. Conner or Dr. O'Donnell at (412) 367-8404 for more information.

Thanks much,

Denese Foltz

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I have been in Medical Billing for 15 years I have worked in Physicians
offices, Hospitals, Pharmacies. I have experience with Internal Medicine, Family Practice, Podiatrists, Cardio, Nursing Homes, Medical Equipment Billing. I have Medisoft,
Medware,Physician Power, Medical Manager, as well as other software experience.
I am also a Certified Coder, Collection Specialist.

I have been wanting to start a business at home and work with a few
companies or Physicians to keep their expenses down, please forward any
information you may have to enlighten this opportunity .

The physicians I worked with did alot in the office - and of course the experience I have had over 18 years I have kept up with all code changes and Compliance. Yes I would like to post an ad.

Thank you,

Janice Gobble

*_* Editor's Note: The notice above is a compilation of three separate emails.   ~ Gayle *_*

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

*_* FootZine Feeture Article *_*

Crystal-Clear Coding Q & A
by Rick Horsman, DPM, and Scott Schroeder, DPM

The First Question:

Gayle,

I have a patient that got DM shoes months ago had to have surgery and needs a different pair of shoes. Will Medicare pay for another pair under the 1-year rule if I send in a medical necessity letter with the claim?

Thanks,
Loretta

The First Answer:

Under DMERC guidelines the patient is eligible for a new pair of Diabetic shoes and three pairs of multi-density molded insoles every "calendar" year meaning from January to December. The patient can receive a new pair at the beginning 2006 even if she/he received a pair in October of 2005. To my knowledge this rule is very strict. I do not know if you will be able to bypass this or not. My recommendation is to contact by phone the provider relations representative with your region's DMERC carrier and ask them directly if they will allow this and if so what hoops you have to jump through. I would first recommend checking to see if they received the full three pairs of multi-density insoles they are entitled to for this year. If not, then a pair of custom molded insoles can be made from molds of their feet after the surgery but they would have to use their old shoes until the beginning of the year. One lab that does these custom diabetic insoles is Safestep. They can be reached at (203) 874-7722 or on the web at www.safestep.net. These are not functional orthotic devices, they are multi-density diabetic type insoles molded to the feet. Functional foot orthotic devices (polypropylene, graphite, etc.) are not covered by Medicare. If DMERC informs you that shoes and insoles after surgery are not covered and they have already received three pairs of insoles for the year then the patient is going to be responsible for the new pair of shoes and insoles.

Scott Schroeder, DPM
Wenatchee, Washington

The Second Question:

Hi! What is the proper code for neuroma injection?

Dr. Rodriguez

The Second Answer:

I have my personal opinion that the correct coding should be CPT 64550- injection of a peripheral nerve. BUT; it's not as simple as that--in Noridian states

Noridian Medicare is currently arguing that CPT 64450 is NOT the correct code to use for injecting a neuroma. Providers are currently directed to bill this as CPT 28899 (unlisted foot service). This is true for Medicare only, in those states administered by Noridian Medicare.

In all other states, and for all other insurers, I would bill it as CPT 64450. Don't forget to also bill for the therapeutic supply (i.e. steroid) with the appropriate HCPCS J code.

Since there seems to be so much confusion with some carriers in this matter, we are petitioning to get a new CPT code to reflect injections of neuromas, and one for tarsal tunnel. In the meantime, we're stuck with this. Such is the result of poorly-drafted CPT code terminology

Rick Horsman, DPM
Olympia, WA

The Third Question:

Dear Gayle,

I have been billing medicare for the ICD-9 code 701.1 (acquired keratodema) along with the CPT code 11040. We were getting paid for this up until about a week ago, now they are not paying. Has there been a change in the way I should be billing for this?

Thank you,

Susan Petrizzo

The Third Answer:

In the state of Washington we can bill 701.1 with a secondary diagnosis of pain - 729.5 and get paid for 11040 (debridement of a painful callous). This is what the current guidelines read but they are in the process of trying to change them. We have had problems where they stopped paying for this in the past and a phone call to the local Medicare provider representative informing them of the problem has taken care of it. Usually there is a glitch in the computer system or Medicare has a new reviewer who does not understand the policy and has to be set straight.

Scott Schroeder, DPM

*_* Editor's Note: There are many more coding questions and answers, enough for a separate issue. Those will go out in Volume 111 as soon as the publishing of this volume is finished. ~ Gayle *_*

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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''Life is once, forever.'' - Henri Cartier-Bresson

*_*

Thank you all for your patience over the recent months, particularly those who have been waiting for answers. And special thanks to Dr. Horsman and Dr. Schroeder, who have continued to send responses to the coding questions even though they didn't know when they would finally be shared with the FootZine subscribers.

Please do continue to participate with letters, either questions or comments. We would really like that.

~ Gayle