I agree they are acceptable for replicating claudication symptoms but....the
description is specific about the treadmill regarding either payment or
rejection (if Medicare knows how the test was performed).
-----Original Message-----
From: Terry J Zwakenberg [mailto:[log in to unmask]]
Sent: Wednesday, September 14, 2005 8:22 PM
To: [log in to unmask]
Subject: Re: ABI'S/POST EXERCISE ABI'S
Bicycle, treadmill, reactive hyperemia, toe ups, walking........all
acceptable forms of exercise. The important factor for reimbursement is
documentation, and your lab"s written protocol. The significant difference
between the techniques is reproducability. A treadmill makes it easy to
document exertion levels.
Terry J Zwakenberg BS RVT RDCS
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Jack Gray
Sent: Wednesday, September 14, 2005 7:58 AM
To: [log in to unmask]
Subject: Re: ABI'S/POST EXERCISE ABI'S
It's always been my understaning that if it isn't a treadmill test you can't
bill medicare.
-----Original Message-----
Here! Here! Terry. Walking the hall would obviously not work for the younger
patient however given our typical 70-80 y/o with concomitant heart disease,
this is truly THE BEST! for the reasons you describe. It also allows you to
observe the gait which will often answer the question. The "neurogenic
shuffle" is a fairly obvious sign when you see it.
Bill Schroedter
Venice, Fl
Andy,
It is real easy to have the patient walk in the hallway at their normal pace
till symptom onset. This way you are not exposing them to any risks they do
not normally expose themselves to in daily routine. I am a big proponent of
arterial imaging but would not consider performing a study without including
at least resting ABI's. Another technique if you are into torture is
reactive hyperemia assessment then there is no exercise component but you
are still able to fully investigate and delineate the origin of a patient
symptoms.
Terry J Zwakenberg BS RVT RDCS
Terry and Kathleen:
I agree that a normal PVR/CW/SBP study should include exercise if the
complaints warrant, however as an IDTF and with no medical doctor on hand
sometimes, I will not perform exercise (toe ups) if the patient has any
cardiac risks. This is where (and why) an arterial duplex is so valuable.
It will localize and quantify disease. The question remains that if the
physiologic study is normal, a duplex is "not medically necessary," "on the
same day" per Medicare!
Andy Bebry
Terry, I agree with you. In the labs that I work with, in their arterial
algorithm for studies, we include exercise with all normal ABI's. If the
patient presents with positive symtoms, such as claudication, atypical leg
pain, buttock pain,etc. and they are found to have normal ABI's, they are
exercised, either by treadmill, or toe up exercises and almost always have
decreased ABI's after minimal exercise. The cardiologists are especially
interested in these findings in light of the recent papers suggesting that
ABI is an excellent marker for atherosclerosis. Normal ABI's can be a
misleading finding; we see it frequently with Diabetics too. K
Kathleen Palmieri, RVT
To unsubscribe or search other topics on UVM Flownet link to:
http://list.uvm.edu/archives/uvmflownet.html
To unsubscribe or search other topics on UVM Flownet link to:
http://list.uvm.edu/archives/uvmflownet.html
|
