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July 2010

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Subject:
From:
Bill Wilson <[log in to unmask]>
Reply To:
UVM Flownet <[log in to unmask]>
Date:
Sat, 10 Jul 2010 22:45:13 -0400
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Hypothetically speaking, if you perform competency testing on a daily or near 
daily basis will this fulfill the new ARDMS requirement for a recertification competency exam being pursued by ARDMS?

Hope everyone is having a good weekend.

BW

On Fri, 9 Jul 2010 10:41:16 -0400, Paul English 
<[log in to unmask]> wrote:

>Back when I started doing vascular (25+ years ago, pre color, I believe in the 
plethezoic era LOL) no one was even talking about valvular competency 
testing.  I studied the ancient tomes, Strandness, Hershey/Sumner/Barnes, 
etc., and when I sat for my RVT exams I studied Kremkau and used the Burwin 
Institute materials.  This was in the mid 90's, one of the last exams given on 
paper just before computer based testing started.  Anyway, in none of these 
materials nor on the registry exam was competency mentioned except for some 
fleeting references to indirect testing.  Where I work now, several of my 
colleagues are taking their RVT exams and they have indicated there is more 
information included in the study materials regarding competency and there are 
even a few questions on the exam about it.
>
>
>That all being said, I was first asked to do competency testing in the mid to 
late 90's as a part of mapping the greater saphenous vein for pre-CABG 
assessment.  Then I went to San Angelo, TX, where the radiologists started up 
an EVLT and sclerotherapy services.  Out pre-procedure protocol was to do a 
standard DVT evaluation and a competency evaluation of the deep and 
superficial vessels including perforator assessment.  
>
>
>If the patient's legs and/or lower abdomen are not too large, I use proximal 
compression to assess competency.  I use valsalva when the leg is so large 
proximally to the interrogation site that adequate cannot be exerted to properly 
assess competency.  I also slow the sweep speed down enough to allow for 
documentation of phasicity, proximal compression (or valsalva), and distal 
compression for augmentation.
>
>
>I use the above methods to evaluate competency on every lower extremity 
venous exam I do for the deep system.  I reverse Trendelenburg the bed and 
assess from the saphenofemoral junction through the popliteal and then the 
distal ankle vessels.  I label the waveform PHASIC, PROX (or VALSALVA), and 
DIST.  With the slow sweep speed all of these segments can be documented 
on a single waveform.  Since there is no specific CPT code for insufficiency 
evaluations the reimbursement is the same.  When the order is specifically for 
insufficiency I add to the above a competency evaluation of the entire greater 
and lesser saphenous exams.
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