Relevancy of PM News

[podourology]

I am... hospital suite.
Tons of PP docs do that (rent office or even buy "condo" in adjacent professional building or hospital itself).
It's more expensive and you don't get XR, but it makes marketing and visibility and comm a lot easier... and way easier and faster on surgery days.

It is really the best of both worlds (imo): support and location of the hospital without the admin junk or hassles or limits of being their employee.

Do you round on in patients? Would be convenient to drop 4-5 notes and make coffee money. XD

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[Hybrocure]

Do you round on in patients? Would be convenient to drop 4-5 notes and make coffee money. XD

If dealing with rounding is only coffee money I would rather not do it lol. That stuff is free in the doc lounge

 

[podourology]

If dealing with rounding is only coffee money I would rather not do it lol.

You should see my student loans. Everyone is getting a note. Walking down the halls listening to " I need a dollar" by aloe blacc.

 

[HardRoadPaved]

Just get https://televeresystems.com/index.php/tiger-smart-c/ ..... bill out fluoro code instead and now not a competing service! Can do blocks with it. Think of those tough joints like the MTPJ

 

[Feli]

Do you round on in patients? Would be convenient to drop 4-5 notes and make coffee money. XD

Eh, I avoid that as much as I can. I will do ER, inpt, etc... sure don't try to solicit it tho.
I will do it to help those patients and keep goodwill with ER docs or hospitalists... but I don't enjoy it, and I'm plenty busy in the office.

Imo, that's more stuff you can do early on in practice when not busy and trying to build up. It is another strength of being in/near a hospital, though... correct. It pays ok to consult (unless ER uninsured).
I suppose you could continue a lot of inpt and ER it if you enjoy it (I sure don't). I find that consults only lead to more consults when I don't want to work (early, late, weekend) or I have office patients. Try to get the ER to send fx and sprains to your office and put infected wounds on IV abx... not call you unless displaced/open fx or really rockin infection or gas. "Live like a resident" is a financial frugal motto... not a work/job ethic you want to keep long after training days. In general, chasing patients and consults is not ideal... you want them to come to you.

Basically, in PP, to the greatest extent you can, you want patients with good payers who will come to you (on your time, your sched, your location). It's just the way to have max efficiency. Let the patients come to you. Have a healthy waiting list to fill any cancels or rescheds. That is how you see Derm or ENT or any well-paid and good hours specialst run... and you should too. Jmo

 

[air bud]

[

Well. Their entire existence is based on surgery.


And surgery as a podiatrist simply does not pay well when done ethically. I get why people unbundle. We are grossly underpaid by insurances for our work, and that is the truth of it.

Every other career scales with inflation but insurances pay us less as time goes on. I don’t blame people for saying F the system.

20 years ago you got paid more for doing a bunion than you do now. How does that make any sense? It’s not because they were getting paid too much before. It’s that we are getting paid too little now

*Elective

 

[air bud]

It's still crazy the disconnect between private practice and Hospital employed. DME you're talking about DME being important to your financial success as a surgeon? It's a G*ddamn boot and it's there to heal an ulcer or protect the surgery that I did I don't give a crap what it pays or what it's cost was I just wanted to protect them when they inevitably walk on it when they're not supposed to

Edit- I don't care because I don't have a financial interest.

 

[Hybrocure]

It's still crazy the disconnect between private practice and Hospital employed. DME you're talking about DME being important to your financial success as a surgeon? It's a G*ddamn boot and it's there to heal an ulcer or protect the surgery that I did I don't give a crap what it pays or what it's cost was I just wanted to protect them when they inevitably walk on it when they're not supposed to

They should talk about this in school

 

[air bud]

They should talk about this in school

Honestly a million other things they should do in school....but yeah.

 

[Hybrocure]

Honestly a million other things they should do in school....but yeah.

I wish I read the attending Sdn board when I was a student but I was too busy studying Netters and thinking First Aid would carry me through the pod tests

 

[air bud]

I wish I read the attending Sdn board when I was a student but I was too busy studying Netters and thinking First Aid would carry me through the pod tests

No truth tellers back then. We are saving lives bros.

 

[Shiyuan]

Anyone else find it funny the same 6-8 docs are the ones posting on PMNews? Kornfeld, Roth, Warshaw, Jacobs…

Kinda like here I guess. They have their (albeit more embarassing) outlet 🤷🏻‍♂️

 

[air bud]

Anyone else find it funny the same 6-8 docs are the ones posting on PMNews? Kornfeld, Roth, Warshaw, Jacobs…

Kinda like here I guess. They have their (albeit more embarassing) outlet 🤷🏻‍♂️

Ok so which one of us is Roth...

 

[Hybrocure]

Ok so which one of us is Roth...

Whichever one of us thinks they’re never wrong

 

[NatCh]

Kinda like here I guess. They have their (albeit more embarassing) outlet 🤷🏻‍♂️

Is it though?

 

[heybrother]

Yes.

 

[air bud]

Whichever one of us thinks they’re never wrong

More specific please.

 

[Hybrocure]

More specific please.

Retrograde got that roth energy. Also cutswithfury (RIP)

 

[Adam Smasher]

Feli =Allen Jacobs, been around forever, plenty of insightful comments, takes LCR to task

LCR = LCR

Air Bud = Brett Ribotsky who used to write in more, both generally fun entertaining guys

Bored Snorlax = random students who write in

Pronation = Robert Bijak, since both of them were trolls who got banned from their platforms

Me = probably Paul Kesselman, mainly because I take biomechanics sort of seriously

 

[Adam Smasher]

Weirdy = Barry Block, 'nuf said

 

[Bored Snorlax]

Is this the SDN-PM showdown lineup? Perfect, I'm ready. And for the record, I fight dirty and will be bringing my trusty toe nail clippers.

 

[Weirdy]

Weirdy = Barry Block, 'nuf said

Barry Block's intern sitting in the closet trying to get the modem to work faster

 

[NatCh]

View attachment 380889
Yes.

I don't knowww... This forum has some doozies. I might call it a tie.

 

[Hybrocure]

Is this the SDN-PM showdown lineup? Perfect, I'm ready. And for the record, I fight dirty and will be bringing my trusty toe nail clippers.

I’ll bring my crushing student debt

 

[Adam Smasher]

Hardroadpaved can be Warshaw, they're both pretty good with coding advice

Icebreaker = Joseph Borregine, both have written somewhat thoughtful and somber posts about the future of podiatry

Deans Chat = the late Leonard Levy

I won't make Hybrocure be Elliot Udell. Not even Elliot Udell deserves to be Elliot Udell

 

[icebreaker32]

I think PM has always had its regulars, just less randoms these days. There are so many other ways to obtain information now.

PM seems like a relic from the past in so many ways. Will it disappear when the boomers age out? Who knows, but it has managed to stay relevant, for now at least, in this small profession…..sort of like a small town newspaper that has not yet gone out of business.

Maybe Barry is incapable of change, but perhaps he knows exactly what he is doing and there is just no money to be made on a modern intern forum so he is keeping the boomer friendly format of a magazine and dated internet site as long as he can.

Aging boomers have not created increased demand for podiatry, but perhaps they and older Gen Xers can keep PM relevant for another decade.….mustache podiatrists do not retire young.

 

[Hybrocure]

I think PM has always had its regulars, just less randoms these days. There are so many other ways to obtain information now.

PM seems like a relic from the past in so many ways. Will it disappear when the boomers age out? Who knows, but it has managed to stay relevant, for now at least, in this small profession…..sort of like a small town newspaper that has not yet gone out of business.

Maybe Barry is incapable of change, but perhaps he knows exactly what he is doing and there is just no money to be made on a modern intern forum so he is keeping the boomer friendly format of a magazine and dated internet site as long as he can.

Aging boomers have not created increased demand for podiatry, but perhaps they can keep PM relevant for another decade.….mustache podiatrists do not retire young.

The irony of it all is it’s still the most popular and well known method of podiatry news. I know Podiatry Today exists (hmpgloballearningnetwork?) but I still read my PM News every day lol.

There’s definitely money to be made for anyone to innovate better mediums for podiatry news

 

[Adam Smasher]

Barry could start a "Podiatry News" twitter account while posting youtube shorts with commentary/news briefs or at least hire people to do it for him. There should be a way to get it monetized by doing ad reads for hyperion medical or the tetra corporation. I'm not on twitter so I wouldn't follow it, but I'm getting older so maybe I should joint twitter?

 

[air bud]

Newsletter bros are all over Twitter and make a killing. Agree it's ripe for disruption and a new model. But certainly requires someone with a love for lotions and potions, lasers and oethotics. Definitely lobster oriented.

 

[Hybrocure]

Hardroadpaved can be Warshaw, they're both pretty good with coding advice

Icebreaker = Joseph Borregine, both have written somewhat thoughtful and somber posts about the future of podiatry

Deans Chat = the late Leonard Levy

I won't make Hybrocure be Elliot Udell. Not even Elliot Udell deserves to be Elliot Udell

I wanna be the outrageous shoe of the day

 

[Retrograde_Nail]

Retrograde got that roth energy. Also cutswithfury (RIP)

I don’t even know what this means

 

[ExperiencedDPM]

That's legit, they talk about this at the ACFAS billing seminar. Clear margin biopsy. "It won't pay much, but it will pay for your lunch"

Clear margin biopsies are not payable. If you were taught to clear margin biopsy and bill for it, that is incorrect information.

NCCI policy clearly states that a biopsy performed during a procedure for a related issue is NOT payable unless you are using the biopsy results for an intra operative decision (ie. frozen section).

I’ve seen cases where a provider does a TMA and bills 20240 x 5 for each proximal margin.

If you amp a hallux and perform a biopsy on the 5th met, it’s payable. But it is not payable if it’s simply to assess margins.

 

[ExperiencedDPM]

Surgery pays fine with good coding (talking ortho codes for insured pts... not MCA wound/amp crap)...
You basically make a bit less per hour doing the actual surgery (esp with associated paperwork and 90d global), but you make it up on DME and higher level E&M - and maybe OTC stuffs - that you would not have gotten otherwise. It also keeps PCPs happy that you can competently fix whatever goes wrong, and that's the biggest gain from OR surgery (for PP docs). With more and more DPMs coming out into an already limited specialty, offering as many services as possible is key.

There is undercoding for surgery, and just plain unbundling... and there is certainly an appropriate middle ground of good and accurate coding. All it really takes is accurate CPTs and mods, proper ICDs to get them paid, and putting highest RVU CPT first line. Here is one forefoot slam (with contralat plate removal from last year) that I just wrote up... not unbundling whatsoever, will pay ok, esp with boot and visits:

28750-LT
20680-RT
28585-T1
28585-T2
28585-T3
28585-T4
28308-LT
28308-LT
28308-LT (all get -59 after first proced)
...it'll all get pad, as it should. Sometimes payer will ask for op report, and good biller can connect those dots. I could've added 28110 or a 28270, but not really needed (capsulotomy might be, can decide post-op and bill it if done).

You don't need the fake skin plasty or tendon lengthens (they are included in capsulotomy MPJ)... or the fake bone biopsies on amps. You don't need the bogus amnio or the plan-to-remove wires sticking out of toes. Surgery pays fine coded accurately.

I will say that podiatry is one of the only surgical specialties that does most or all of their own pre/post op appointments and non-op appointments (as opposed to midlevels or non-op docs and assistants/tech doing most of them). That part is a major drag and why many DPMs claim surgery does not pay (esp if they're associate and their owner does not cut them in on DME or dumps owner/partner post-ops on them).

28585?? I think and hope you meant 28285.

 

[ExperiencedDPM]

But the ACFAS “coding” workshop would never promote fraudulent unbundling…

Don’t get me started.

 

[ExperiencedDPM]

That's legit, they talk about this at the ACFAS billing seminar. Clear margin biopsy. "It won't pay much, but it will pay for your lunch"

Ha. That is 100% NOT legit.

 

[Adam Smasher]

Don’t get me started.

I remember the speaker was talking about how cases with a 78 modifier only reimburse 80% for hospital employed (or something), so it's better to spin any unplanned surgical takebacks as staged revisions to use a 58 mod for full reimbursement. "58 is the new 78" she literally said

 

[Hybrocure]

Ultimately doesn’t most silly coding just not get paid? How does this end up with people getting in trouble with the law?

The only thing I can think of is people purposely falsifying events, getting paid, then investigated later.

But most of this silly stuff like billing 5 bone biopsies in a tma doesn’t make it through that first filter, no?

 

[Adam Smasher]

The payer only sees your cpt and icd10 codes. Often times they just pay. If it's something irregular, they may want to review documentation but they'll most often pay.

If they detect patterns of irregular coding (eg billing 11730 on half your nursing home pts), and they've paid these claims, they may choose to review them all and that's where malfeasance gets found out.

 

[ExperiencedDPM]

Ultimately doesn’t most silly coding just not get paid? How does this end up with people getting in trouble with the law?

The only thing I can think of is people purposely falsifying events, getting paid, then investigated later.

But most of this silly stuff like billing 5 bone biopsies in a tma doesn’t make it through that first filter, no?

It depends on the insurer. Some have programs that will pick up edits and some don’t. And there are CCI edits based on the CPT coding manual and there is NCCI policy, which is a government/Medicare policy. Most private insurers follow NCCI policy.

It’s simply a fact that not every claim can get reviewed due to volume. That’s why you hear these idiots bragging that they were paid for billing 28585 for an arthroereisis.

Getting paid doesn’t mean it was billed correctly, it just means you didn’t get caught. Billing is basically an honor system. So if you bill an ORIF or a talo tarsal dislocation the insurer has no reason to believe that’s NOT what was performed. But if they found out you popped in a sinus tarsi implant……you’re paying some money back.

 

[AttackNME]

It depends on the insurer. Some have programs that will pick up edits and some don’t. And there are CCI edits based on the CPT coding manual and there is NCCI policy, which is a government/Medicare policy. Most private insurers follow NCCI policy.

It’s simply a fact that not every claim can get reviewed due to volume. That’s why you hear these idiots bragging that they were paid for billing 28585 for an arthroereisis.

Getting paid doesn’t mean it was billed correctly, it just means you didn’t get caught. Billing is basically an honor system. So if you bill an ORIF or a talo tarsal dislocation the insurer has no reason to believe that’s NOT what was performed. But if they found out you popped in a sinus tarsi implant……you’re paying some money back.

Serious question, how are we supposed to know if we’re billing things correctly?

 

[ExperiencedDPM]

Serious question, how are we supposed to know if we’re billing things correctly?

Ask me first. And use your gut. If you have the slightest feeling it’s wrong, you’re probably correct.

The easiest way to explain it is that all components needed to complete a procedure are likely included in that procedure. If any component you are considering billing is an integral part to complete the procedure, it’s likely included.

 

[HardRoadPaved]

Patient shows me this and I can show them a referral to derm...

 

[Shiyuan]

View attachment 381008


Patient shows me this and I can show them a referral to derm...

What an idiot. It’s called aging.

 

[HardRoadPaved]

What an idiot.

Just think this OP took the time out of their day to take a history, a photo then figure out how to send it to Barry Block. Then await a response then call the patient to tell them what they found out...

 

[Feli]

View attachment 381008


Patient shows me this and I can show them a referral to derm...

Through my career, I've noticed that colleagues are always "esteemed" when people speaking of them need something from them.

 

[HardRoadPaved]

Through my career, I've noticed that colleagues are always "esteemed" when people speaking of them need something from them.

Esteemed Google does the same thing without the wait

 

[Hybrocure]

We just gonna ignore the fact they submitted a ****ing hand to PM News

 

[Shiyuan]

As professionals we should be just as much nail experts as our dermatology colleagues. But that is just my opinion.

 

[air bud]

As professionals we should be just as much nail experts as our dermatology colleagues. But that is just my opinion.

Do our dermatology colleagues cut fingernails? I am happy to look at somebody's toenails and tell them no nothing will work on these and anybody who tells you laser is trying to rip you off. Or yes, here's some lamisil. I will happily do ingrown toenails all day long. I will not cut toenails unless medically necessary.

 

[Shiyuan]

Do our dermatology colleagues cut fingernails? I am happy to look at somebody's toenails and tell them no nothing will work on these and anybody who tells you laser is trying to rip you off. Or yes, here's some lamisil.

I’m not talking talking about debriding nails. I’m talking about being able to identify nail tumors, cancer, and systemic conditions affecting the nails.