I would like to know where we can find the rules to logging cases.  Your column about bundling or unbundling was very interesting and total news to me.  Our residency director approves all our logs and has never told us that itemization of each separate procedure was wrong.  Does this mean that if we do two separate procedures through the same incision it counts as one procedure?  Your argument makes total sense to me and has been how we do it at our program.  If we are doing it wrong however I'd like to know that too and what the rules actually say, since I've never seen that before.

Thanks for heading this up.

P. Roman Burk, D.P.M
St. Josephs Regional Medical Center
roman_empire@hotmail.com

Editor's Response

You’re not the first person to say it’s new to you.  You bring up an interesting point about the number of procedures and incisions.  At my program we’re constantly talking about whether this procedure or that can be counted for more than one through multiple procedures.  A pan met head resection is the best example.  It’s done through multiple incisions but only counts for one.  That brings us back to the triple arthrodesis.  Where does that fit?  I believe the CPME document 320 is the one that describes the “rules” for all this.  If I’m wrong write in and let me know.  This may have changed with the new PM&S 24/36 programs.

Jarrod

I am a female vascular surgery attending at an academic institution, and even though this is a resource for residents, I feel compelled to comment on the letter that you posted. I am concerned to hear those comments. I have worked closely with podiatrists throughout residency, fellowship, and currently as an attending. Some of my good friends are the podiatrists with whom I work. First, I would like to say that I enjoy working closely with podiatrists on the very challenging population of diabetic patients. It is exciting to dialogue with them about foot surgery for the complex ulcers and gangrene that we see. I enjoy operating and managing patients together. I realize that in podiatric residency, you often participate in cases with orthopedic surgeons. I would offer as a suggestion to attempt to develop a relationship with the vascular surgeons at your hospital. I truly enjoy having the podiatry residents scrub in on cases with me.

Please do not let others discourage you. You have chosen an exciting and much needed field. You must be quite self-motivated and intelligent to have made it this far. I hope this response helps to give you a little encouragement.

Best regards,

Sherry D. Scovell, MD
Director, Endovascular Surgery
Division of Vascular Surgery
Beth Israel Deaconess Medical Center
Boston, MA
sscovell@bidmc.harvard.edu

Editor's Response

It’s wonderful to hear such a positive response from one of our vascular surgery colleagues, and a contributing author to PRESENT Courseware.  I congratulate the podiatric residents at Beth Israel Deaconess in Boston for being lucky enough to have such a resource!

Don't miss Dr. Scovell's excellent PRESENT lecture on Venous Insufficiency.  You can check it out by CLICKING on this LINK:

Venous Insufficiency
by Sherry Scovell, MD

Jarrod

You mentioned in your latest "letter to the editor", that as residents we should learn as much as we can about coding and billing so when we venture out on our own we have the knowledge to get the $$$$$. Now, I have one year left, so this really wouldn't affect me much. But, I would love to see the logging system COMBINED with billing and procedure codes...wouldn't that solve several problems? Think about it, learning about modifiers while logging your cases. The computer could play "the insurance company" and reject bad logs with reasons and how to correct the mistakes, teaching future doctors how to bill properly!!! I would really like to see this established in the next five to ten years. Pass this along to anyone who can get the ball rolling on this project. Thanks for your time!

Editor's Response

Michael,

Great idea!  I’m not the most computer savvy person in the world, but if there’s someone out there with the ability, let me know.  We'll set up a call with  Residency Resource and get the ball rolling.  That is a truly creative idea that would greatly benefit the resident community

Jarrod

Reply to Anonymous letter from last week
From: Robert D. Phillips, DPM
            Residency Director
            Coatesville VAMC

Everyone in podiatry can extol some grievance or another in the education process. At this point in your career you've got to keep the vision that you started with. You got into podiatry because it is a developing field, not because it is already fully developed. You got into it because you could see the vision of what it should be, and you wanted to be part of that unfolding vision. You got into the profession because you wanted to see people walking more and being more active -- which is the key to good health. What good is life in a rocking chair? You are already familiar with those in society who take 20-50 pills/day and are still very unhealthy. Without feet that can function properly, what can one really do? And who is doing more than podiatry? Certainly not the Foot & Ankle Society.

I would encourage you to finish your program. When you're done, then take all the good things that you learned and use them. And also use all the "bad" experiences as learning experiences, i.e. never to be perpetuated. Get involved in the teaching process yourself, or the research process, or the professional service process -- and do more to help the profession move along to reach its potential. One of the great motivators in my career were the teachers that I swore I would never be like. I had some great ones and I had some terrible ones. I have tried to emulate the great ones, and to totally avoid the traits of the terrible ones. I have tried to teach my own residents accordingly.

Remember, no one invited the podiatry profession into the mainstream of medicine. There are still those that want to keep us out, but we can't let them dictate to us who we are.

I had no residency, but somehow I have overcome that handicap to make contributions to the profession, and I am doing everything I can to see that no one has a similar handicap. I love the profession. I jump out of bed each morning, eager to get to the workplace. There is nothing so gratifying as having someone say, "Thank you for making me feel better." Yes, at times things have been rough; there have been many disappointments and closed doors, but I persevere, knowing that you just have to keep knocking. Sooner or later the door will open. Most of my past residents may say there were deficiencies in the program I direct. Some of those residents just complained and some of them got out there and tried to help it become better. And I expect them to leave this program and go out and make things even better than they found them - just as I've tried to do.

I know the profession has a great number of naysayers. One of my heroes is Dr. Leonard Levy, first dean of the podiatry school in Des Moines. He used to remind us over and over again, "The Chinese have the same word for crises and opportunity." I don't know anything about the Chinese language, so can't say that this is true about the Chinese language. But I can say that the idea is correct. Dr. Levy lived this concept and he taught it, and it gives me great hope when there are difficult times.

Best wishes,
Robert D. Phillips, DPM
Residency Director
Coatesville VAMC
Robert.Phillips2@va.gov
 

Editor's Response

Well said, Dr. Phillips.  Thanks for helping with this issue.

Jarrod