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MBPME : scope

For Your Information: Scope of Practice Issues

Index

  1. Symes Amputation

  2. Musculoskeletal Ultrasound

  3. Venous Stasis Ulcer

  4. Coding and Practice Management

  5. Harvest Skin Graft on the Leg

  6. Common Peroneal Nerve Release

  7. Split Thickness Skin Graft

  8. Electronic Medical Records Program

  9. Medical Records Act

  10. Botox Injections

  11. Acupuncture

  12. Ring External Fixation

  13. Pulse Dye Laser to Remove Lesions of the Lower Leg

  14. Perform Pre Operative Examination

  15. Primary Lateral Ankle Stabilization Procedure

  16. Blood Sequestering

  17. Ultrasound and Fluoroscopy

  18. Performing nerve conduction studies in the office with an outside company

  19. Wound Care Specialist Certification

  20. Procedure in an ASC vs. Practice Act Section 16-103(a)

  21. Performing CPT 76942

  22. Low Dye Strapping/Taping

  23. Nerve Conduction Velocity Testing

  24. CPT 95937: Neuromuscular Junction Testing

  25. Administration of an Anesthetic for a Syme's Amputation

  26. Low Level Laser Therapy

  27. Podiatric assistants and the cutting of nails

  28. Closed reduction of acute ankle fractures

  29. Hyperbaric Oxygen Therapy

  30. CPT Code 99354—Prolonged Services with Direct Face-to-Face Patient Contact Service

  31. CPT Code 76942 Ultrasound guided injections

  32. Podiatry Services and Preferred Vendors

  33. Nerve Conduction Studies

  34. Radiographs

  35. Total Ankle Joint Replacements

  36. Repair of Acute Fracture of the Ankle Joint

  37. Interpretation of "Acute Ankle Fracture"

  38. CPT Code 11422: Requirements of procedural code identified as 11422

  39. CPT Codes L1970 and L2210

  40. Advertising Off Label Use of Lasers for Treating Toenail Fungus

 


HEALTH OCCUPATIONS ARTICLE
 TITLE 16. PODIATRISTS

Subtitle 1. Definitions; General Provisions.

§ 16-101. Definitions.

 

(a) In general. – In this title the following words have the meanings indicated.

(b) Board. – “Board” means the State Board of Podiatric Medical Examiners.

(c) License. – “License” means, unless the context requires otherwise, a license issued by the Board to practice podiatry.

(d) Licensed podiatrist. – “Licensed podiatrist” means, unless the context requires otherwise, a podiatrist who is licensed by the Board to practice podiatry.

(e) Podiatrist. – “Podiatrist” means an individual who practices podiatry.

(f) Practice Podiatry – (1) “Practice podiatry” means to diagnose or surgically, medically, or mechanically treat any ailment of the human foot or ankle, or any ailment of the anatomical structures that attach to the human foot.

                                     (2)”Practice podiatry” does not include:

                                           (i) Surgical treatment of acute ankle fracture; or

 

                                           (ii) Administration of an anesthetic, other than a local anesthetic.

 

§ 16-102. Scope of title.

(a) Individual exempt. – This title does not limit the right of an individual to practice a health occupation that the individual is authorized to practice under this article.

(b) Commercial sale or fitting. – This article does not affect the commercial sale or fitting of shoes or foot appliances.

 

 

§ 16-103. Procedures required to be performed in a licensed hospital.

(a) In general – - All surgical procedures of the ankle below the level of the dermis, arthrodeses of 2 or more tarsal bones, and complete tarsal osteotomies that are performed by a licensed podiatrist shall be performed in a licensed hospital, subject to the provisions of §19-351 of the Health-General Article.

(b) Requirement for procedures in ambulatory surgical center. – A licensed podiatrist who performs an osseous surgical procedure of the ankle, arthrodesis for 2 or more tarsal bones, or a complete tarsal osteotomy in a licensed ambulatory surgical center must:

                                           (1) Have current surgical privileged at a licensed hospital for the same procedure; and

                                          (2) Meet the requirements of the ambulatory surgical center.

 

(c) Qualification requirement and delineation of privileges by hospital or ambulatory surgical center. – Nothing in this title shall prohibit a licensed hospital or ambulatory surgical center from establishing qualifications or delineating privileges for the performance of surgical procedures of the human foot or ankle, the anatomical structures that attach to the human foot, or the soft tissue below the mid-calf by a licensed podiatrist in the hospital or ambulatory surgical center.

 


SCOPE OF PRACTICE ISSUES DISCUSSED BY THE BOARD

 

1) Symes Amputation: The Board determined that Symes Amputation is within the scope of practice in Maryland. This procedure must always be performed in a hospital setting.

 

25) Administration of an Anesthetic for a Syme's Amputation: The Board reviewed the inquiry and determined that Syme's amputation is within the scope of practice of podiatry in Maryland. Also, the Board determined that an anesthesiologist could administer an anesthetic other than a local for podiatry surgery.

2) Musculoskeletal Ultrasound: The Board stated that a trained podiatrist may use the machine as a diagnostic tool and in therapeutic treatment if it is used within the scope of practice set forth in the Podiatry Act.

3) Venous Stasis Ulcer: The Board determined that it is within the scope of practice for a podiatrist to treat a venous stasis ulcer of the medial ankle.

4) Coding and Practice Management: The Board determined that it is not appropriate for podiatrists using pulse dye laser for warts to bill using CPT codes 17106, 17110 and 17111. The Board determined that the procedure should be billed using the 17000 codes.

5) Harvest Skin Grafts on the leg: The Board determined that harvesting skin grafts on the leg and treating venous stasis wounds on the leg are not within the scope of practice because the primary wound is above the ankle.

7) Split Thickness Skin Grafts: The Board determined that it is not within the scope of practice for a podiatrist to perform split thickness skin graft taken from the thigh.

6) Common Peroneal Nerve Release: The Board determined that it is not within the scope of practice to perform a common peroneal nerve release from the fibular head.

8) Electronic Medical Records Program: The Board determined that a program that replaces paper charting with electronic charting is an acceptable method of documentation. However, the Board strongly urges that the electronic chart be systematically backed up.

9) Medical Records Act: The Act states that if a patient wants his record or x-ray he is entitled to copies within a reasonable period. The patient may not be entitled to the original chart, unless for litigation purposes. For full review of this law see: Health General Article 4-301 et seq.

10) Botox Injections: The Board of Podiatric Medical Examiners reviewed the request to offer the procedure of Botox injections for the treatment of Hyperhydrosis of the feet. The Board determined that the administration of this procedure is within the scope of practice for licensed podiatrists in Maryland.

11) Acupuncture: Still pending; currently undecided.

12) Ring External Fixation: The Board reviewed the inquiry regarding the use of ring external fixation, which is placed above the ankle joint for fixation when performing ankle arthrodeses. The Board determined that the administration of this procedure is within the scope of practice for licensed podiatrists in Maryland. The Board also determined that ankle distraction, which requires the use of ring fixators as well as injectable synovial fluid such as Supartz, is within the scope of practice.

13) Pulse Dye Laser to Remove Lesions of the Lower Leg: The Board reviewed the inquiry regarding the use of a pulse dye laser to remove vascular lesions of the lower leg to the tibial tuberosity. The Board determined that this procedure is not within the scope of practice for Maryland podiatrist because the practice of podiatry means to diagnose or surgically, medically, or mechanically treat any ailment of the human foot or ankle, or any ailment of the anatomical structures that attach to the human foot.

14) Perform Pre Operative Exam: The Board reviewed an inquiry regarding whether it is in a podiatrist’s scope of practice to perform the history and physical portion of pre operative examinations. The Board determined that it is within the scope of practice for Maryland podiatrists to perform pre operative History and Physicals. The required credentialing to perform H&Ps are determined by individual hospitals or ASCs.

15) Primary Lateral Ankle Stabilization Procedure: The Board determined that the law specifies that this procedure can only be performed in a hospital setting where emergency equipment and personnel are at hand.

16) Blood Sequestering: The Board determined that the blood sequestering process when applied to utilization of the Harvest Technology is within the scope of practice for a podiatrist licensed in Maryland. However, the Board is not able to confirm the CPT code that should be used for this procedure.

17) Ultrasound and Fluoroscopy: The Board confirmed that ultrasound and fluoroscopy are radiologic procedures that are FDA approved, non-experimental, and fall within the scope of practice of podiatry in Maryland.

18) Performing nerve conduction studies in the office with an outside company: This procedure is within the scope of practice of a Maryland podiatrist. It is acceptable to order and provide the technical component of the nerve conduction studies. However, be advised that specific insurance companies may not recognize a podiatrist performing these studies and thereby deny reimbursement.

33) Nerve Conduction Studies: The Board revised the prior determination as follows: Nerve conduction testing is within the scope of practice for the evaluation of nerve symptoms of the lower extremities. The Board determined that a licensed podiatrist can delegate the performance of this testing under his or her supervision.

19) Wound Care Specialist Certification: The Board has received numerous inquiries regarding the appropriateness of wound care performed above the ankle. All practitioners as well as those who have received certification from the American Academy of Wound Management may only practice wound care that is within the Scope of Practice for Maryland podiatrists as defined in Section 16-101(f). The Board will actively investigate any violation of the Practice Act relating to wound care.

20) Procedures in an ASC vs. Practice Act Section 16-103(a): The Law states that all surgical procedures of the ankle below the level of the dermis, arthrodese of 2 or more tarsal bones, and complete tarsal osteotomies that are performed by a licensed podiatrist must be performed in a licensed hospital. Consequently, these procedures may not be performed in any ASC whether it be office or hospital based.

21) Performing CPT 76942: The Board has determined that performing CPT 76942, using ultrasound imaging for the placement of injections in the foot, ankle or leg (below the level of the mid-calf) is considered within the scope of practice of Podiatry.

31) CPT Code 76942 Ultrasound guided injections : The Board has determined that using ultrasound imaging for the placement of injections in the foot, ankle or leg (below the level of the mid-calf) is considered within the scope of practice of podiatry and is coded as CPT Code 76942.

22) Low Dye Strapping/Taping: The Board reviewed this scope of practice inquiry and determined that low dye strapping/taping can be performed by a medical assistant under the supervision of a podiatrist. The Board discussed that according to Medicare guidelines, this service must be performed by the podiatrist to be eligible for reimbursement. The Board advised that for billing purposes, podiatrists should consult with the individual carriers for their requirements.

23) Nerve Conduction Velocity Testing: The Board determined that nerve conduction velocity testing is within the scope of practice of Maryland licensed podiatrists and that any and all diagnostic related procedures shall remain limited to the soft tissue no higher than the level of the mid-calf. Additionally, a licensed podiatrist may indeed delegate the performance of such testing to a technician under his or her direct supervision.

24) CPT 95937: Neuromusular Junction Testing: The Board reviewed the inquiry and determined that Neuromuscular Junction testing using CPT 95927 is within the scope of practice of podiatry in Maryland.

26) Low Level Laser Therapy: The Board determined that the use of low level laser therapy to treat the human foot or ankle, the anatomical structures that attach to the human foot, or the soft tissue below the mid-calf is within the scope of practice of podiatry in Maryland.

27) Podiatric assistants and the cutting of nails: The Board affirmed its prior determination that a podiatric assistant may debride/cut nails under the supervision of a podiatrist. The Board noted that a podiatrist may not bill Medicare for this service when performed by a podiatric assistant. According to Medicare guidelines, this service must be performed by the podiatrist to be eligible for reimbursement. For billing purposes, you should consult with the individual insurance carrier for their requirements.

28) Closed reduction of acute ankle fractures: A Maryland licensed podiatrist may perform closed reduction of an acute ankle fracture.

29) HYPERBARIC OXYGEN THERAPY BY PODIATRIC PHYSICIANS : It is the Board’s opinion that the LCD by CMS of 5/1/2011 represents the current delineation of Hyperbaric Oxygen Therapy by Podiatric physicians.

Podiatric physicians may supervise hyperbaric oxygen therapy if such a service is within their State scope of practice. However, such supervision is only covered/reimbursed when the body area or condition being treated by the hyperbaric oxygen is also within the scope of practice (e.g., a diabetic wound of the leg distal to the mid calf).

Physicians supervising hyperbaric oxygen therapy should be certified in Undersea and Hyperbaric Medicine by the American Board of Emergency Medicine (ABEM) or the American Board of Preventive Medicine (APBM) or must haw completed additional training in hyperbaric medicine, such as the 40-hour training required by the ABPM Advanced Cardiac Life Support (ACLS) training and certification of supervising physicians (and NPPs) is required in physician offices and off-campus hospital sites; and in on-campus provider-based departments for which provider-response time to the chamber can be expected to exceed five minutes.

30) CPT Code 99354—Prolonged Services with Direct Face-to-Face Patient Contact Service: The Board determined that CPT code 99354 is within the scope of practice of podiatry in Maryland.

32) Podiatry Services and Preferred Vendors: The Board determined that it is within the scope of practice of Maryland podiatrists to prescribe, manufacture and dispense orthotics. Concerns regarding preferred vendors are outside of the Board’s purview.

34) Radiographs: Please be advised that all radiographs must be labeled to include the following information: Patient name, Date, Appropriate extremity (Left/Right), Podiatrist’s name, and City and State in which the practice is located.
When reviewing patient records, the Board has found that in many instances, this information is identified on the actual digital radiographic images, but not printing on copies provided for patients. Digital X-ray vendors may need to be contacted to update software, so that this information can be generated on any copies that are being provided.

35) Total Ankle Joint Replacements: The Board identified that total ankle joint replacement is within the scope of practice of podiatry

36) Repair of Acute Fracture of the Ankle Joint: This procedure is currently not within the scope of practice. Please see the October 2009 Public Minutes for further information.

37) Interpretation of "Acute Ankle Fracture": The Board affirmed its prior determination that applying a single static timeframe to all ankle fractures is inappropriate and that sound clinical judgment applied on a case by case basis which includes the completion of a thorough clinical assessment is required.

38) CPT Code 11422: Requirements of procedural code identified as 11422:This code only requires excision and does not require wound closure. The Board advises that podiatrists may obtain additional information regarding CPT codes by referring to the current edition of the American Medical Association’s Current Procedural Terminology (CPT) manual.

39) CPT Codes L1970 and L2210:CPT Codes L1970 and L2210 for addition to lower extremity, dorsiflexion assist (plantar flexion resist) each joint are within the scope of practice of podiatry.

40) Advertising Off Label Use of Lasers for Treating Toenail Fungus: Pursuant to the Board’s Regulations, advertisements may not include statements containing misrepresentations of facts that are likely to mislead or deceive because in context the statement makes only partial disclosure of relevant facts; and likely to create false or unjustified expectations of favorable results. Code of Maryland Regulations (COMAR) 10.40.06.03. This applies to devices not FDA approved or cleared for the treatment of toenail fungus, and must contain a statement indicating that the device has not received FDA approval or clearance.


The Board suggested that those practitioners who are interested in expanding the scope of practice should address the Maryland Podiatric Medical Association (MPMA) at 1 800 560 1818 for legislative action on behalf of the profession.

Want to know if a procedure is within the scope of practice of podiatric medicine in Maryland? Then fax in your request to (410) 358 3083. Please note that the Board meets on the second Thursday of every month.

 


What’s Not Included in the Practice of Podiatry

Many products and programs have been developed that involve multilevel marketing and product selling. These programs, while pursued in a personal setting, have no impact on the Maryland licensing restrictions of Podiatric Medicine. However, while pursued in the doctor’s office in the treatment of patients, these products become a tool of the podiatrist in patient care. As such, it is important for the podiatrist to realize the scope of his/her practice. It is the opinion of the Board that offering “non medical” products for the treatment of hypertension, weight, cholesterol, and/or other similar medical problems does not, generally, fall within the scope of practice of a podiatrist in the State of Maryland.

Last Updated: 06/15/2014