Increased Access for Podiatrists to Diagnostic Imaging

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APodA (NSW) are reporting:
Increased Access for Podiatrists to Diagnostic Imaging

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Lower-limb?

Trochanteric tendinopathy? Ischial bursitis? Patella tendinopathy?



Maybe we should increase our diagnostic skills first?

 

We can refer for x-ray up to the level of the head of the femur.

How is this any different - its just consistent with the plain film imaging provisions (by the sounds of it)?

Fan-bloody-tastic!!! Finally a good news outcome from APodC

Nothing like a bit of pre-election pork-barrelling to please the masses...good work Mr Abbott.

LL

 

Ummm....I, for one, don't have any training in interpreting radiograhic images of anatomical areas above the ankle particularly in relation to osseous diseases. Maybe 'lower limb' was a generalisation?

 

Scott (is that right?)

Podiatrists in Australia can refer for rebatable x-rays under the following Medicare item numbers:

Podiatrists may request:

57521 FOOT, ANKLE, LEG, KNEE OR FEMUR (R)
Fee: $43.40 Benefit: 75% = $32.55 85% = $36.90

57527 FOOT AND ANKLE, OR ANKLE AND LEG, OR LEG AND KNEE, OR KNEE AND FEMUR (R)
Fee: $65.75 Benefit: 75% = $49.35 85% = $55.90

In terms of interpreting "osseous diseases" above the ankle - the pathology doesn't change just because we aren't looking at a foot anymore. All of the common extremity pathologies (the arthridities, infection, trauma, metabolic conditions etc) all present in much the same way, whether you are looking at a foot, a knee, a hip, a wrist, an elbow or wherever. Same applies for ultrasound.

When you aren't sure, you can always pick up a textbook, or the phone and discuss with the radiologist. At least in this country, they are the one's ultimately responsible for (and who get paid for) radiological diagnosis.

LL

 

My point refers to the comments/questions raised by Atlas.

 

Scott

These are the points raised by Atlas.

I guess the point that I was trying to make (in the case of US) is that a bursitis or tendinopathy in the foot/ankle will appear ultimately in the same way as does everywhere else in the body.

However, this all becomes academic if you are not confident about diagnosis in the "upper" part of the lower extremity - or you haven't seen a lot of US scans of soft tissue pathology within the foot/ankle.

I have no doubt that the universities and Association will be on the move to upskill once this is confirmed to be going ahead. For instance, already here in Queensland one of our local podiatrists has been good enough to contact the Australian Institue of Ultrasonography on the Gold Coast, and they will be running a course on ultrasound for Podiatrists in a few months from now.

 

I can add to that point LuckyLisfranc, being a final year podiatry student at QUT. We have been lucky enough to be exposed to diagnostic US during the course (during third year in particular) and have had an ultrasonographer present to us and provide us with the basics of use of US and a good general undertsanding of it. From my point of view this is a positive outcome for Podiatrists

 

Has anyone heard of an "official" confirmation that this is truly through?

Or is it still "unofficial"?

Yet to see anything in print yet...

LL

 

I have seen a copy of the Ministers letter - its official.

 

Thanks Craig - was there any mention in the letter of the timeline for implemention?

LL

 

What about the use of diagnostic ultrasound by pods themselves? Will Pods be able to use Ultrasound in real time and bill Medicare??. I think this should be the next stage to aim for as we will be dependent on an ultrasonographer interpreting the image if we can only refer and I am not so sure on their detailed knowledge of foot anatomy. The advantage in US is being able to see it in real time and diagnose/interpret - the still images are difficult to read without viewing the real time display! Are we pushing for Pods to be able to use US equipment ourselves and bill Medicare??

 

Significant training in 3D transectional anatomy and the technicalities of sonographic imaging and interpretation would be a welcome addition to podiatry education - if I had my time all over again.

 

Cpcpod, in Australia we're never reliant on the ultrasonographer's interpretation - the radiologist reads it.

Also, with regard to the comments about pods using it themselves, it's a nice idea but perhaps we're oversimplifying how much training goes into radiography. In Melbourne I believe it's at least a 3 year undergrad degree with an compulsory internship to follow. We are the ones who grumble about quickie weekend courses in orthoses for other professions, after all....

Just a thought..

Richard

 

No, and not for a VERY long time, if ever - unlike our USA colleagues.

We already use a countless number of Medicare item numbers that are the same as those used by the medical profession (eg Doppler arterial assessment, nail surgery, podiatric (orthopaedic) surgical procedures...etc) - but the rebates on these item numbers are only restricted to medical practitioners. Where's the ACCC when you really need them, eh?

One useful step in this direction would be for the APodC to drop the "podiatry" item numbers we use, and adopt the HIC/Medicare item number set. This already is done by the ACPS. Then the government could really compare apples with apples, rather than apples with dried prunes.

As an aside, it was dissapointing that the proposal did not include the item number for ultrasonic-guided steroid injections! Why wasnt it on there? Its one thing to another diagnostic trick up your sleeve, but it sure would be better to offer patients more than a piece of plastic on the treatment front.

LL

 

If anyone is interested, there are 2 year postgraduate diplomas in sonography available in Australia [not sure with which universities] that would be worth checking out...but maybe this imaging area might well be left to specialist radiographers?

 

I suppose the more specialised the profession becomes over time, the likelihood is that practitioners will take an interest, do further training, invest in equipment and become known for performing US imaging, much the same way as other interest groups have developed (e.g. Paeds). The truth is that it can really only benefit us all if there are podiatrists practising with more advanced skill sets, but on the other hand we are just as likely to be damaged as a group by tiered levels of ability. If anyone's seriously interested, become an ultrasonographer (strangely, we have an unused unit in the office next door, although I haven't the feintest idea how to use it and probably won't in the near future). Still, if you have 2 years to spend on post-grad education, there's perhaps more diversity offered in a masters by coursework...
I agree with LL on iontophoresis though. After all, we are one of the few groups that regularly inject the foot and ankle... the use of imaging has meant that radiologists, who have access to it, have needed to become more involved in procedural therapeutics and it stands to reason that it can work both ways..

 

If anyone's seriously interested, become an ultrasonographer...Still, if you have 2 years to spend on post-grad education, there's perhaps more diversity offered in a masters by coursework...

The 2-year diploma in sonography, I'm told, is geared for health professionals who wish to work in the area at the same time as undertaking the course, so in effect it is actually part-time.

 

Generally to become a sonographer you need to have completed a Medical Imaging Degree first (though there are some exceptions)
Monash University Master of Medical ultrasound

But remember for a Medicare Rebate to apply

(b) the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)

ie: you can't reffer to youself

 

Has the diagnostic imaging upgrade been implemented yet. When will be able to forward on for soft tissue diagnostic ultrasound??

 

The APodC update, newsletter said Nov 07

 

Just received a letter from a local Radiology practice saying that from NOV 1st we are able to refer for ultrasound.