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Which portion?Can you spell A-U-D-I-T??!
Which portion?Can you spell A-U-D-I-T??!
Long live the kingI take full credit
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Visit 2 - problem resolved, no medication - how are you billing a level 3? you really spending 15 mins with them?
Can you spell A-U-D-I-T??!
Nothing wrong with this... a 99213 is a LOW complexity visit 2 of 3 EnM components required and they are very simple to hit in your note .... time can or cannot be used, not a requirement.... but know that time is never on your side as you are a limited scope practitioner
Back on topic I use verrusol with some decent results. If it fails that typically then do in office excision.
What do you do for wound care after you excise in office under local? What is your treatment algorithm post procedure?
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Got beat to posting this - If an "established problem, stable or improving" is worth 1 point, how do you get to level 3 established on a "cya" visit? MDM is the heart of valuing the visit and it requires 2 columns of MDM - problem, data, risk etc
I'm not trying to ask that aggressively. My "training" from this is reading E&M university so maybe I'm not seeing it.
By that logic, a person with completely resolved plantar fasciitis is a level 3 also. Now I'm muddying the warts because the heart of the matter to me is its really about what you discussed and additionally plantar fasciitis could be presenting with 3 other mechanical problems.
At the ACFAS billing course the other day they said a healthy 12 year old with a wart is a 99202. The real question is - what did you say to their parents. If you walk in, take a glance and say "Its a plantar wart, its likely to go away on its own, don't worry about it" - it doesn't seem like there's a lot going on though I'll concede there are other conditions where lack of treatment doesn't mean lack of thought or decision making. But if you discuss - look, you were referred here because it didn't resolve - I'm going to definitively treat this - I have multiple treatment modalities - I can canth, freeze, excise, prescribe aldara, cimetidine, 5-FU. Here are the ups and downs. Aldara can irritate the skin. Cantharidin - blah blah blah - you've covered a lot of ground. Similarly - if a person with plantar fasciitis is resolved, but its there 5th episode in a year and you intend to discuss something more - sure, but add relevant problems.
Call me terrible, but I sort of regret attending the ACFAS billing conference the other day. The heart of their E&M section was "you all need to bill higher level codes" along with a fight over the classic can I bill a matrixectomy and a 203 together. Eruption. A dive into true multi-part MDM discussion, what is risk, etc was not done.
Other small thing - data points. Unless you work for a hospital where you can easily review charts, labs, etc - I don't think I really ever hit higher level visits on datapoints. I sometimes hear people say - you'll need another set of X-rays to get you there. Its 2 points for independent review of tracing.
I would think because there is already an EM component built into the wart treatment code?Regarding healthy 12 year old with wart, as for MDM you need two of risk/problem point/data point. In my opinion you don't have the data points, but you have moderate MDM (99202 is straightforward MDM). The risk is moderate because you have "new illness with complicated/uncertain progression. The problem points add up to 3 because you have "new problem with no additional workup planned." So I'm not sure why they are saying 99202? Is it because of the exam portion?
So for new patients with a procedure are people not including an e&m? Let's say you do a wart procedure on the new patient, with no other problems, are you billing an e&m alone or an e&m along with 17110?I would think because there is already an EM component built into the wart treatment code?
Yes. I was getting some things confused, don't mind me and my old ageSo for new patients with a procedure are people not including an e&m? Let's say you do a wart procedure on the new patient, with no other problems, are you billing an e&m alone or an e&m along with 17110?
He's not very busy these days. He has forgotten how to podiatrist. He should do an ACFAS fellowship so he can reinvent himself into a "Fellowship trained Foot and Ankle Surgeon" on LinkedIn but....he/she has a DPM behind their name.Yes. I was getting some things confused, don't mind me and my old age
not very busy is a relative term....haven't you done more in the last 2 months than I did all last year?He's not very busy these days. He has forgotten how to podiatrist. He should do an ACFAS fellowship so he can reinvent himself into a "Fellowship trained Foot and Ankle Surgeon" on LinkedIn but....he/she has a DPM behind their name.
I think that chemo surgery is for bleomycin and yes pays very well.
3 days seems like a long time to leave cantharidin on. I never left on for more than 24 hours.
Cryo and doing 5 to 7 in this day and age is robbery.
Lol smoking was essential to her life because of personal stress..Check out this article, I have never tried Bleomycin though.
What I Learned From A Recent Malpractice Case On Warts
I recently had the opportunity to participate as a defense expert in a malpractice case. The jury returned a verdict in favor of the defendant podiatrist, determining that the plaintiff was 75 percent responsible for damages and the defendant was 25 percent responsible. However, the case was in...www.podiatrytoday.com
Check out this article, I have never tried Bleomycin though.
What I Learned From A Recent Malpractice Case On Warts
I recently had the opportunity to participate as a defense expert in a malpractice case. The jury returned a verdict in favor of the defendant podiatrist, determining that the plaintiff was 75 percent responsible for damages and the defendant was 25 percent responsible. However, the case was in...www.podiatrytoday.com
What I learned is that in a patient who is desperate for a cash grab she can find any unscrupulous idiot willing to destroy another's reputation. **** that guy who was the expert witness for the plantiff.
Maybe try bleach or disinfectant to get rid of warts? Maybe UV light?
Maybe try bleach or disinfectant to get rid of warts? Maybe UV light?
Hello all,
My office is looking into starting cantharone treatments. Can someone direct me to a place we can order from at a decent price? Our current supplier doesn't keep it in stock
Contact a local compounding pharmacy to make their own version of it. I'd give you the contact info for the pharmacy that I use but I don't want them running out of stuff. Make sure it has the podophyllin component (the "plus" part of Cantharone Plus), otherwise it won't do squat.Hello all,
My office is looking into starting cantharone treatments. Can someone direct me to a place we can order from at a decent price? Our current supplier doesn't keep it in stock
Can I get an application to be a beetle squeezer?Okay, that seals the deal. I’m opening a beetle farm and will soon be the number one supplier of beetle juice in the the universe. I will supply all who need it at a grossly inflated price. I will cure the world’s warts.
Only if you have a CAQ in that area.Can I get an application to be a beetle squeezer?
Most of the pharmacies won't or can't make cantharidin anymore. Supply issues or FDA lack of approval are what they state, but it's probably they just don't have enough margin or demand, or whatever.... cost went up and up, now it's very hard to find.Contact a local compounding pharmacy to make their own version of it. I'd give you the contact info for the pharmacy that I use but I don't want them running out of stuff. Make sure it has the podophyllin component (the "plus" part of Cantharone Plus), otherwise it won't do squat.
In that case I'm DEFINITELY not telling you guys where I get mine from.Most of the pharmacies won't or can't make cantharidin anymore. Supply issues or FDA lack of approval are what they state, but it's probably they just don't have enough margin or demand, or whatever.... cost went up and up, now it's very hard to find.
As long as you debride well and have patient debride daily with pumice this works miracles.Go Efudex. Works great and well tolerated.
As long as you debride well and have patient debride daily with pumice this works miracles.
Problem is getting insurance to cover it.
I believe @NatCh once posted about "auto innoculation". There is an article out of india on it. I had a 20ish year old patient with massive mosaic warts both feet. I didnt know what to do as both plantar feet were basically 70% wart. So I took a 2-3mm punch biopsy and punched a central nasty looking area. Flipped it around and steri stripped it down with mastizol. Patient reported 10/10 pain for about 7 days at biopsy site but came back at 3-4 weeks and every wart was gone. It was a miracle.We should probably start a verruca-podiatry-dermatology-fellowship to better understand this, but there is I think definitely a difference between a patient show shows up asking "what is this" and has done nothing and a patient who is a 3rd opinion, did 3 months of salicylic acid, had new expansive lesions, got a painful cryo sessions from their PCP and then was injected with antigen by dermatology. The latter is frustrated, scared, hurting, etc and obviously in danger of having something stupid and expensive done to them in a podiatry office.
Interestingly, no podiatry problem can be discussed without hearing about someone somewhere doing something bizarre. Another podiatrist in my town kept applying something to people and telling them to leave the bandaid on for weeks. I figured it was cantharone though I still didn't understand the time table... "did you blister underneath, did it hurt, did he tell you what would happen, did you reapply something?" Turns out it was just salicylic acid. Thank you for the undertreated patient, I guess.
I believe most of wart care with topical keratolytics is just exposing the wart to the immune system. Once the immune system knows its there its over. Game of hide and seek. Turn the light on in the closet and its game over (see my post about auto innoculation above).I do have my patients perform self debridement and use compound w in between visits. I also am very honest with patients and tell them that they can treat it themselves if they are patient enough. I had one on my finger in high school. I never even used a topical and after years worth of trauma from sports (it would get damaged, ripped, bled, etc. frequently at football practice and during track season), the dead skin just fell off one day and there was normal healthy skin underneath.
But maybe my home care routine is the real reason I feel like cantharone regular (blue label) has still worked, just less effective.
Cash only. The machine has some big upfront cost but its less than I thought it was. They used to have a calculator on their website and I wondered if you could reverse engineer the cost from it but you can't ie. someone on Iped called and was given an exact number and it was lower than what I calculated. Maybe something like $10-14K or something like that. Could call and ask but its more than cantharone so f7*( it.Real talk. This swift machine thing. Sounds like it costs $10k but how do you bill for this? Cash pay only?
Yes, that's the start and end of it. ^^I believe most of wart care with topical keratolytics is just exposing the wart to the immune system. Once the immune system knows its there its over. Game of hide and seek. ...
I thought about buying one but right after I made contact with them they came at me with the hard sell. Emails and phone calls wouldn't stop. That put me off. The quote was around $20K for outright purchase. I chatted with a colleague who owns a machine and she said that it works but only a small portion of her patients opt to use it because it's pay out of pocket whereas their insurance covers more traditional methods. Also, the disposable tips cost $60 per use, which means that in the end she's netting about the same amount per patient as she was using Cantharone or whatever else.Real talk. This swift machine thing. Sounds like it costs $10k but how do you bill for this? Cash pay only?
Yeah. 60 percent salicylic acid too.Contact a local compounding pharmacy to make their own version of it. I'd give you the contact info for the pharmacy that I use but I don't want them running out of stuff. Make sure it has the podophyllin component (the "plus" part of Cantharone Plus), otherwise it won't do squat.
True, you have to debride down until you see pin point bleeding. A lot of PCPs or Derms don't like to see blood.I think a lot of PCPs and even Derms or DPMs fail on plantar foot since they don't debride aggressive enough before applying whatever.