Logging question

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txlioness

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Anyone know how to correctly log a Keller bunionectomy in podiatry residency resource (PRR)?

Thanks!
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Ankle Breaker said:
I'd log it as a first ray procedure, under hallux valgus category, and specify it as an MPJ arthroplasty
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Before logging the Keller arthroplasty procedure as MPJ arthroplasty, you need to determine what deformity are you correcting with the Keller arthroplasty. If you are doing the Keller for bunion correction, you would log it under the hallux valgus category, as suggested by Ankle Breaker. If you are doing the Keller for hallux rigidus correction, you wold log it under the hallux rigidus category. MPJ arthroplasty procedure is listed under those two categories.
 
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How do you guys log closed reduction with application of external fixator for unstable trimal? I don't know if I'm just blind but I couldn't find closed reduction of ankle fracture anywhere and I'm getting flagged for logging it under "other non-elective osseous rear foot procedure"
 
janV88 said:
How do you guys log closed reduction with application of external fixator for unstable trimal? I don't know if I'm just blind but I couldn't find closed reduction of ankle fracture anywhere and I'm getting flagged for logging it under "other non-elective osseous rear foot procedure"
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You're not blind. Closed reductions aren't loggable. It doesn't make a difference if you put an ex-fix on. You log for the procedure you do, not the fixation usually. If you did an open reduction and put an ex-fix on you would just log open repair of adult ankle fracture (notice that it doesn't say ORIF). Closed reducing a fracture and holding it out to length with an ex-fix isn't loggable, IMO.
 
ldsrmdude said:
You're not blind. Closed reductions aren't loggable. It doesn't make a difference if you put an ex-fix on. You log for the procedure you do, not the fixation usually. If you did an open reduction and put an ex-fix on you would just log open repair of adult ankle fracture (notice that it doesn't say ORIF). Closed reducing a fracture and holding it out to length with an ex-fix isn't loggable, IMO.
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I see, thanks.

Now what about ulcer sub 5th met head with suspected osteo where a debridement of the ulcer and 5th met head resection was performed, incision for met head resection was separate from wound. Would you log that as "management of bone infection" or "met head resection"? What about the debridement procedure? The auto audit comes up if you log either bone procedure + debridement.
 
janV88 said:
I see, thanks.

Now what about ulcer sub 5th met head with suspected osteo where a debridement of the ulcer and 5th met head resection was performed, incision for met head resection was separate from wound. Would you log that as "management of bone infection" or "met head resection"? What about the debridement procedure? The auto audit comes up if you log either bone procedure + debridement.
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You can only log one of those procedures. I would probably log the met head resection, but you could probably log the management of bone or joint infection if you wanted. But you can only choose one. There is a paper out there that CPME put out with some clarifications on logging, I'll see if I can find it and post the link to it, it clarifies several things.
 
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AttackNME said:
How do you guys log a Weil? I have been doing it both as "lesser MPJ arthroplasty" and "central metatarsal osteotomy" and haven't been ding'd for those yet...
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Are you saying you have been logging a Weil as 2 procedures or that you have been alternating between the two and logging them both at different times? If you've been logging both for the same procedure, then that isn't correct, IMO. I've always logged them as central metatarsal osteotomy. I don't think a Weil really qualifies as a lesser MPJ arthroplasty. I would reserve that for a true MPJ arthroplasty, with an implant for example. In any case, if you're doing, for example, an isolated Weil of the second MPJ, it would be wrong to log it as 2 procedures, ie both a central metatarsal osteotomy and lesser MPJ arthroplasty.
 
There is a met head resection (single or multiple) code for met head resection. It shouldn't be logged as arthroplasty
 
And I think a Weil is a central meatarsal osteomyelitis, end of story. No other way to log. A Keller would be an arthroplasty. Isn't there an MPJ implant option too? No reason for it to be an arthroplasty if so
 
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air bud said:
And I think a Weil is a central meatarsal osteomyelitis, end of story. No other way to log. A Keller would be an arthroplasty. Isn't there an MPJ implant option too? No reason for it to be an arthroplasty if so
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Actually just checked. Yes there is an option for lesser MPJ implant. So my example doesn't really work. And while a Keller is an arthroplasty, I'm assuming AttackNME was logging it as a lesser MPJ arthroplasty. But I agree, a Weil should be logged as a central metatarsal osteotomy.
 
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Thanks for the comments, yea I meant to say that I've been alternating it and haven't gotten dinged for either. At first I thought central metatarsal osteotomy meant a midshaft osteotomy of a metatarsal (i.e. shortening of a 2nd metatarsal with dorsal plate and removal of a small cylindrical segment of bone from the midshaft), but then thought they might mean central as in metatarsals 2-4. Haven't found anything on the website to clarify.. mreh.
 
AttackNME said:
Thanks for the comments, yea I meant to say that I've been alternating it and haven't gotten dinged for either. At first I thought central metatarsal osteotomy meant a midshaft osteotomy of a metatarsal (i.e. shortening of a 2nd metatarsal with dorsal plate and removal of a small cylindrical segment of bone from the midshaft), but then thought they might mean central as in metatarsals 2-4. Haven't found anything on the website to clarify.. mreh.
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Yeah, central metatarsal osteotomy in this case means mets 2-4, in other words not the first ray which has it's own category and not 5th mets, which are logged differently.
 
AttackNME said:
hate this logging stuff, esp the biomechanics requirements. doesn't make sense
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For biomechanics, dictate a brief gait exam and BM exam into the op report, kill 2 birds with one stone.
 
DJ Quik said:
For biomechanics, dictate a brief gait exam and BM exam into the op report, kill 2 birds with one stone.
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I've heard of people doing this, and I think I've done it once, but making people get up and walk in the pre-op area just so you can log a biomechanical exam never made much sense to me. I guess if you don't get much clinical exposure, it's what you might have to do.
 
ldsrmdude said:
I've heard of people doing this, and I think I've done it once, but making people get up and walk in the pre-op area just so you can log a biomechanical exam never made much sense to me. I guess if you don't get much clinical exposure, it's what you might have to do.
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Oh I'm sure most people who do that aren't actually performing a WB biomechanical exam, let alone gait analysis...

But the biomechanical exam requirement is dumb anyways so out of principles I support people who fudge that, 100%

I'm also sure there are programs where they are logging things like closed reductions under "other" purposefully to get RF numbers. That's bush league but even that doesn't matter as the board cert process will weed out most of them. The number of people who don't get RF certified after being qualified is pretty impressive.
 
Ankle Breaker said:
I don't understand how you aren't able to log enough biomechanical cases. Just bang out a quick BM exam with some of your clinic pts. Include the exam in your clinic progress note. Done deal.

I've never heard of any resident logging closed reductions of fractures as RF cases but if they are able to log these experiences as "other" surgical cases to achieve their RF numbers then we need to question the entire logging system in general and the individuals responsible for auditing programs. I bet programs who have a hard time meeting their RF numbers get a free pass, for the sake of keeping programs open, where programs that have an abundance of cases are the ones who get audited.
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I don't think its about not having the opportunity to log BM cases, but more "what's the easiest way to meet this pointless requirement?" IMO dictating a BM exam on an operative patient sounds easier even than filling out a dot phrase on a clinic patient with whatever EMR system you use. It's probably a lot quicker if you don't have the ability to use a template on your clinic notes. So I'm sure people who are dictating those aren't actually doing the exam just like I'm not actually doing a full BM exam on some random bunion patient when I put in my dot phrase and log it.

I haven't necessarily heard of residents logging closed reductions like JanV mistakenly did, but if you don't think it's happening somewhere I think you are naive/mistaken. I know there are residents who inappropriately log cases as "1st assist" regularly. Sad that people feel the need to or have to (to get numbers) do this, but it is what it is. Luckily board qual/cert is king in terms of privileges and ultimately will keep people who don't have the experience from doing procedures they shouldn't.
 
The 1st/2nd assist system replaced the A/B/C system for 2 reasons. 1. Residency shortage demanded more spots which for a lot of programs was not feasible with the old system. Assuming people were logging legitimately. 2. The A/B/C system was too subjective. Nothing stopped programs from fudging their numbers and logging all cases as C's.

IMO the current minimum RF numbers are way too low. You need like 60 or so 1st ray procedures but only 50 RF?? That makes a lot of sense... That's 1.5 RF procedures per month for 3yrs or 1 RF procedure per week for 1yr. It seems like the powers that be did this on purpose to say that 100% of podiatrists are rearfoot trained. If you're only hitting the minimum then you shouldn't even be touching the rearfoot.
 
Ankle Breaker said:
Define inappropriate.

There are very few programs out there that always let their residents do 100% of the cases all the time.

We've both clerked at a very well known program where the surgery volume was high but none of the residents ever did a case skin to skin. Their graduates still end up pretty damn good surgeons and hold leadership roles in the profession.

If you want to be a purest then the profession should have never gotten rid of the A/B/C format of logging. By far the worst decision the profession has made in terms of maintaining "quality" training within the profession.
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Easy, resident is the only other person at the table besides the attending. They hold sticks for an hour. Maybe they make the incision, maybe they close the entire surgical wound, maybe they do both. No matter how you slice it, that resident did NOT meet 1st assist requirements of CPME 320. Being the 1st assistant at the table does not = logging a case as 1st assist. Also, it's one thing to inappropriately log procedures yet have well over a thousand cases and another to log inappropriately just to meet MAVs. Like I said though, it doesn't really matter because those who didn't get the training are very unlikely to get the board certification. Heck, many who do get the training still don't get the certification due to the limitations of their practice.

From CPME:
"If a resident is the sole resident on the procedure, that does not mean he/she is automatically the first assistant. If the resident is retracting, assisting, and/or performing limited portions of the procedure under direct supervision of the attending, this does not meet the definition of first assistant."

A/B/C was a much more convoluted way of doing it, but absolutely more accurate in describing true level of participation by the resident.

janV88 said:
IMO the current minimum RF numbers are way too low. You need like 60 or so 1st ray procedures but only 50 RF?? That makes a lot of sense......If you're only hitting the minimum then you shouldn't even be touching the rearfoot.
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Agreed, but we all know why its that way. Thank goodness for ABPS.
 
I have another question....tried logging a plantar plate repair (used Scorpion for repair, not that it matters) under category other soft tissue procedure and selected other soft tissue procedure not listed and got an error that said, "Other procedures may only be used if a more appropriate procedure does not exist."

So how should I be logging this? any insight would be helpful.

Thanks!

****UPDATE****
Figured it out, thanks anyway
 
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