Questions for Podiatry's Leaders

[Adam Smasher]

There's going to be a tipping point in 5-10 years. By then, we will have had about 20 years worth of classes of 3-year residency trained DPMs. Obviously not all of those residencies were any good. But too much of podiatry is boring "I stubbed my toe and now the nail is black and I just want to make sure it's not infected" type complaints. We don't need to recruit surgeons to handle this excess, but that is what we are producing. Makes more sense for a lot of us PP guys to recruit NPs just for clinic work than to hire a suregon who will operate little/not at all. I've written on here before about the "bait and switch" in podiatry recruitment, and many more of us are starting feel it. I just wonder if the leadership is prepared for the eventual backlash and what that will look like.

---

Members don't see this ad.

 

[DMEpod]

There's going to be a tipping point in 5-10 years. By then, we will have had about 20 years worth of classes of 3-year residency trained DPMs. Obviously not all of those residencies were any good. But too much of podiatry is boring "I stubbed my toe and now the nail is black and I just want to make sure it's not infected" type complaints. We don't need to recruit surgeons to handle this excess, but that is what we are producing. Makes more sense for a lot of us PP guys to recruit NPs just for clinic work than to hire a suregon who will operate little/not at all. I've written on here before about the "bait and switch" in podiatry recruitment, and many more of us are starting feel it. I just wonder if the leadership is prepared for the eventual backlash and what that will look like.

This is spot on. Close to half of what I see in PP can easily be handled by a PA/NP. Often times I'm surprised the NP that refer to us even bothered sending instead of just telling the patient to try some otc antifungal or prescribing lamisil or ketoconazole. Lots of students going in with the mindset of being big time surgeons are going to have to understand that they will come out talking to people about their calluses and cracked heels just as much if not more than talking to them about their lapidus or ankle scope. Not that this is a bad thing but it is something that needs to be communicated to students much more than currently.

 

[Shiyuan]

This is spot on. Close to half of what I see in PP can easily be handled by a PA/NP. Often times I'm surprised the NP that refer to us even bothered sending instead of just telling the patient to try some otc antifungal or prescribing lamisil or ketoconazole. Lots of students going in with the mindset of being big time surgeons are going to have to understand that they will come out talking to people about their calluses and cracked heels just as much if not more than talking to them about their lapidus or ankle scope. Not that this is a bad thing but it is something that needs to be communicated to students much more than currently.

100%. Nobody dare say this at an ACFAS conference, else all the Foot and Ankle Surgeons will come after you 😅

 

[pod squad]

Not only is this going to cut out 'non-surgical' pods but it limits the amount of surgical DPMs needed in hospitals/organizations. There's only so much surgery to go around....

 

[Shiyuan]

Not only is this going to cut out 'non-surgical' pods but it limits the amount of surgical DPMs needed in hospitals/organizations. There's only so much surgery to go around....

The place I am interviewing with has a nonsurgical DPM on staff, has been there for like 20+ years. I bet after he retires they will probably put in a mid-level or surgical provider.

 

[pod squad]

The place I am interviewing with has a nonsurgical DPM on staff, has been there for like 20+ years. I bet after he retires they will probably put in a mid-level or surgical provider.

The only way they hire a non-surg DPM will be if they can pay them less than a mid-level

 

[Pronation]

This was a defining conversation at ACFAS. Every busy hospital based pod I knew and talked to had a PA/NP. Even in states that didn't allow direct supervision. They just had an Ortho in their department sign off on everything instead. This is the future. Some were using PA/NP as a true extender with them seeing post-op etc but most had them practicing independently. Some only clinic based some surgery. But mostly clinic based. All of these additional hospital jobs out there, I am telling you they are filling up fast. The future is NP/PA, not non surgical pods. Until the surgery is overwhelming there is not a need for another pod. Heel pain? NP. Non op 5th met Fx? NP. Painful bunion? Surgery for the pod. I am telling you this is the very near future.

Any when they do bring in another surgical pod.....it is not to do the flatfoots and ankle fx....

Oh 100%. I mentioned it earlier, the hospital gigs are going to dry up so hard for pods. Sleazy mustache pods are salivating at the thought of hordes of desperate applicants looking for a job.

 

[air bud]

The place I am interviewing with has a nonsurgical DPM on staff, has been there for like 20+ years. I bet after he retires they will probably put in a mid-level or surgical provider.

Yes,. Was going to edit my post to add this. All these older non surgical pods will not be replaced. Think about it....what hospital pod is going to say nah I don't to do 2 days OR, 2 days clinic, see no post ops, nails etc.....let's just hire another pod and do 1 day OR....

 

[air bud]

This is spot on. Close to half of what I see in PP can easily be handled by a PA/NP. Often times I'm surprised the NP that refer to us even bothered sending instead of just telling the patient to try some otc antifungal or prescribing lamisil or ketoconazole. Lots of students going in with the mindset of being big time surgeons are going to have to understand that they will come out talking to people about their calluses and cracked heels just as much if not more than talking to them about their lapidus or ankle scope. Not that this is a bad thing but it is something that needs to be communicated to students much more than currently.

Sir I am a SURGEON. I operate and 🦶 🐴 and all out of operations.

 

[pod squad]

Question for Podiatry's Leaders: What can be done to combat the encroachment of PA/NP/RNs into our territory? In my geographical area there are 3 full time job postings for 'Podiatry PA/NP' at well-regarded organizations and zero full-time DPM opportunities.

Asking @diabeticfootdr again, is podiatry leadership aware of this problem?

 

[619]

This is spot on. Close to half of what I see in PP can easily be handled by a PA/NP. Often times I'm surprised the NP that refer to us even bothered sending instead of just telling the patient to try some otc antifungal or prescribing lamisil or ketoconazole. Lots of students going in with the mindset of being big time surgeons are going to have to understand that they will come out talking to people about their calluses and cracked heels just as much if not more than talking to them about their lapidus or ankle scope. Not that this is a bad thing but it is something that needs to be communicated to students much more than currently.

I agree but being solo in PP, I love when the NP/PA send me all the foot and ankle pathologies (this is what I tell them when I do my door to door marketing). I don't care how dumb or stupid it is, just send my way. It is still a new patient visit and most times, patient may be referred to me for their toenail and then they mention their long term ankle pain or arch pain or oh since I am here I have a painful bunion etc.

It's a whole different mindset between being hospital employed vs associate vs owner. As a practice owner, you just want to see a full clinic schedule with lots of new patient referral.

I personally dislike the patients that come in for general numbness or neuropathy but the truth is in life beggars can't be choosers. Not just podiatry but every specialty is a beggar. We all rely on PCPs for referrals.

 

[diabeticfootdr]

Asking @diabeticfootdr again, is podiatry leadership aware of this problem?

What’s the problem?

Podiatrists supervising an APP?

 

[619]

What’s the problem?

Podiatrists supervising an APP?

Problem is APP taking the jobs of podiatrist. The low hanging fruit (hospital non-surgical "more pay than an associate" DPM jobs) are being taken away.

I doubt any organization or Dr Rogers can do anything to fight that. The market condition will determine who they hire and fire.

 

[pod squad]

Problem is APP taking the jobs of podiatrist.

Precisely, there are a lot of people out there (new grads especially) that would love to take a 120k+ salary at a Kaiser or similar organization to get their foot in the door. Being outsourced to PA/NP even RN now

 

[PeaJay]

Problem is APP taking the jobs of podiatrist. The low hanging fruit (hospital non-surgical "more pay than an associate" DPM jobs) are being taken away.

I have explained previously why it is more advantageous to have an NP working with me than a non-op podiatrist. It obviously is not optimal from a podiatry jobs standpoint, but it is about making things easier/streamlined. Adding a non-op unfortunately does not work.

There is a reason that most sports Med groups have a 1:1 or 1:2 orthopod to PA/NP ratio and not a non-op doc (IM/FP doc with sports fellowship) pairing.

 

[heybrother]

I have explained previously why it is more advantageous to have an NP working with me than a non-op podiatrist. It obviously is not optimal from a podiatry jobs standpoint, but it is about making things easier/streamlined. Adding a non-op unfortunately does not work.

There is a reason that most sports Med groups have a 1:1 or 1:2 orthopod to PA/NP ratio and not a non-op doc (IM/FP doc with sports fellowship) pairing.

I think we need a NP/PA thread - you've had at least 2 good posts on this but I suspect they are in different threads.

 

[Pronation]

What’s the problem?

Podiatrists supervising an APP?

Subtle. I like it.

 

[air bud]

Subtle. I like it.

Dr Rogers is not Lord El Presidents of Podiatry. I don't think he needs to be asked for a position on every facet of podiatry.

 

[619]

I have explained previously why it is more advantageous to have an NP working with me than a non-op podiatrist. It obviously is not optimal from a podiatry jobs standpoint, but it is about making things easier/streamlined. Adding a non-op unfortunately does not work.

There is a reason that most sports Med groups have a 1:1 or 1:2 orthopod to PA/NP ratio and not a non-op doc (IM/FP doc with sports fellowship) pairing.

I 100% agree with you. Every decision is made by the market and right now the market and even logic favors hiring a PA/NP.

A lot of general podiatry stuff literally only require a one year residency training to make diagnosis and treatment. The bread and butter stuff that PCPs don't want to deal with are sent to us. Personally I like those so called bread and butter referrals from PCPs or NP/PA. Even an ingrown nail is a bread and better referral that pays well and quick recovery. Routine ingrown nail, heel pain, warts, callus can all easily be handled by a PA/NP.

 

[diabeticfootdr]

Dr Rogers is not Lord El Presidents of Podiatry. I don't think he needs to be asked for a position on every facet of podiatry.

Make Podiatry Great Again!

 

[air bud]

Make Podiatry Great Again!

Maybe go with Make Podiatry less Podiatry-ee

 

[DYK343]

Its not just podiatry that midlevels are encroaching on. Its every single medical field. Were actually not that special.

Talked with admin. I am pushing hard for a NP and it looks like im gonna get my way.

 

[air bud]

Its not just podiatry that midlevels are encroaching on. Its every single medical field. Were actually not that special.

Talked with admin. I am pushing hard for a NP and it looks like im gonna get my way.

Yeah, I've already seen my numbers for January when I saw about 20 patients a week and did maybe 15 surgeries, I'm getting an NP sooner than later I would imagine by the end of the year. Each of my Ortho partners have one.

 

[PatchAdamsFan]

We're actually not that special

Understatement of the year

 

[dtrack22]

Its not just podiatry that midlevels are encroaching on. Its every single medical field. Were actually not that special.

I think the difference is that the rest of medicine doesn’t really seem concerned. Maybe anesthesia? But even then it’s not as if anesthesia doesn’t have opportunities to go work anywhere they want.

There is simply more Derm, ortho, anesthesia, primary care, OBGYN, Emergency medicine, vascular surgery, radiology, etc demand/need/jobs than there are physicians in each of those respective specialties. Podiatry…not so much at the moment.

 

[DYK343]

I think the difference is that the rest of medicine doesn’t really seem concerned. Maybe anesthesia? But even then it’s not as if anesthesia doesn’t have opportunities to go work anywhere they want.

There is simply more Derm, ortho, anesthesia, primary care, OBGYN, Emergency medicine, vascular surgery, radiology, etc demand/need/jobs than there are physicians in each of those respective specialties. Podiatry…not so much at the moment.

Cant argue with that

We should open 2 more schools.

 

[Boba Foot]

Its not just podiatry that midlevels are encroaching on. Its every single medical field. Were actually not that special.

Talked with admin. I am pushing hard for a NP and it looks like im gonna get my way.

I mean, isn’t this the problem with all industries in America since the 80’s? Cut high paying skilled jobs and replace with lower paying midlevel jobs so admin, executives, and insurance can walk away with higher profits?

Its just medicine catching up to all other industries even though we thought we were immune because of education and yada yada. Just so happens pods are getting screwed more because we pay the same amount for school with a lower income ceiling.

 

[Feeter]

Unless youre wRVU based then it pays less than a 99203.

11720 1.05 wRVU
99203 1.6 wRVU
If I do a nail avulsion and talk about options, post op care, Rx topical antibiotic, etc etc my billers will not let me bill an office visit. Only a 11720.

I had a meeting with management today. Starting this Friday all nail care referrals will go elsewhere. Its just not worth it to me on a wRVU system.

Did you mean RVU instead of wRVU? 11720 is not 1.05 wRVU. I think it's about half of that...?

11720 can not be billed with office visit unless you are also treating a separately identifying problem like heel pain or something.

If it is a new pt and you did a nail avulsion on the same day then you should be able to bill nail avulsion and e&m. If they are coming back for a nail avulsion visit then just nail avulsion can be billed. Someone correct me if I am wrong.

 

[heybrother]

Did you mean RVU instead of wRVU? 11720 is not 1.05 wRVU. I think it's about half of that...?

11720 can not be billed with office visit unless you are also treating a separately identifying problem like heel pain or something.

If it is a new pt and you did a nail avulsion on the same day then you should be able to bill nail avulsion and e&m. If they are coming back for a nail avulsion visit then just nail avulsion can be billed. Someone correct me if I am wrong.

He presumably meant to type 11730.

The funniest part about all this is that somewhere out there is a cold blooded hospital manager who should simply tell a podiatrist in this situation to suck it up. If the patient has commercial insurance and the hospital charges a facility fee then it really doesn't matter at all what the podiatrist gets in RVUs. The RVU value has no relation to what the hospital gets paid. Dyk gets essentially 1 RVU at $50 or whatever. If the hospital gets paid the massive mark-up that hospitals get for things then what do they care that he only keeps $50 if they got $500 for the procedure or whatever.

 

[Feeter]

He presumably meant to type 11730.

The funniest part about all this is that somewhere out there is a cold blooded hospital manager who should simply tell a podiatrist in this situation to suck it up. If the patient has commercial insurance and the hospital charges a facility fee then it really doesn't matter at all what the podiatrist gets in RVUs. The RVU value has no relation to what the hospital gets paid. Dyk gets essentially 1 RVU at $50 or whatever. If the hospital gets paid the massive mark-up that hospitals get for things then what do they care that he only keeps $50 if they got $500 for the procedure or whatever.

My understanding is that they don't get a facility fee for these clinic pts if they are under a corporation that is separate from the hospital but still under the umbrella of whatever organization that runs both clinic and hospital.

 

[heybrother]

My understanding is that they don't get a facility fee for these clinic pts if they are under a corporation that is separate from the hospital but still under the umbrella of whatever organization that runs both clinic and hospital.

You may know better than everyone else. The general feedback from hospital employed podiatrists is "facility fees, yay". I actually see a cardiologist employed by a large hospital system and while his professional fee is greater than what I receive from the same insurance - its not unreasonable and I've never been charged a facility fee. And I've seen this cardiologist both in a large off-site cardiology building and in an outpatient office on the campus of a major hospital. Fees were the same each time.

Medicare was supposedly battling to pay outpatient services at the Medicare fee schedule as opposed to the OPPS or whatever its called with a distinction being made for offices/facilities etc before and after 2015. I was under the impression the American Hospital Association or whatever fought it off for the historic facilities.

 

[DYK343]

Did you mean RVU instead of wRVU? 11720 is not 1.05 wRVU. I think it's about half of that...?

11720 can not be billed with office visit unless you are also treating a separately identifying problem like heel pain or something.

If it is a new pt and you did a nail avulsion on the same day then you should be able to bill nail avulsion and e&m. If they are coming back for a nail avulsion visit then just nail avulsion can be billed. Someone correct me if I am wrong.

Sorry yes thats a typo its a 11730 (avulsion, nail plate) I get 1.05 wRVU and my billers auto deny any E&M code I attach to it.

They say its included in the cost of the procedure.

 

[619]

Sorry yes thats a typo its a 11730 (avulsion, nail plate) I get 1.05 wRVU and my billers auto deny any E&M code I attach to it.

They say its included in the cost of the procedure.

Even for a new patient? That's wild. What about for a 11750

 

[dtrack22]

my billers auto deny any E&M code I attach to it.

They are wrong

The California Medical Association has a decent article discussing and giving examples of when a procedure could be billed separately vs. when the e&m component is included.

If it’s a new patient or new complaint from an established patient, you can bill both. If it’s a plantar fasciitis patient who has tried stretching and inserts and is doing ok but comes in for injection because you already told them that may be necessary if symptoms don’t improve/resolve, then yeah, you’re only supposed to bill the injection code.

Coding Corner: Coding to support an injection procedure with a same-day E/M service

Your billers are costing you tens of thousands of dollars annually…

 

[DYK343]

They are wrong

The California Medical Association has a decent article discussing and giving examples of when a procedure could be billed separately vs. when the e&m component is included.

If it’s a new patient or new complaint from an established patient, you can bill both. If it’s a plantar fasciitis patient who has tried stretching and inserts and is doing ok but comes in for injection because you already told them that may be necessary if symptoms don’t improve/resolve, then yeah, you’re only supposed to bill the injection code.

Coding Corner: Coding to support an injection procedure with a same-day E/M service

Your billers are costing you tens of thousands of dollars annually…

I agree. They are super conservative.

I cut out all nail care, including ingrown nails, because its just not worth it to me.

In my last MSG job I billed office visits with ingrown nails (not follow up RFC) and they never said anything.

But my first 30 days hospital job they reviewed every chart and pulled every nail avulsion I had because I billed a 99203 with it. I failed the audit.

I would fight them. But I no longer accept the care. Its not me thinking its below me. Its a reimbursement issue. Im not making 1 wRVU for a minor procedure. Its not worth the risk. My manager and clinic coordinator agreed.

 

[619]

I would fight them. But I no longer accept the care. Its not me thinking its below me. Its a reimbursement issue. Im not making 1 wRVU for a minor procedure. Its not worth the risk. My manager and clinic coordinator agreed.

I will like to open an office next to you. Will appreciate all the ingrown nail referrals.

 

[air bud]

I will like to open an office next to you. Will appreciate all the ingrown nail referrals.

Yeah I love ingrowns. I talked to a guy who trained me who partnered up with a guy who owns 3 peds clinics. He does 10 to 20 a day....doesn't care at all about trauma/recon anymore. That is the life.

 

[Pronation]

I will like to open an office next to you. Will appreciate all the ingrown nail referrals.

Oh absolutely. A new patient ingrown in the private setting is a goldmine. In the RVU setting, the RVU/hour I think is actually less than cranking out office visits or wounds.

 

[DYK343]

I will like to open an office next to you. Will appreciate all the ingrown nail referrals.

Its amazing how the reimbursements differ from wRVU compared to fee for service/private office.

Hospital jobs are great and I make good money generative wRVUs but thats mostly in the OR.

If I do a FF slam I get full wRVU for every procedure. There is no decline in reimbursement with successive procedures like a fee for service provider.

Where I am losing in my current job is in the office. Patient with plantar fasciitis. Spend 15 minutes discussing conservative care and bill a 99203 I make 1.6 wRVU. I always leave cortisone injection as optional treatment. If they accept cortisone injection my office visit automatically goes to only a 20550 which is worth 0.75 wRVU. Its makes absolutely zero sense to offer an invasive treatment which increases risk (infection, p fasciitis rupture, adverse med reaction, vasal vagal, etc, etc) even if its the quickest path to recovery for the patient.

All my procedures with office visit were audited by the billers and failed. I am fighting them on this in case anyone is wondering.

 

[619]

Yeah I love ingrowns. I talked to a guy who trained me who partnered up with a guy who owns 3 peds clinics. He does 10 to 20 a day....doesn't care at all about trauma/recon anymore. That is the life.

This is the direction my life is going towards also. I love my clinic days and not so stocked about going to the OR. Even patients with no insurance will happily pay cash to get their ingrown nail taken out.

 

[619]

Where I am losing in my current job is in the office. Patient with plantar fasciitis. Spend 15 minutes discussing conservative care and bill a 99203 I make 1.6 wRVU. I always leave cortisone injection as optional treatment. If they accept cortisone injection my office visit automatically goes to only a 20550 which is worth 0.75 wRVU. Its makes absolutely zero sense to offer an invasive treatment which increases risk (infection, p fasciitis rupture, adverse med reaction, vasal vagal, etc, etc) even if its the quickest path to recovery for the patient.

Maybe they have it this way so you can order imaging and send them to physical therapy for sessions. When we all know a trigger point steroid injection most times takes care of the heel pain at the first visit.

 

[dtrack22]

In the RVU setting, the RVU/hour I think is actually less than cranking out office visits or wounds.

A new patient ingrown where matrixectomy is done same day is worth 3.18 wRVU. Unless you have DYKs billers who should be fired for losing both him and his group money.

As a RVU based, hospital employed, foot and ankle podorthopedic surgeon, I will take all of the ingrowns. It’s still one of the most valuable office visits when billed correctly.

 

[Pronation]

A new patient ingrown where matrixectomy is done same day is worth 3.18 wRVU. Unless you have DYKs billers who should be fired for losing both him and his group money.

As a RVU based, hospital employed, foot and ankle podorthopedic surgeon, I will take all of the ingrowns. It’s still one of the most valuable office visits when billed correctly.

Yes 3.18 RVUs but I can see at least 2 more patients in the time it takes me to do an ingrown.

 

[dtrack22]

Yes 3.18 RVUs but I can see at least 2 more patients in the time it takes me to do an ingrown.

I would have thought an experienced total toenail replacement surgeon wouldn’t take 20 minutes to do an ingrown…

A new patient matrixectomy is maybe 5-10 min of my time face to face and the note is 30 seconds. There is no way I’m getting through 2 new patient encounters or 3 established patients (unless it’s a level 2 but then you’d need 4 of them) in the time I do an ingrown.

 

[Boba Foot]

Yes 3.18 RVUs but I can see at least 2 more patients in the time it takes me to do an ingrown.

Come on brah. See the patient, explain what you’re gonna do, inject. Go see another patient or two while lido or marcaine (lido shortage) is working. Go back, pop that baby out. Rinse and repeat.

 

[Feli]

The surgery is fine, but it's a loser in PP (it makes $... but nothing per hour compared to visits and in-office procedures). Even when scheduled ahead and in blocks of 2-5+ pts and/or a dozen plus procedure codes and an efficient surgeon, it's sub-optimal. It's done basically to offer those services, keep local PCPs happy, keep the hospitals happy, help the pts. That's not to mention the paperwork nightmares that can come with it. The DME and rep/refers that comes with doing good surgery is the only saving grace for PP.

I would say verruca are actually creme de la creme for PP: very fast and easy, pays well, get 3 or even 5+ visits in quick succession. Ingrown and inject and other stuff is good, but they're essentially one and done with maybe a single 99213 follow up. Sometimes.

Limb salvage is the WORST in PP... going to the hospital early/late/weekend, poor payers, those surgeries pay low yet 90d global (hence so many amps coded 28003 to avoid global), most are add-on and never start on time. There are a lot of results to chase down mri, path, wcx, consults, etc. Sure, the wound care wizardry can pay ok, but it's very resource-intensive and often just strings pts along with endless "grafts" and debride nonsense.

There is always finding that middle ground to do what pts need, but docs will tend to do what pays them at the end of the day. It's very situational hospital rvu versus PP versus wound center.

 

[icebreaker32]

To make a good salary and benefits with chiropody is not easy.

I used to think it was about ego many years ago, but more and more podiatrists on wRVU are not accepting nail patients and even some also in private practice in non saturated areas. I know of someone shot down by multiple different podiatrists for nail care. Even the podiatrist treating the wounds at the hospital, after it eventually went on to be a Q7 modifier applicable situation refused. I was not able to care for the patient myself due to my employment situation, but felt bad in this extreme example. Yes chiropody is not going away anytime soon, but perhaps it really should if saturation ever goes away in podiatry or be delegated to a medical assistant while the podiatrist is in the office for “supervision“. Obviously saturation is here for a very long time so chiropody is not going away.

If you have the luxury of only accepting traditional Medicare with private secondaries and really limit it, you likely have a good portion of your nail care patients you can also sell orthotics, lotions and anitfungals etc.

In saturated areas it is a way to get patients in the door and then you need to try hard to find other pathology to treat. Then of course there are there scammers with unnecessary PCR and foot soaks etc.

I have come to the conclusion as long as there are jobs advertised for chiropody on the internet our profession is saturated.

 

[619]

I would say verruca are actually creme de la creme for PP: very fast and easy, pays well, get 3 or even 5+ visits in quick succession. Ingrown and inject and other stuff is good, but they're essentially one and done with maybe a single 99213 follow up. Sometimes.

I personally love the one and done or maybe a follow up visit for 99213. Leaves my schedule open for more new patients to fill up. I don't want to fill up my schedule with endless follow ups. My typical day is 15-20 patients and half of them are new patients. I could easily fill up to 30 patients a day if I reschedule every patient for endless follow ups but I choose not to.
I do enjoy the verruca though to see them biweekly since 17110 has a 10 day global.

 

[619]

As a RVU based, hospital employed, foot and ankle podorthopedic surgeon, I will take all of the ingrowns. It’s still one of the most valuable office visits when billed correctly.

I am with you on ingrowns. I like them too and the billing is very straight forward. Hard to screw it up. 99204 + 11730 or 11750 (T modifier).
The billing is very straight forward and it always pays except if you forget the T modifier.

For me, a 99204 + 11750. Medicaid pays the lowest of around $220 and highest is Aetna (through an IPA) which reimburses about $750 for the same procedure. Average is around $350-$400 for the rest. Pays more than a toe amp or I&D at the hospital. Surgery for bunion or hammertoe reimburses close to $700 for most insurance and even less for medicare. You see why I will rather spend all my time in clinic.

 

[Feli]

I personally love the one and done or maybe a follow up visit for 99213. Leaves my schedule open for more new patients to fill up. I don't want to fill up my schedule with endless follow ups. My typical day is 15-20 patients and half of them are new patients. I could easily fill up to 30 patients a day if I reschedule every patient for endless follow ups but I choose not to.
I do enjoy the verruca though to see them biweekly since 17110 has a 10 day global.

This can very work well in ok or good economy, especially with little or no competition/saturation around. ^^
It's sort of the urgent care type of foot office. It definitely has its upside.

When times get thinner (overall economy) or if competition arrives (new pod schools, nearby hospital brings in a pod, etc), it can be very valuable to have the recursion of the "boring" follow-ups, nail pts, etc.... particularly the ones with good payers. The new patient appointments will begin to become more scarce, and some PCP sources are "lost" in those scenarios. I would much rather have the option to see a few follow-up visits than resort to chasing inpatients or having my budget get quite lean in those inevitable crunch times.

...In the end, I guess I want to have it all: new pts from PCPs, new pts find me from marketing, follow-ups, RFC pts, long term post-ops and post-trauma OA pts, quarter/semi/annual DM exam and shoe Rx pts, ER refers, second opinions... eveeeeeerything 👑