Benjamin W. Weaver,, CWS, DABPOPPM, FACFAOM, FAPWCA, FCCWS, FAAPPM, Physician Certified in Wound Care CMET President of the American Academy of Podiatric Practice Management Bringing It All Together using forms to accelerate better patient outcomes Mrs. Smith s CDFE It s Tuesday morning at 6:00am, and Mrs. Smith arrives for her scheduled appointment. Her diabetes is certainly getting the best of her. Mrs. Smith s gait is now shuffling as her legs often cramp up. She claims that she can barely feel the floor. Although she uses a walker, you just know that she is a hip fracture waiting to happen! Just yesterday, she found a small pebble inside of her shoe that nearly punctured her skin without her realizing it. She is forced to wear slippers since all of her other shoes irritate her hammer toes The Patient is Interviewed By Medical Assistant Mrs. Smith s history is significant for traumatic amputation of the left great toe at age 5 in a bicycle accident. She has severe hammertoes, fungal nails, extremely dry skin. She has bronzing of the shins bilaterally with redness to the left shin and pain with swelling.
H&P Treatment At risk nail care At risk callous care Diagnostics Nail Biopsy Education Recall Visit #1 Additional Considerations Dispense to patient diabetic foot care instructions and copies of PressureStat sheets with depiction of pre-ulcerative hot spots Dispense Amerigel blue for xerosis, Metanx, and Neuremedy for numbness RTC 1 week for ABI and shoe dispensement with L5000 and heat molded inserts
3 rd Visit Vascular Assessment Mrs. Smith is coming back for her Padnet- ABI/PVR study because Coding and Reimbursement Referral or no referral Reading physician More ABI s PADNet Primary Care More referrals Interventionalist Vascular surgeon CT angiogram Saved limbs and lives CPT Code 93923: Non-invasive physiologic studies of upper or lower extremity arteries, multiple levels or with provocative functional maneuvers, complete bilateral study (eg, segmental blood pressure measurements, segmental volume plethysmography) Medicare Avg. = $129.00 Per Test/Professional and Technical Medicare Avg. for Technical component only: 106.67 Reading Specialist using modifier -26: Medicare Avg = $21.82 Approximately 160 tests will pay for machine: At 5 tests per week, (127.00X5 X52) =33.5K Machine is paid for in less than a year JAMA 2008 Ankle-brachial index improves CV risk prediction ABI is rarely applied in routine clinical practice, as most clinicians are not aware that a low ABI is a marker of cardiovascular risk and would not know how to perform the test Results showed that a low ABI (0.90 or less) predicted vastly increased risks of 10-year cardiovascular mortality in both men and women. Biomedix PADnet System
3 rd Visit Cont Dispense diabetic shoes A5500 x 2 Dispense Heat molded inserts x 3 Right foot Dispense L5000 x 1 Left foot 4 th Visit Go over ABI results Refer to PT for cardiac rehabilitation. Mrs. Smith is coming back for her CVI because RTC 1 week for ABI results, CVI, f/u on Metanx, Neuremedy, and hydration of feet Biomedix PADnet+ What tests will my patient need? Venous Refill Time (PADnet +) Venous Refill Testing Photoplethysmography uses infrared light to asses capillary filling following exercise. Increased capillary filling is indicative of venous reflux and, consequently, incompetent veins.
Venous Refill Testing Non Invasive Study of Extremity Veins (CPT Code 93965-TC, 26) Effects of dorsiflexion maneuver Venous Refill Time (1 Block = 1 Second) 26 Venous Study Venous Study 27 28 Chronic Venous Insufficiency Early Detection Program 5th Visit PADNet Physical Therapist Vein Specialist Mrs. Smith we have the results from you vein test last week. They are abnormal, and I want to schedule with a vein specialist to discuss the treatment options they have available to you.
5 th Visit Cont Today, I am going to write order for a special trained Physical Therapist called a Certified Lymphedema Specialist, who will work on get some of the addition swelling out of your legs. They will teach how to take care of this chronic health condition on a day to day basis. Total Reimbursement over the Course of Treatment For Mrs. Smith The Smart Way Instituting CDFE s on all diabetic with using in office self referral forms Approximate profit $2500 The Not-So Smart Way No CDFE Approximate profit $59 WWW.AAPPM.ORG BWEAVER@ BWEAVER@AAPPM.ORG AAPPM. ORG