Index
Scope Definitions
Practice Issues Discussed by the Board
- Symes Amputation
- Musculoskeletal Ultrasound
- Venous Stasis Ulcer
- Coding and Practice Management
- Harvest Skin Graft on the Leg
- Common Peroneal Nerve Release
- Split Thickness Skin Graft
- Electronic Medical Records Program
- Medical Records Act
- Botox Injections
- Acupuncture
- Ring External Fixation
- Pulse Dye Laser to Remove Lesions of the Lower Leg
- Perform Pre Operative Examination
- Primary Lateral Ankle Stabilization Procedure
- Blood Sequestering
- Ultrasound and Fluoroscopy
- Performing nerve conduction studies in the office with an
outside company
- Wound Care Specialist Certification
- Procedure in an ASC vs. Practice Act Section 16-103(a)
- Performing CPT 76942
- Low Dye Strapping/Taping
- Nerve Conduction Velocity Testing
- CPT 95937: Neuromuscular Junction Testing
- Administration of an Anesthetic for a Syme's Amputation
- Low Level Laser Therapy
- Podiatric assistants and the cutting of nails
- Closed reduction of acute ankle fractures
- Hyperbaric Oxygen Therapy
- CPT Code 99354—Prolonged Services with Direct Face-to-Face
Patient Contact Service
- CPT Code 76942 Ultrasound guided injections
- Podiatry Services and Preferred Vendors
- Nerve Conduction Studies
- Radiographs
- Total Ankle Joint Replacements
- Repair of Acute Fracture of the Ankle Joint
- Interpretation of "Acute Ankle Fracture"
- CPT Code 11422: Requirements of procedural code identified as
11422
- CPT Codes L1970 and L2210
- Advertising Off Label Use of Lasers for Treating Toenail Fungus
Questions
What's not Included
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: The Board affirmed its
prior determination that podiatrists may assume the responsibilities of
Administrative Medical Director of a hyperbaric center; however, podiatrists may
not assume the supervision of whole body Hyperbaric Oxygen Therapy. The Board
determined that administering Hyperbaric Oxygen Therapy localized to the lower
extremities is within the scope of practice of podiatry in Maryland.
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: 04/15/2010