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November 04, 2008 #3,391 Editor-Barry Block, DPM, JD

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'Bob' Enstrom, DPM, 83

Dr. Robert G. "Bob" Enstrom, 83, died Oct. 19, 2008. He graduated from Illinois College of Podiatry and Foot Surgery in 1953. He married Lois Price in 1943, then was called to service in the U.S. Army. A paratrooper in the 517th Parachute Infantry Regiment during World War II, he served in France in the Battle of the Bulge.

Dr. Bob Enstrom

Enstrom began his medical practice in Hillsboro on Nov. 28, 1953, and held many offices, including president within the Oregon Podiatric Medical Association. Honored with the Vance McNish award, he served six years as president of the Oregon State Podiatry Board, and was a founding member of the Region 7 Northwest Chapter of the American Podiatry Association. He retired from practice in 1998.

He participated in his children's activities as PTA president, Little League coach, and Scoutmaster.

PM News policy is to request that memorial donations be made to the APMA Education Foundation Student Scholarship Program, 9312 Old Georgetown Rd. Bethesda, MD 20814.

Source: The Hillsboro Argus, [10/31/08]

IL Podiatrist is Volunteer Operator in Radiothon

On October 31, 2008, Dr. Joseph Borreggine, podiatric physician, recently took part in the "Vision 2008" fundraiser for a local Christian radio station 97.1FM WBGL in Champaign, IL. He was a volunteer operator taking calls from listeners who wanted to donate to the station. This year's fundraiser was trying raise over $1.5 million to help fund a new ministry center because WBGL has outgrown their current location.

Dr. Borreggine is pictured with Zoe Fuller, WBGL's station manager

At the end of the four day event, they received pledges equaling 53% of the goal. Borreggine has been a long time supporter of the station. WBGL's parent company has multiple stations broadcasting to listeners all over Illinois and Indiana. Borreggine practices in Charleston and Effingham, IL.

Poor Economy Means Reduced Christmas Spending for MS Podiatrist

Bargains abound, but not every consumer is buying just yet. Even half-price glass ornaments and Disney snow globes at J.C. Penney in Cool Springs Galleria couldn't entice podiatrist Preston Boles, 45, to buy last week. Instead, Boles said his family planned to revamp its old decorations and put up a 4-year-old artificial Christmas tree. "We have to reuse the old," Boles said, adding that heavy discounts in stores are a "reflection of the economy. It's sad."

Boles said he's seen his 401(k) drop $30,000 over the past three months because of stock market volatility, forcing him to cut his spending on gifts this year by half to $1,000 and to seek out smaller presents. He'll still browse the big department stores — like Belk and Dillard's — but this year, Boles said he's more inclined to buy presents at Wal-Mart and Target to save a few bucks at stores known for value.

Source: Wendy Lee, The Tennessean [11/2/08]

Query: Liability Insurance for IME or Peer Review

I am looking for some leads on liability insurance coverage for a new venture in IME/Peer Review and consulting. These activities are considered non-patient care, and are not covered by my medical malpractice coverage. I can obtain some limited indemnification from medical manufacturers, but this is insufficient. Any assistance with this matter would be greatly appreciated.

Name Withheld

Query: Excision of Ulcer with Sesamoidectomy

What would be the appropriate coding for the following outpatient surgery center procedures?

1) Surgical excision (full thickness to capsule) of chronic diabetic wound sub1st metatarsal-phalangeal joint right foot, 1.5 cm in diameter. The excision included deep removal of fibro/necrotic tissue. I performed a primary closure of the wound with nylon suture.
2) Removal of tibial sesamoid (total), same joint.
3) Extensor hallucis longus open z-plasty lengthening same foot for contracture at the 1st metatarsal-phalangel joint.

The patient is covered by Medicare (Palmetto).

Tim Shea, DPM, Concord, CA

Response: I would recommend you code this surgery as follows:

CPT 11044 - debridement skin, subcutaneus tissue, muscle, and bone.
CPT 28208 - repair, extensor tendon, foot, without graft.

Howard Zlotoff, DPM, Camp Hill, PA

Codingline subscription information can be found here

RE: Bleomycin for Warts (Michael H. Warheit, DPM)
From: John Etcheverry, DPM, Gene Mirkin, DPM

I have used bleomycin for years. I first inject a minimal amount of %1 lidocaine to the wart. Next, I inject .25cc of Marcaine with epinephrine in the area (with the exception of toes). I then use approximately .25cc's of bleomycin and inject it directly in the wart, but try not to inject it into the subcutaneous area. The wart will turn black within three days and become almost a blister-type of lesion. It is somewhat painful at this point. It dries out over the next three weeks. I have them back at three weeks and it will be a black scab/eschar at this point. You simply debride it at this point without anesthesia and it should come right out. It is very effective, but just like any other wart treatment, it does not work all of the time.

John Etcheverry, DPM, Bakersfield, CA, jetch@footnankle.com

I use bleomycin for recalcitrant warts that fail other treatments. I give a Rx for bleomycin 15 units, #1 bottle. I then have the patients bring that bottle with them. I dilute it with 3 cc.s of 0.5% Marcaine and give sublesional anesthesia. I then give the injection intradermally until the skin blanches. Do not go subcutaneously. Warn the patient to expect a significant hematoma that may need to be drained, if painful. Let them know that the darker it gets, the better the reaction to resolve the lesions. Do not give more than 0.4 cc. in any one area.

Another method of delivery is a small amount of bleomycin on the skin surface and multiple intradermal innoculations. Repeat every week until necrosed. No matter what, do not use it near or in digits due to potential vasospasm and permanent nerve damage. Use caution not to get it on your bare hands, as there are reports of Raynaud's resulting from repeated exposure.

Gene Mirkin, DPM, Kensington, MD, gsmirkin@comcast.net

RE: Fixation S/P Fracture (Dale Berkley, DPM)
From: Jan David Tepper, DPM,

I would like to add that in metatarsal fractures, patients should be non-weight-bearing. Although healing will take place, the likelihood of the distal fragment healing in an elevated position is great (weight-bearing with or without boot cast or BK casting). After healing takes place, surgery is more likely if an orthotic device is not sufficient to control symptoms or unwanted sequella. The earlier the NWB takes place, the better the chances of avoiding a poor outcome. I wouldn't operate on it at this point. I would only operate if it is symptomatic or if patient is a good surgical candidate who refused NWB, as many times, even with healing in an obvious dorsal position, the patient is not symptomatic until months or even years later, if at all.

Jan David Tepper, DPM, Upland, CA, jdtdpm@aol.com

RE: Non-Payment to Associate (Name Withheld)
From: Eric J. Lullove, DPM

Name Withheld did the right thing by consulting with an attorney. These situations can be very acrimonious and you need to have your interests protected by legal counsel.

Please make sure that you have all documentation of hours worked, number of patients seen, potential claim collection per patient and/or other documentation that you would need to adjudicate this claim in small claims court.

Keep in mind, however, that if your former employer is one who does things "his/her" way, AND ONLY HIS/HER WAY, your former employer may contest the claim and counter-claim after they consult with their attorney(s). The most costly thing one can do is get into a "pissing contest" with another individual who is willing to spend the money to drag a legal action out in an effort to drain you of funds; and this counterclaim would not be in small claims, but circuit civil court (or equivalent). This claim is NOT covered by any type of insurance liability carrier endorsement, so you would be paying ANY attorney per hour for their time regarding collecting $3,700.

Eric J. Lullove, DPM, Boca Raton, FL, ericsops@yahoo.com

POSITION - NORTHERN VIRGINIA/DC SUBURB

ASSOCIATE POSITION- NEW YORK

We’re in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in the scenic Hudson Valley region of New York State. All DPM´s in our group are board-certified and there is a residency program affiliated with our practice. This is a special opportunity for the right person(s), with an excellent compensation package available. Please reply to HVFA, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com.

PODIATRISTS NEEDED - CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

EQUIPMENT FOR RENT - EXTREMITY MRI

Now you can rent an extremity MRI, have the scan performed, read by a board-certified radiologist and derive all the income. two convenient locations, Manhattan East 60th street between Park and Lexington, and Plainview, Long Island. Conforms to the Stark amendment; call for information (516) 476-1815.

ASSOCIATE WANTED – NORTH CENTRAL PENNSYLVANIA

Excellent associate practice opportunity leading to a partnership for PSR 24-36 trained foot and ankle, surgically trained podiatrist. A well-established, ethical and academic, successful, solo, half-time and multi-faceted podiatric practice wishes to expand surgical services. No competition with foot fellows. Need diabetic limb salvage, plastic surgery techniques, strong surgical rear foot and ankle reconstruction, ABPS qualified certification required. Practice has state-of-the-art orthopedic surgical environment and plenty of future expansion capabilities for a bright, eager, reliable associate. Excellent salary and benefits; no nursing homes. Present doctor is podiatric chief of three hospitals. Mail CV with current references to fgsddpm@verizon.net

ASSOCIATE POSITION –GEORGIA

A well-established practice in South Georgia seeks a full time PSR-24/36 trained podiatrist. Excellent benefit package. Please send CV to agriffin@southernpodiatry.com. For more information, visit our website

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for full-time podiatrist in a multi practice location in the Chicagoland and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

WEEKLY SPECIAL - One week of ads (5x) for $89 One month of ads (20x) for $340 .

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