Care FAQs
Below you will find answers to questions we frequently receive. Patients at Performance Orthopaedics & Sports Medicine in Metro Atlanta, including Duluth, and Snellville, Georgia find this information helpful. Should you need further assistance, please call us at (404) 973-2444 and we will happily answer your questions.
What to Expect
You can make an appointment by calling the office at (404) 973-2444, or by having your primary care physician’s office schedule the appointment, or by requesting an appointment online.
We ask that you allow at least one hour for your appointment. Due to the nature of our specialty – caring for acute injuries – we work in emergencies as needed to provide the best care to all. Initial visits usually take one hour with follow-up visits being shorter, depending on the complexity of the problem.
At the time you schedule your appointment, you will be given a password to access your personalized patient account online. You may log in to www.pbomd.com, go to the patient portal at your leisure, and fill out all of the necessary paperwork, which will then be available to us at the time of your appointment.
If this is not convenient for you, you can download the forms from our website and fill them in prior to your appointment, or the forms can be emailed to you.
It is important for you to bring your X-rays from the emergency room with you to your visit. If the ER or hospital did not give you a copy when you left, you will need to go to the department of radiology and have them give you a copy.
If we must repeat X-rays, some insurance companies may not pay for the additional X-rays.
At Performance Orthopaedics & Sports Medicine, we see patients of all ages, particularly focusing on acute injury and sports care.
Dr. Martin specializes in adult sports medicine, pediatric sports medicine, and pediatric and adult orthopedics, uniquely combining these skills for the new spectrum of lifelong activity.
Having completed fellowships in both sports medicine and pediatric orthopedics, Dr. Martin is highly capable of caring for athletes and active individuals of all ages.
- American Academy of Orthopaedic Surgery (AAOS)
- USA Swimming for Tips & Training, Injury Prevention
- spineuniverse.com
- stopsportsinjuries.org
- webmd.com
- medlineplus.gov
Yes, for your convenience, we offer same-day appointments for our pediatric and adult patients. You don't have to put your life on hold just because you experienced an injury.
In-Office and Surgical Care
For your convenience, we offer same-day appointments for trauma care. If you or your child has an acute injury, fracture, or possible fracture, please call our office and we will get you an appointment as soon as possible.
Some injuries need to be seen and taken care of early to have the best recovery. Some fractures need to be splinted while waiting for the swelling to go away prior to putting the patient in a cast.
Occasionally, if you have a fracture that needs to be set, you will have to go to the emergency room or require surgery to fix the fracture. If you have been seen in the emergency room, call our office and talk with one of our schedulers. We will make sure that you are seen as soon as possible.
Pain and swelling are normal after a fracture. Make sure that the extremity is elevated, and make sure that the splint is not on too tightly. This is the best way to minimize swelling.
You can also put an ice pack directly over the fracture or the splint at the area of the fracture. If the pain does not respond to elevation and pain medication, call our office.
Yes, we have waterproof casts. The difference between a waterproof and non-waterproof cast is the Gore-Tex® lining. All fiberglass cast material is waterproof, but the lining is typically made out of a soft cotton-like material that is not waterproof.
A waterproof Gore-Tex lining allows you to bathe and swim as you normally would. Not all fractures are suited for Gore-Tex, however. Long-arm and long-leg casts usually don’t do well with Gore-Tex because it is hard for the water to drain out of the cast. Also, very young children (3 years and under) may not tolerate the waterproof material.
Yes, we have X-ray capabilities in each of our offices. We have certified radiologic technologists who are able to perform all standard radiographic techniques. Occasionally, Dr. Martin will order additional tests such as a bone scan, CT, or MRI, which needs to be scheduled, pre-certified with your insurance, and done at either a hospital or a specialized imaging center.
After you and Dr. Martin agree that surgery is necessary for you or your child, we will call you to schedule the date, and then we will notify the surgery center.
The surgery center will send you a surgery packet and will call you to confirm the surgery date. They will give you any pre-operative instructions including when to stop eating and drinking, when to arrive, where to come, and what to bring with you.
If you are having surgery on your lower extremities, please bring crutches to the surgery center with you.
When preparing for surgery, your post-op physical therapy will be scheduled as well as your follow-up with Dr. Martin.
If you or your child needs a specialized radiology exam, like a CT or MRI, our office will call you within 48 hours of your appointment to schedule the study. Our staff will obtain all the necessary information from you and then schedule an appointment for your CT or MRI.
After your test, the results will be faxed to our office within a few days. Dr. Martin will then review the studies and call you with the results or go over it with you at your follow-up appointment.
The amount of time this process takes can vary, with most test results back within a few days and some particular tests taking a bit longer.
There are several factors to consider when choosing a physical therapy facility: your location, your insurance plan, the type of therapy the doctor recommends (physical or occupational), and the particular condition being treated.
Dr. Martin works with an extensive network of rehabilitation specialists and she will generally recommend someone in your area and in-network with your insurance.
In other cases you may contact your insurance company and inquire about the physical therapy locations that are in-network and closest to your home. It is important that physical therapy be convenient and on your insurance plan if possible.
Post-Treatment
Sports can sometimes be played in a splint or a cast, depending on the fracture and the sport. Certain fractures are less stable and falling on the extremity can displace the fracture and worsen the injury. Perspiration can sometimes make the splint or cast loosen, or at the very least become extremely itchy.
All sports should be avoided at least until your child is seen by Dr. Martin. At that time, she can discuss with you if your child can participate in sports.
Each child will have different instructions that are specific for the type of injury they had or the procedure performed. Dr. Martin will give those instructions to you directly either in our office or at the surgery center.
You should not bear any weight on the affected leg until Dr. Martin or the physical therapist tells you that you can get off of the crutches. In general, you will wear and sleep in the knee immobilizer for 6 weeks after the operation, until you are instructed that you can be out of it.
Most patients will go to physical therapy 48 hours after surgery. You can shower, but not submerge the leg, 48 hours after the procedure, and you should leave the steri-strips on the wound until they fall off.
You should not bear any weight on the affected leg for 6 weeks after the surgery and you should not bend the knee past 90 degrees (a right angle) for 6 weeks. You can shower, but not submerge the leg, 48 hours after the procedure, and you should leave the steri-strips on the wound until they fall off.
At 6 weeks post-op, Dr. Martin will see you back in the office to assess whether you can start weight-bearing activities. At this point, however, you are still not cleared for any sports activity.
Airport metal detectors are quite sensitive to metals, including metal implants that may have been placed inside your body. Belt buckles, key chains, and steel-toed shoes may set off these sensitive metal detectors. Many commonly used orthopedic implants may also set off the metal detectors. The most commonly implanted orthopedic materials include stainless steel, cobalt chrome, and titanium.
Ten years ago, 40-50% of all orthopedic patients with metal implants set off the metal detectors. Lower extremity hardware was 10 times as likely as that for a spine or upper extremity patient to set off metal detectors. And, 90% of all total joints would set off the machines. Now, there is new technology with full body millimeter scanners. They are designed to look at the skin and not any deeper.
If the airport still uses metal detectors, implants can still trigger them. But the metals used have significantly changed. Just looking at scoliosis hardware, before 2008, almost all would set off the machines and now after 2008, none will set off the machines.
Obviously, there is nothing you can do to change this. If you have a hip replacement or knee replacement, a metal plate and screws, a metal rod inside your bone, or one of the many other types of orthopedic implants, you, too, may set off the airport metal detector. We used to give patients a card to carry to inform the security staff of your implanted device. However, there is no need to continue to use these cards.
Whether or not you have a card to alert the security personnel, they will have you step aside for further screening. In the US, the TSA will accept a card but it will not change the way you are screened.
Patients with pacemakers are asked (but not required) to carry an ID card, but patients with orthopedic implants, including joint replacements, do not need special identification.
To help you on your way, wear clothes that allow you to easily reveal your surgical scar (such as sweat pants, short sleeve shirts, etc.). Alert the security staff that you have a metal implant, and let them know where it is in your body. You will likely be screened with a metal detecting wand. Security sees many patients with these types of implants, and you should not be delayed.
Billing / Payment / Referrals
Yes, we do submit your medical claims to your insurance carrier. If there is any discrepancy with your insurance carrier regarding your claim, we will assist you in resolving the matter. However, you are ultimately responsible for the charges incurred for medical services.
You must contact your primary care physician, who will provide you and our office with a referral issued by your insurance carrier. Please bring a copy of the referral to your visit.
Your insurance company, depending on your co-payment system and any deductibles that are to be paid, determines what you pay at each visit. Aside from insurance, our office will work with you because you are responsible for the costs of medical care at the time you are seen.
We do not bill the school for medical expenses. If you have health insurance through your child’s school, we will submit medical claims to their insurance carrier. Any costs not covered by the school insurance would then be submitted to your health insurance carrier. However, please remember that you are ultimately responsible for any charges incurred for medical services.
Payments for services are due at the time of service. We will work with all patients to develop a plan to pay for medical services. Please contact our office for a list of methods for you to remit payment.
In addition to our charges, you may receive a bill from a first assistant. Please follow up with them regarding additional fees for services.
CareCredit is your family's health, wellness, and beauty credit card. Our office can help you with the application, and you will know immediately whether or not you qualify. They offer promotional financing. There's no better time than now to see if CareCredit can help you finance your orthopedic treatment.
Fracture Care Coding Explained
Our office makes every effort to follow the current coding practices for reporting medical services as dictated by the federal government (CMS) and the American Medical Association (the AMA). These regulations can be quite complicated and generate many questions.
A fracture, or broken bone, is most often diagnosed by X-ray and can vary greatly in severity and treatment options. For billing and insurance coding purposes, fracture care is listed in the surgery section of the AMAʼs coding book and is subject to global or surgical rules regardless of whether these services were provided at the hospital or in the office.
A fracture code (20000 codes) will be assigned based on the site, type of fracture, and whether the treatment is closed or open. Open treatments, and closed treatment requiring manipulation of the fracture, are performed in an operating room at the hospital or outpatient surgery facility. Closed treatment that does not require manipulation may be done in the office. However, all fracture treatment is considered “major surgery” by the federal (CMS) and AMA coding systems and will oftentimes be reported as surgery on your insurance companyʼs “Explanation of Benefits.” This includes clavicles (collar bones), hands, and feet.
According to CPT guidelines, fracture care is billed as a “package” or “global” service.
This means that at the time of initial care, a charge is generated that INCLUDES:
- Evaluation of the fracture
- The APPLICATION of the first cast or splint. (There will be a separate charge for supplies.)
- 90 days of normal, uncomplicated, follow-up care
Items NOT INCLUDED in the package or global service charge:
- X-rays
- All casting or splinting and supplies or durable medical equipment
- Any replacement cast, splint, or supply application
- The evaluation and management of any additional problems or injuries
- The treatment of complications
Items not included will be billed as separate charges.
Durable medical equipment (DME) is any device (brace, insert, strap, or sling) that is applied to you during your clinic visit or ordered custom for you. Each insurance has different coverage for DME. We will submit the bill to your insurance company, and they determine your patient responsibility.
Miscellaneous Questions
Some people worry that X-rays aren't safe because radiation exposure can cause cell mutations that may lead to cancer.
We live in a radioactive world. Radiation is part of our natural environment. We are exposed to radiation from materials in the earth itself, from naturally occurring radon in the air, from outer space, and from inside our own bodies (as a result of the food and water we consume). This radiation is measured in units called millirems (mrems).
The amount of radiation you're exposed to during an X-ray depends on the tissue or organ being examined. The average dose per person from all sources is about 620 mrems per year. It is not, however, uncommon for any of us to receive less or more than that in a given year (largely due to the medical procedures we may undergo.)
International standards allow exposure to as much as 5,000 mrems a year for those who work with and around radioactive material.
Please see the following sites that can calculate an individual’s exposure to radiation and the amount of radiation individual X-rays require:
Calcium is key for the health of your bones and teeth. It also affects your muscles, hormones, nerve function, and ability to form blood clots.
Think of the amount of calcium in your bones as your retirement account. The more you have when you stop “saving,” the more you will have to live on for the rest of your life.
We used to believe that calcium was incorporated into the bones until age 30, but now we believe that it is more like up to 18 years.
So whatever amount of calcium you store before you graduate from high school is the amount of calcium you will have in your bones for the rest of your life. The stronger your bones are during adolescence, the better your bones will be during menopause.
Calcium Supplements
Several different kinds of calcium compounds are used in calcium supplements. Each compound contains varying amounts of the mineral calcium — referred to as elemental calcium. Common calcium supplements may be labeled as:
- Calcium carbonate (40 percent elemental calcium)
- Calcium citrate (21 percent elemental calcium)
- Calcium gluconate (9 percent elemental calcium)
- Calcium lactate (13 percent elemental calcium)
Calcium supplements may be combined with vitamins and other minerals. For instance, some calcium supplements may also contain vitamin D or magnesium. Check the ingredient list to see which form of calcium your calcium supplement is and what other nutrients it may contain. This information is important if you have any health or dietary concerns.
To Learn More Information
Calcium supplements:
Calcium recommendation for adult women:
Calcium calculator: Look under “Best for Bones” and “Add It Up” to find out how much calcium you are getting through your diet on a daily basis.
Vitamin D
Vitamin D is converted into its active form by our skin with the addition of sunlight. Unfortunately, because of the concern for melanoma, most people use sunblock. This use of sunblock decreases the conversion of vitamin D and thus creates deficiencies, which can interfere with your body’s absorption of calcium and other minerals.
Supplementing with vitamin D and calcium may help to increase bone density. People over 50, those who have any health conditions that affect mineral absorption, and people who get little sun exposure may benefit the most from supplementation. Talk to your doctor to see whether you need vitamin D supplements.
Grandparents often tell parents that babies need a certain type of shoe at a certain age. This is not true. You are not a bad parent if you do not put your child in Stride Rite shoes.
Shoes serve two functions: one is protection of the foot (from stepping on something like glass, or from being stepped on) and the other is cosmetic (to be able accessorize an outfit).
Shoes will not correct a deformity that exists with a foot. For instance, a flat foot will not develop an arch from having arch supports.
Shoes are often the cause of foot deformities. High heels will cause bunions and hammertoes. Cultures that do not wear shoes do not have the foot issues that we have in America.
As you will see from the following website, shoes need two qualities.
- They need to be flexible and breathe.
- They need rubber soles so that they can grip.
Shoes that lace up are better because they will stay on a variety of foot shapes. Make sure to get shoes long enough and wide enough. You do not have to spend a fortune on shoes to protect your child’s feet.
For more information, please visit How to Select Children's Shoes from the American Orthopaedic Foot & Ankle Society (AOFAS).
Airport metal detectors are quite sensitive to metals, this includes metal implants that may have been placed inside your body. Belt buckles, key chains, and steel toed shoes may set off these sensitive metal detectors. Many commonly used orthopedic implants may also set off the metal detectors. The most commonly implanted orthopedic materials include stainless steel, cobalt chrome, and titanium.
Ten years ago, 40-50% of all orthopedic patients with metal implants set off the metal detectors. Lower extremity hardware was 10 times as likely as that for a spine or upper extremity patient to set off metal detectors. And, 90% of all of the total joints would set off the machines. Now there is new technology with full body millimeter scanners. They are designed to look at the skin and not any deeper.
If the airport still uses metal detectors, implants can still trigger them. But the metals used have significantly changed. Just looking at scoliosis hardware, before 2008, almost all would set off the machines and now after 2008, none will set off the machines.
Obviously, there is nothing you can do to change this. If you have a hip replacement or knee replacement, a metal plate and screws, a metal rod inside your bone, or one of the many other types of orthopedic implants, you too may set off the airport metal detector. We used to give patients a card to carry to inform the security staff of your implanted device, however, there is no need to continue to use these cards.
Whether or not you have a card to alert the security personnel, they will have you step aside for further screening. In the U.S., the TSA will accept a card, but it will not change the way you are screened.
Patients with pacemakers are asked (but not required) to carry an ID card, but patients with orthopedic implants, including joint replacements, do not need special identification.
To help you on your way, wear clothes that allow you to easily reveal your surgical scar (such as sweat pants, short sleeve shirts, etc.). Alert the security staff that you have a metal implant, and let them know where it is in your body. You will likely be screened with a metal detecting wand, but security sees many patients with these types of implants, and you should not be delayed.
Anti-inflammatory Use Questions
Aspirin and ibuprofen belong to a large class of drugs known as nonsteroidal anti-inflammatory drugs, commonly called NSAIDs. Acetaminophen and NSAIDs can block pain and reduce fever. Together, they make up the most widely used group of drugs for treating pain conditions.
The primary difference between NSAIDs and acetaminophen (Actamin, Tylenol) lies in the way each relieves pain. Acetaminophen works primarily in the brain to block pain messages and seems to influence the parts of the brain that help reduce fever. That means it can help relieve headaches and minor pains. But it does not have any effect against inflammation. It also does not have any sedating properties.
Inflammation is a common feature of many chronic conditions and injuries. NSAIDs reduce the level of certain chemicals called prostaglandins that are involved in inflammation. Treatment with NSAIDs can lead to less swelling and less pain. NSAIDs also do not have any sedating properties.
NSAIDs are cleared from your body by your kidneys and acetaminophen is cleared via your liver. They can be safely taken at the same time. NSAIDs do sometimes cause gastrointestinal irritation, and so you need to be aware of possibly needing to take them with food. Normal kidney function for NSAIDs and normal liver function for acetaminophen are required for long-term safe use.
Osteoarthritis & Viscosupplementation Questions
Osteoarthritis (OA) is the most common form of arthritis. It affects more than 27 million people in the United States. OA is sometimes called degenerative joint disease because it is caused by the wear and tear of a joint’s cartilage, the tissue that covers the ends of bones and provides cushion over many years of use. OA can also be caused by an injury to the joint, obesity, or genetics.
Healthy cartilage acts as a shock absorber and prevents your bones from taking the full impact of everyday walking, running, twists, and falls. A healthy knee also contains sufficient synovial fluid, a thick, gel-like liquid that reduces friction in the joint. A substance in the synovial fluid called hyaluronic acid acts as the joint’s grease and provides lubrication between bones and cartilage.
As cartilage begins to wear away and the amount of synovial fluid in the joint decreases, you may begin experiencing symptoms of OA. The most common signs of OA of the knee include pain at the joint, tenderness, stiffness, and loss of flexibility.
Over time and without treatment, the symptoms can become more severe, and the OA may cause loss of motion and bone spurs (bone growths around the affected joint).
In the most severe cases, the cartilage can disappear entirely. This results in a very painful form of OA that typically can only be treated with total knee replacement.
Osteoarthritis (OA) of the knee has no cure, but several treatment options may ease the symptoms and possibly slow down the condition’s progression.
Doctors may begin treatment with a conservative approach, asking patients to first try exercise, physical therapy, and even weight loss to reduce the pain and inflammation.
If these treatments prove ineffective or are no longer effective in the face of worsening OA, doctors may need to consider more aggressive treatments.
In the search for less invasive treatments that provide greater relief, doctors and researchers discovered the benefits of lubrication injections, or viscosupplementation. Viscosupplements are doses of hyaluronic acid that are injected into the knee and into the synovial fluid.
This is a relatively new form of treatment for knee OA. In recent years, viscosupplementation has become more popular and more widely accepted and is being used to treat symptoms of mild to moderate OA of the knee.
For each dose of a viscosupplement, a doctor injects hyaluronic acid (also called hyaluron and hyaluronate) into the knee joint’s synovial fluid. Patients with osteoarthritis (OA) of the knee have lower levels of hyaluronic acid in their synovial fluid.
What fluid does remain in the joint is often thinner and less effective than fluid in healthy joints. It is not able to protect the cartilage and bone from grinding and damage as well as it once could.
The additional hyaluronic acid fills the joint area and increases lubrication in the joint, making joint movement much easier.
Also, researchers think the injection of hyaluronic acid may stimulate the body to produce more of its own hyaluronic acid, which will further cushion the joint and make the effects of the injections last longer.
Most viscosupplements originally came from birds — chickens, in particular. Hyaluronic acid was often made from sterilized rooster combs, the fleshy crown on top of a rooster’s head. Patients with a known or suspected allergy to chicken, poultry, and eggs were told to avoid receiving viscosupplements derived from avian sources in order to avoid a potential allergic reaction.
Now we have viscosupplements that are man-made and do not have the same complications as the original versions.
ORTHOVISC® is derived from bacterial cells, not rooster combs. This makes it an ideal option for osteoartiritis (OA) patients with sensitivities or allergies to birds or chickens, eggs, and feathers.
ORTHOVISC is available as a three- or four-dose injection. The most common side effects of an injection of ORTHOVISC include swelling around the joint and a rash or bruise at the injection site.
For the first 48 hours after an injection of ORTHOVISC, it’s recommended that you avoid any strenuous or high-impact activities. The most commonly reported adverse events are joint pain, back pain, and headache, as well as temporary pain at the injection site.
Strenuous activities that should be avoided include playing tennis, jogging, or heavy lifting. Ice your knee if you have any mild pain or swelling near injection site. Avoid standing on your feet for more than one hour at a time during the first 24 to 48 hours following the injection. Be sure to schedule your follow up ORTHOVISC appointments to receive all of your injection series.
Call your doctor or go to the emergency room immediately if any signs of infection appear (red, excessive drainage, fever) and always comply with your physician's instructions.
Even though you may experience pain relief after your first or second injection of ORTHOVISC, be sure to get all three or four injections for maximum benefits. An ice pack applied to the knee, after being wrapped in a towel, can help with any post-injection discomfort.
The number of courses/injections is a decision you and your doctor need to make. When it comes to duration of pain relief, each person is different.
In general, one course of ORTHOVISC treatment may provide up to six months of pain relief. Consult your insurance provider to find out about coverage for any re-treatment you may receive.
Viscosupplementation is ideal for patients with mild to moderate osteoarthritis (OA) of the knee. It may be especially useful for patients who have not responded to other OA treatments, such as physical therapy, weight loss, pain relievers, and corticosteroid injections.
Patients with severe OA, especially those who have bone-to-bone contact in their knee joint, will likely not benefit from viscosupplement injections and will instead need more aggressive treatment, such as surgery or joint replacement.
The benefits of viscosupplementation injections are not immediate. Because the injections are given over time, you may begin to feel some benefit after the first injection, but the greatest benefit may not be felt until several weeks after your first injection.
Most patients report the greatest decrease in discomfort occurs 8 to 12 weeks after the initial injection. The injections should be repeated every six months for greatest relief.
For more information, please visit Viscosupplementation Treatment for Knee Arthritis by the American Academy of Orthopaedic Surgeons.
Glucosamine and chondroitin are part of normal cartilage. Cartilage acts as a cushion between the bones in a joint. It is thought that taking glucosamine and chondroitin will make you feel better if you have osteoarthritis.
Both of these compounds are supplements and are not regulated like drugs by the FDA. Studies have not shown that they relieve pain or slow joint destruction any more than a placebo.
And, since the FDA does not regulate supplements, what amount of these substances is actually in a dose may not be the amount stated on the bottle. Anecdotally, people say that they feel better around 50% of the time.
Patient Stories
“Dr. Martin is the best. When I broke my leg playing roller hockey, she got me back playing sports in no time.”
Thank you for recognizing Dr. Martin as Atlanta’s Top Doc for 2020.
