If I understand this right, there was an UE segmental
exam done that was read as abnormal and then the physician
has ordered a duplex scan.  If this is correct, your
argument about reinbursement may be futile.  If a segmental
"indirect" test is performed and found to be abnormal, it is
OK to do a "direct" duplex exam.  There is a good
possibility that there may be an aneurysm, or even a
non-hemodynamic stenosis that could be ulcerated and
embolizing to the distal arm.
    I agree that communication with your physician is
important.  You may not get the answer you would like, but
you would at least hear where the doc is coming from and may
stumble into a good learning experience.  If the patient
goes on to an angio, make sure to get your hands on it and
see what is going on.

Nancy Hohn, RVT
NE Heart Institute.