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
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.
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 medical
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.
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.
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.
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 Lag: 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 is limited to treating
ailments of the foot or ankle or structures attached to the 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 examination. The Board determined that it
is within the scope of practice for Maryland podiatrists to perform pre
operative History and Physicals.
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.
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
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.
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 requirement.
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.
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.
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.
The Board suggested that those practitioners who are interested in
expanding the scope of practice should address the Maryland Podiatrist
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 06/16/08
