Treatment notes from podiatrist

[Creflo]

I am a podiatrist who treats nursing home patients. In order to get medicare to pay for nail and callus care, I often need a diagnosis of peripheral vascular disease (which this patient population often has, but often isn't charted). I have been advised by a well known medicare billing consultant that I can make the diagnosis, but need to notify the primary care provider by fax that I have made the diagnosis and request that the pcp perform follow up treatment as deemed necessary for this condition. My concern is that this will be seen as a hassle, leaving the MD/DO to wonder if they need to order ABI studies, vascular consult, etc. when my only real intention is to pass a medicare audit. Any advice?

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[deleted87716]

I can only speak for myself, but I wouldn't consider it a hassle. Depending on the patient, no action may be needed. If necessary, ordering ABIs is no big deal.

 

[deleted87716]

Just curious, though...how are you making the diagnosis?

 

[Creflo]

Non palpable pedal pulses, absent hair growth on feet, thin skin on feet. These are "class findings " in medicare language that help qualify the patient for reimbursement for otherwise non covered nail care.

 

[deleted87716]

Got it. Again, no problem from me.

I appreciate the fact that patient care is a team effort. Not everyone does, of course. I recently saw a new patient who transferred care from one of my colleagues in another office in our group practice because he went ballistic over the fact that the patient's dentist had the AUDACITY, the SHEER UNMITIGATED GALL, to order a HgbA1c (on a morbidly obese patient with periodontal issues) which was (unsurprisingly) in the diabetic range. The dentist (appropriately) told the patient to see her PCP ASAP. The patient thought it was odd that her PCP would be pissed off over what was, obviously, a good pickup on the part of the dentist.

 

[smq123]

Got it. Again, no problem from me.

I appreciate the fact that patient care is a team effort. Not everyone does, of course. I recently saw a new patient who transferred care from one of my colleagues in another office in our group practice because he went ballistic over the fact that the patient's dentist had the AUDACITY, the SHEER UNMITIGATED GALL, to order a HgbA1c (on a morbidly obese patient with periodontal issues) which was (unsurprisingly) in the diabetic range. The dentist (appropriately) told the patient to see her PCP ASAP. The patient thought it was odd that her PCP would be pissed off over what was, obviously, a good pickup on the part of the dentist.

He was upset that the dentist provided good quality care?

Ooookay.

 

[deleted87716]

He was upset that the dentist provided good quality care?

Ooookay.

I agree. He's a good doc, but he can be a bit of a dick at times. His argument was that the dentist shouldn't be ordering "medical" tests. I think he was actually a bit embarrassed for not picking it up himself.

 

[VA Hopeful Dr]

I agree. He's a good doc, but he can be a bit of a dick at times. His argument was that the dentist shouldn't be ordering "medical" tests. I think he was actually a bit embarrassed for not picking it up himself.

I actually get madder when dentists/oral surgeons tell me what tests I have to order so they can do surgery on my patients. I wish more would do their own work.

 

[TableMD]

I actually get madder when dentists/oral surgeons tell me what tests I have to order so they can do surgery on my patients. I wish more would do their own work.

I think this comes down to not wanting to own the test results. If they ordered it and didn't want to manage any problems, they could get it to us. Sigh.

No reason whatsoever why a podiatrist couldn't dx vascular insufficiency as noted above. Anyone who provides foot care for nursing home patients should be supported.

 

[BigSib]

It makes sense that you should assess the patient for the appropriate diagnosis and ensure they have adequate treatment thereafter. The other aspect is if this is primarily in a nursing home population I'm probably not going to do anything for the vast majority of the patients that carry this diagnosis.

 

[Bacchus]

It makes sense that you should assess the patient for the appropriate diagnosis and ensure they have adequate treatment thereafter. The other aspect is if this is primarily in a nursing home population I'm probably not going to do anything for the vast majority of the patients that carry this diagnosis.

I understand you're not speaking in definites, but remember there are a wide array of "nursing" homes. My mom works in a "nursing" home. It's an assisted living facility. I did nursing home rounds in residency at a SNF, assisted living and in between. The majority of nursing home patients are active elders and would potentially benefit from risk reduction measures for their PVD and assumed CVD.

 

[VenusinFurs]

I agree, if a podiatrist wanted me to follow up on a clinical diagnosis of PAD I would be happy to, I often have patients who have seen the podiatrist multiple times in the past 6 months but haven't seen a pcp in that whole time

Yes, I realize that is horrendous and I gotta say I work in a p frustrating area sometimes

 

[SilentCool]

I wouldn't let some nail-clipper tell me what to do. If they wanna diagnose PAD, let them treat it.