News From ACFAS

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You have two opportunities to get a leg up on coding and billing from the comfort of your home or office! Whether you need an introduction into coding or the next level course, we have you covered.

Live-Streamed Coding and Billing for the Foot and Ankle Surgeon
Join us for the live-streamed Coding and Billing for the Foot and Ankle Surgeon course June 9-10. Taught by coding and billing experts, this comprehensive workshop is the perfect opportunity to take your coding and billing skills to the next level of reimbursement for the care you provide.

Gain knowledge of the ever-changing pertinent issues related to properly coding surgical procedures and evaluation and management services. Plus, at the end of the course, you’ll have the tools you need to code more efficiently and effectively—it’s an easy way to see an immediate return on investment in your practice.

Coding Fundamentals OnDemand
This pre-recorded course is now available through June 2 OnDemand for those in need of an introduction to coding and billing before June’s live-streamed Coding and Billing course.

This course will give you a background in coding and billing led by faculty members Danielle Butto, DPM, FACFAS and Sean Grambart, DPM, FACFAS. Walk away with the tools to understand the use of Evaluation and Management (E&M) and Current Procedural Terminology (CPT) codes in your practice, recognize the most common modifiers and their use in your practice, and understand how to code minor in-office procedures.

Visit acfas.org/PracticeManagement for more information on the upcoming coding courses. ACFAS Student Club Presidents play a key role as the liaisons between the College and their school. Each podiatric medical school has a club presence on campus and provides ways for students to get involved and learn outside of the classroom. Club Presidents and their officers coordinate various club activities, including presentations and lectures, surgical skills and suturing labs, discussion forums, new student recruitment, and more. Student Clubs are often podiatry students’ first interaction with the College and are instrumental in welcoming future foot and ankle surgeons into the profession.

Let’s welcome the newest class of ACFAS student leaders and wish them success in growing the ACFAS community!

AZPod: Dylan Mariano, Class of 2024
Barry: Sheena Cherukara, Class of 2024
CSPM: Youssef Moustafa, Class of 2024
DMU: Megan Palmer, Class of 2024
Kent State: Alexis Peters, Class of 2024
NYCPM: Marvin Durand, Class of 2024
Scholl: Taha Mahmood, Class of 2025
Temple: Jacklyn Zvonar, Class of 2024
Western U: Donya Rabadi, Class of 2025 Four newly released podcasts featuring the Case Study, Scientific, Systematic Review, Student Club and ASC Committee Choice Poster Award Winners from ACFAS 2022 are now available on ACFAS OnDemand. These podcasts are a miniseries of interviews with the poster authors led by the poster Chair, Katherine M. Raspovic, DPM, FACFAS and Jacob Wynes, DPM, MS, FACFAS.

Case Study:

• 1st Place – Poster No. CS-916: Incidence of Nonunion Following Naviculocuneiform Arthrodesis - A Retrospective Review of 61 Cases, Steven A. Tocci, DPM; Jacob A. Harder, DPM; Andrew M. Ganshirt, DPM and David M. Sved, DPM
• 2nd Place – Poster No. CS-903: Z-Shortening Technique to Repair an Overlengthened Achilles Tendon: A Case Report, Kristen M. Brett, DPM
• 3rd Place – Poster No. CS-1214: Pediatric Transmetatarsal Amputation Secondary to Complications of COVID-19, Sandeep K. Sandhu, DPM

Scientific:

• 1st Place – Poster No. SCI-319: Calcaneocuboid Joint Preparation in Charcot Reconstruction and its Effect on Postoperative Outcomes, Taylor J. Bunka, DPM
• 2nd Place – Poster No. SCI-305: Risk Factors and Surgical Outcomes in Patients With Positive Soft Tissue Cultures at Time of Closure, Robert Scheckler, DPM
• 3rd Place – Poster No. SCI-320: Outcomes in Drainage Ankle Disarticulation versus Guillotine Transtibial Amputation in the Staged Approach to Below Knee Amputation, Nicole K. Cates, DPM, AACFAS

Systematic Review:

• 1st Place – Poster No. SR-907: Time to Revision After Periprosthetic Joint Infection in Total Ankle Arthroplasty: A Systematic Review, Samantha A. Miner, DPM, AACFAS, and John A. Martucci, DPM, AACFAS
• 2nd Place – Poster No. SR-902: Functional Outcomes and Complications Associated with Total Talus Arthroplasty: A Systematic Review, Alex J. Bischoff, DPM
• 3rd Place – Poster No. SR- 301: Prevalence of Pseudomonas Aeruginosa in Diabetic Foot Infections in the United States: A Systematic Review and Meta-Analysis, Tyler L. Coye, DPM

Student Club:

• 1st Place – Student – 6: Comparison of Open versus Minimally Invasive Surgery in the Correction of Hallux Valgus Deformity: Temple University School of Podiatric Medicine, Shuran Zhang and Jennifer T. Vazquez

• 2nd Place – Student – 8: Conservative vs. Surgical First-Line Treatment of Navicular Stress Fractures in the Athlete Population: A Systematic Review and Meta Analysis: Midwestern University Arizona College of Podiatric Medicine, Desiree C. Major and Whitney Branham
• 3rd Place – Student – 9: Return to Activity After Excision of the Symptomatic OS Trigonum: A Systematic Review Comparing Arthroscopic Verses Open Excision: Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, Sarah E. Langer

ASC Committee Choice Award:

• Poster SCI-314: Predictive Value of Neutrophil to Lymphocyte Ratio in Wound Healing Among Patients Undergoing Transmetatarsal Amputations: A Retrospective Cohort Study, Jonathan D. Furmanek, DPM.

Access a roundup of award-winning research from ACFAS 2022 with the latest podcasts now on ACFAS OnDemand.

Foot and Ankle Surgery

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Researchers compared the outcomes following bone marrow stimulations (BMS) for osteochondral lesions of the talus (OLTs) in men and women between 2007 and 2015. Included were 31 females and 38 males. The mean Foot and Ankle Outcome Scores (FAOS) in female patients improved from 60±16 preoperatively to 84±8.9 at one- to two-year follow-up and then declined to 80±13 at final follow-up at three to four years. In male patients, the mean FAOS pain score improved from 65±17 preoperatively to 83±9.2 at one- to two-year follow-up before falling to 76±14.6 at final follow-up at three to four years. Lateral lesions occurred more frequently in male patients while medial lesions were more common in female patients. Post-BMS outcomes in both female and male patients were good with no significant differences at short term follow-up.


A study was held to calculate the minimal clinically important difference (MCID) of Patient Reported Outcome Information System Physical Function (PROMIS PF) scores for ankle fracture patients. There were 331 patients included in the distribution-based analysis and 195 patients in the anchor-based analysis. Mean age was 45.3 years and 59.4 percent of participants were female. MCID for PROMIS PF scores was 5.05 in the distribution-based method and 5.43 in the anchor-based method. The researchers concluded that this procedure can be used to identify patients outside the normal preoperative and postoperative models and may help to make clinically relevant practice decisions.


A study was held to calculate the incidence of adverse events (AEs) requiring revision after surgical fixation of "potentially stable" displaced isolated lateral malleolar fractures (ILMFs) prior to non-operative treatment becoming standardized. A stability-based classification system was applied to a cohort of 1,006 patients with AFs treated surgically from 2011 to 2016, which included 108 patients with "potentially stable" displaced ILMFs. Four patients had AEs requiring revision in the first 12 months after surgery, and another five had functionally significant AEs where revision surgery was not indicated within the first 12 post-surgical months. An additional five patients had AEs managed in the outpatient clinic, while 36 patients needed secondary implant removal because of implant-related discomfort. The results indicated that surgical fixation of ILMFs risks severe AEs, and many patients will subsequently require implant-removal operations.

Practice Management

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Racial discrimination is a widespread problem encountered by Black doctors in the US, some experts say. "We have scores of doctors that are sending us letters about these same discriminatory practices all the time and seeking our help as an association in fighting that," said National Medical Association President Rachel Villanueva. Attorney C.K. Hoffler, who is representing a Black doctor who is suing his former employer for racial-based marginalization and dismissal, said the law stipulates that racial bias cannot be used to penalize someone. "And that's what many, many highly skilled, highly trained, highly credentialed African American doctors are experiencing in this country," he explained. Black doctors in Georgia and elsewhere said the hierarchy and competition in hospitals can lead to people being targeted if they are disliked or viewed as professional threats, which racial prejudice can worsen.


There are five core elements of an effective physician practice merger, starting with open and direct communication with key players from the target practice. The merger or acquisition also needs to be mutually advantageous for both practices, while a shared vision and identity of the merged practice should be established early on. Furthermore, the critical details of the merger need to be carefully planned out, and an experienced transaction consultant can help in this regard. Finally, an integration team can play a vital role in the merger's successful execution and implementation, and a strong and well-executed integration plan is required to guarantee a smooth transition.


Negotiating favorable payer contracts can be easier for medical practices that secure copies of payer contracts and fee schedules and that consider alternative payment schemes like joining an accountable care organization or clinically integrated network. Providing cost and quality data should also be part of their strategy, as they likely participate in Medicare's Merit-based Incentive Payment System. Other suggestions include practices differentiating themselves from local peers in terms of the value they can offer payers; specifying their volume of active patients and considering an escalator clause that ensures a specific payment increase during a define period. A payer analysis can compare different payers' payment rates, and practices can negotiate carve-outs for high-utilization services.. They can also add services to their fee schedule and have a clear idea of when to terminate a payer contract.

Health Policy and Reimbursement

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The US House Energy and Commerce Committee said that its proposed user fee authorization bill will include a revised policy from US Rep. Frank Pallone (D-NJ) to facilitate the US Food and Drug Administration's (FDA's) ability to withdraw approval for drugs cleared through its accelerated approval pathway if drugmakers fail to conduct required follow-up studies. More than 90 patient groups recently wrote to lawmakers asserting that "establishing clear circumstances under which the expedited withdrawal of an accelerated approval product would be appropriate is important for holding drugmakers accountable." The latest version of Pallone's user fee legislation calls for FDA to meet with the drugmaker, respond to all public comments and convene an expert panel on the decision if a sponsor requests such a meeting. Furthermore, the bill includes language enabling drugmakers to "support" or "augment" their follow-on studies using so-called real world evidence. The accelerated approval reforms comprise just one medicine-related "rider" in the user fee bill, which provides approximately one-half of FDA's operating budget and must be passed by the end of September. If enacted, the bill would let drug and device manufacturers share information about their products with insurers before the product is formally approved, require drugmakers to submit their "action plans" to FDA for diversifying their clinical trials and allow FDA to approve generic drugs even when the label of the drug they are copying has changed in the prior 90 days.


A recent Health Affairs study found that the US Centers for Medicare and Medicaid Services telehealth waiver led to an expansion of virtual care services during the pandemic and increased access to those services to Medicare beneficiaries in disadvantaged neighborhoods. Researchers' analysis of Medicare fee-for-service claims for individuals with at least one outpatient visit between January 1, 2019, and March 31, 2021, revealed that before the waiver, the telemedicine utilization rate was stable across the Area Deprivation Index (ADI) quartile for socioeconomic disadvantaged neighborhoods. After the waiver, utilization increased across all ADI quartiles, with beneficiaries in the most deprived communities experiencing a 28.9-fold increase.

Medicine, Drugs and Devices

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Computerized medication cabinets — or automated dispensing cabinets — help US hospitals keep track of hundreds of drugs efficiently, but the technology carries risk from human error. The nurses who typically access them often must search by name, with the field of possibilities narrowing with each consecutive letter entered. Most of the systems are designed to allow a search with only a few letters, which sets the user up to inadvertently choose the wrong medication. "One letter, two letters or three letters is just not enough," declares Michael Cohen, president emeritus of the nonprofit Institute for Safe Medication Practices (ISMP), which has been gathering error reports from medical professionals since the 1990s. Typing in M-E-T, for example, would yield results including the diabetes drug metformin and the antibiotic metronidazole — a significant error if the wrong one is selected and administered. According to reports provided by ISMP, mix-ups in the past few years have involved staffers mistakenly pulling the paralytic vecuronium instead of the sedative Versed, the pain reliever ketorolac instead of the anesthesia drug ketamine, the diabetes treatment Pitressin instead of the labor inducer Pitocin and the antibiotic Rocephin and overdose antidote Romazicon instead of the paralytic rocuronium. Medicine cabinet makers Omnicell and BD are updating their technology so that users get search results only after entering five-plus letters, but so far hospitals have the ability to turn these features off.


A study in the European Journal of Radiology found magnetic resonance imaging (MRI) to be superior to ultrasound for assessing plantar plate injuries, although the latter accommodates dynamic stressing of plantar structure during imaging and is more sensitive than MRI. The investigators analyzed 10 studies covering 227 MRIs and 238 ultrasounds. They determined that foot ultrasound beat foot MRI on pooled sensitivity, 95 percent to 89 percent, while trailing on specificity, 52 percent to 83 percent. The outcomes suggest a negative ultrasound "would likely rule out a plantar plate injury in the presence of an equivocal physical exam," the authors commented. However, grading injury severity "is best served with MRI," in view of the scan's ability to "provide added insight into the joint's supporting structures (e.g., collateral ligaments) and integrity."


Insurance plans can start raising the price of drugs less than a month after Medicare's drug plan enrollment period terminates in early December. An AARP analysis found the list prices for the 75 brand-name drugs most frequently prescribed to Medicare enrollees climbed as much as 8 percent between the end of December 2021 and the end of January 2022. Regardless of how much the prices go up, most beneficiaries cannot switch to cheaper plans after Jan. 1, said Fred Riccardi of the Medicare Rights Center. Meanwhile, Medicare officials admit that drugmakers' prices and out-of-pocket costs can fluctuate. "Your plan may raise the copayment or coinsurance you pay for a particular drug when the manufacturer raises their price or when a plan starts to offer a generic form of a drug," Medicare notes on its website. AARP is urging Congress to pass legislation to control drug prices.