04/16/2018 Allen Jacobs, DPM
The Importance of Examining Legs Michael Forman, DPM)
The Importance of Examining Legs Michael Forman, DPM)
Dr. Forman raises the issue of a concurrent E/M
code with nail and/or callus care. In the case of
the diabetic patient, the question Dr. Forman
brings to the table is rather straightforward.
What is your job as a podiatric physician? Your
“job” is to improve quality of life, and reduce
the risk of limb loss. This requires the
identification of risk factors and the initiation
of appropriate interventions. Subsequently, the
effectiveness and safety of such therapies, and
appropriate adjustments must be conducted.
That requires evaluation and treatment of
dermatologic, neurologic, arterial, venous,
musculoskeletal, rheumatic pathologies, gait, and
fall risk evaluation, and assessment of footwear.
In my humble opinion, the problem is not that Dr.
Forman’s 33% concurrent E/M use is above the
norm. The problem is “the norm”. It is the
failure of our colleagues to actively diagnose
and treat risk factors for limb amputation. It is
the failure of our colleagues to treat
symptomatic neuropathy, edema, xerosis and
fissuring, to seek out PAD prior to overt
manifestations of such disease. It. is the
failure to actively treat onychomycosis and tinea
pedis.
A final problem is that of allowing third party
carriers such as Medicare to threaten caring and
legitimate podiatrists by attempting to enforce
their preconceived notions and definitions of
podiatry. The standard of Podiatric care should
be defined by podiatrists. Not third party
carriers interested in profit maximization.
Conversely, you may be held liable for the
failure to diagnose and treat or refer for
treatment pathology which results in limb loss or
even death.
Of course there is the necessity to document
separate and impactful pathology with appropriate
evaluation (that’s the E) and management (that’s
the M).
33%? The issue is not Dr. Forman. In my view 33%
is too low. The real question is whether
amputation prevention is a proactive or reactive
circumstance. If I were Medicare, I’d rather pay
3 or 4 level 2 or 3 EM visits per year than pay
for years of wound care, HBO, hospitalizations
and amputations.
Allen Jacobs, DPM, St. Louis, MO
code with nail and/or callus care. In the case of
the diabetic patient, the question Dr. Forman
brings to the table is rather straightforward.
What is your job as a podiatric physician? Your
“job” is to improve quality of life, and reduce
the risk of limb loss. This requires the
identification of risk factors and the initiation
of appropriate interventions. Subsequently, the
effectiveness and safety of such therapies, and
appropriate adjustments must be conducted.
That requires evaluation and treatment of
dermatologic, neurologic, arterial, venous,
musculoskeletal, rheumatic pathologies, gait, and
fall risk evaluation, and assessment of footwear.
In my humble opinion, the problem is not that Dr.
Forman’s 33% concurrent E/M use is above the
norm. The problem is “the norm”. It is the
failure of our colleagues to actively diagnose
and treat risk factors for limb amputation. It is
the failure of our colleagues to treat
symptomatic neuropathy, edema, xerosis and
fissuring, to seek out PAD prior to overt
manifestations of such disease. It. is the
failure to actively treat onychomycosis and tinea
pedis.
A final problem is that of allowing third party
carriers such as Medicare to threaten caring and
legitimate podiatrists by attempting to enforce
their preconceived notions and definitions of
podiatry. The standard of Podiatric care should
be defined by podiatrists. Not third party
carriers interested in profit maximization.
Conversely, you may be held liable for the
failure to diagnose and treat or refer for
treatment pathology which results in limb loss or
even death.
Of course there is the necessity to document
separate and impactful pathology with appropriate
evaluation (that’s the E) and management (that’s
the M).
33%? The issue is not Dr. Forman. In my view 33%
is too low. The real question is whether
amputation prevention is a proactive or reactive
circumstance. If I were Medicare, I’d rather pay
3 or 4 level 2 or 3 EM visits per year than pay
for years of wound care, HBO, hospitalizations
and amputations.
Allen Jacobs, DPM, St. Louis, MO