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PODIATRY
Definition of Podiatry:
In the United States, a podiatrist is a Doctor of Podiatric Medicine (DPM), also known as a podiatric physician or surgeon, qualified by their education and training to diagnose and treat conditions affecting the foot, ankle and related structures of the leg.
- Our team of podiatrists visit your facility at regularly scheduled intervals.
- Podiatry services are compensated by most insurance plans, Medicare Part B and Title IX. There are no Facility costs.
- Some of our services include soft tissue procedures like nail and callus care and treatment of ingrown and infected nails. We complement your staff in establishing a long term care plan for your residents.
- Medicare has very stringent guidelines for reimbursing Podiatric medical services. ROUTINE FOOT care advertised by some providers is NOT a covered service.
- Patients who receive services compensated by Federal or State Funds must meet very strict medical and demographic criteria. Aggeus Healthcare, meets and exceeds all applicable regulatory requirements. Your residents will receive the necessary medical services they are entitled to in accordance with your states patient care statutes, at no cost to your facility. Our physicians will evaluate and treat all residents who meet the Medicare requirements for Podiatric Serives.
- Nail management is covered by the Medicare Part B program not greater then, 4-5 times per year. Please call us to explain Medicare "Global Period" exclusions at 866-216-5518. Our Medical Director will speak or meet with you to discuss our services, their benefits and limitations.
Podiatric On-Site Services
- Initial examination, assessment, and care plan creation. Even ‘simple’ nail care requires careful patient assessment, a review of the patient’s medical history and a physical examination. Any and all physician- patient interaction must be charted in the resident’s medical record. others, skin and vascular assessment must be performed before a single nail or callus can be cut. The care plan portion of the medical record will reflect all findings, procedures and recommendations. This is the standard of care.
- Condition appropriate diagnostic testing. Vascular testing is not only required by Medicare and most insurances for diagnosis and reimbursement, but, it is the mainstay of our profession. Simply feeling for a pulse that may or may not be there is not sufficient. We must be able to document, and produce a record of the vascular examination, which includes Ankle Brachial Indeces (ABI’s) and wave patterns for further analysis.
- Nail debridement. This is defined as a surgical procedure (see Common Procedural Terminology) which reduces the fungal load of the nail plate. The nail’s thickness is diminished by the use of surgical cutters or electric or pneumatic rotary burrs.
"Medicare defines debridement as "a surgical procedure performed to remove all of the abnormal and/or diseased nail body/plate and debris of the infected nail bed."Reduction of the length or partial thickness of the nail body/plate should not be reported using the debridement Current Procedural Terminology (CPT) codes. Debridement may be performed by manual, mechanical, or chemical means."
http://www.wpsic.com/medicare/j5macpartb/faq/specialty/_files/b_type_footcare.pdf
- Callus Management. Calluses build up for several reasons. High pressure areas, areas of repeated friction, and areas of skin overlying deformed joints or bones tend to build up calluses or hyperkeratotic material for ‘protection.’ The body has no other means of creating a barrier to what it perceives as a dangerous event or trauma. If left untreated these areas tend to become painful and often may become infected. A painful callus frequently covers an area of soft tissue which has become ulcerated. When these calluses are removed the physician often finds a pocket of infection or pus.
- Wound debridement and management. We use the latest wound care materials by such vendors as Smith&Nephew and Johnson&Johnson, as well as, wound vacs, and pressurized irrigation and debridement devices.
- Selection of appropriate wound care materials and protocols
- Gait analysis and Balance testing
- Gait stabilization. We use certified pedorthotists to create the correct device for your residents’ individual problems. We advocate the use of custom-made devices when demanded by medical necessity.
- Fall prevention
- Physical Therapy referral. We will work with your physical therapy department to develop the best program for your residents.
- Evaluation and treatment of peripheral neuropathy. SWM 5.07 and NCV testing of peripheral neuropathy
- Evaluation and treatment of PVD/ASO
- Diabetic shoe program administration
Call us now to speak with one of our Directors: 866-216-5518
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Claudication is leg pain caused by poor blood flow in the legs.
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Routine Services
Medicare considers the elderly patient to be a higher risk patient, who may develop difficult to treat problems, if they are not seen regularly by a podiatrist. Residents of nursing homes qualify for "Routine Services" if they meet certain criteria. Medical statistics show a significant decrease in complications and need for expensive procedures if maintenance care is provided to the elderly every 2-3 months, as nails grow and thicken.
Lower Extremity Complications
The elderly frequently have poor blood circulation in the legs and feet(PVD), they may have diseases such as Diabetes, Neuropathy, and Edema. As a result nails will become thick and painful. The nails also become infected with fungus, once that has occurred they may also develop small bacterial infections called abscesses inside the nail itself. Because these conditions are longstanding and because the elderly patients have difficulty communicating what bothers them, these issues go unresolved.
Basic Podiatric Procedures
I&D
- Incision and Drainage. This is removing a pocket of infection that may not be obvious without first removing a part of the nail plate. This a definitive procedure that usually resolves the problem and does not require antibiotics. Nail abscesses once drained, generally do not present with symptoms of pain or further drainage, and follow up is minimal.
- This may also refer to draining a simple blister or a blood blister(hematoma).
Nail Avulsion
- This basic bedside procedure involves a simple removal of a part, or the whole of a nail plate using an injection of Lidocaine for local anesthesia. A wedge of nail is removed to decrease pressure on the nail bed or the nail groove. As nails thicken, debris and thickening of the skin around the nail's borders, causes discomfort and pain. Removing the thick or 'ingrown' nail border allows the podiatrist to clean out the nail groove and relieve the pressure and hence pain.
Ulcer Debridement
- A wound specialist uses a scalpel or special instruments(water jet) to remove nonviable material from the wound. In order to heal, wounds must be pink and free of debris. Wounds which do not bleed after debridement have a poor prognosis for healing. Circulation and a clean wound bed is essential for cells from the wound edge to migrate toward the center of the wound and assure closure.
- Wounds heal from the bottom up.
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