Personally, I would strongly recommend that anyone intending to bill for
Doppler echocardiography color flow velocity mapping (93325) when, in fact,
not performing echocardiography obtain legal counsel prior to the fact lest
it become a false claims issue.  However, the decision on whether it becomes
a false claims issue doesn't sit with a provider or their attorneys, it lies
with the Dept. of Justice (& I agree with Brian, they carry a big stick).

With regard to Bill, it is true that he represents a significant number of
providers of diagnostic testing as well as professional societies.  However,
in all the talks I've seen Bill provide, I have never heard him recommended
that providers noninvasive vascular studies bill 93325.  Additionally, I
agree that he would never knowingly provide "fraudulent advice."  I do
believe that he might well have comments for any client that came to him
with a decision to bill 93325 (a client's decision) when not performing
echocardiography, specifically in an attempt to minimize risk.  That is only
his job and he is excellent in his performance.  Still, the decision,
responsibility and risk in billing lies with the provider, and we all have
varying levels of risk-tolerance.

*************************************************
Franklin W. West
PVI
18702 North Creek Parkway, Suite 212
Bothell, Washington   98011
425.398.7774 (voice)
425.486.8976 (fax)
[log in to unmask]
*************************************************

-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]On
Behalf Of Robert T. Kane
Sent: Wednesday, February 07, 2001 5:59 AM
To: [log in to unmask]
Subject: Re: CPT coding for vascular testing

Brian,
These are not false claims. We submit our claims electronically EXCEPT for
color flow. As I explained previously, we submit color on a paper claim with
a notation that we know this will not be reimbursed but we are submitting it
to preserve our appeal rights. We do this under the direction of our
attorney Bill Sarraille who happens to be SVT's attorney. I can assure you
Bill would not give us fraudulent advice.
Robert T Kane
Phoenix Cardiovascular
Doylestown PA
----- Original Message -----
From: "rdempsey" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, February 05, 2001 6:31 PM
Subject: Re: CPT coding for vascular testing


> [log in to unmask]    wrote:
>
> > While I'm in total agreement there is an inequity in the reimbursement,
> the
> > adversary you are suggesting to engage carries a huge club.  I would not
> > advocate the misuse of a CPT code which I clearly think this is an
> example.
> > I congratulate you on your success, but one must realize the peril of
> > submitting false claims even if you think you're entirely in the right.
>
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>
> I believe it was Frank West who posted the section of  the regulations
which
> mentioned  a $17,000 fine  PER  willfully submitted false or fraudulent
CPT
> code. (For Medicare reimbursement.)
>
> I still can't figure out how HCA/Columbia managed to remain in business,
> after their cheerfully  fraudulent billing practices came to light.   I
> believe that HCA  recently agreed  to pay a $750 million penalty, to avoid
> being cut-off from the tax-payer supplied Medicare trough.    Neat trick.
I
> doubt it is a viable option for the small fish. The fact that the
> HCA/Columbia folks are still in business ( even though most facilities
have
> removed the Columbia logo from their institutions name) is  a great
example
> ot the 2-rule theory of government. One rule for "us" ( the Big Fish) ,
the
> other rules are for "them" (the small fry) .
>
>  You are probably  one of  "them", ( the small fry)  Mr.  Kane.  But go
> ahead, and give it  a try .
>
> Rich Dempsey RDMS/RVT
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
>
> ----- Original Message -----
> From: "Stockard Brian" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, February 05, 2001 5:24 PM
> Subject: Re: CPT coding for vascular testing
>
>
> > Don't blame Dr. Conti or his sonographer Sandy Olson for my statement.
> > While I'm in total agreement there is an inequity in the reimbursement,
> the
> > adversary you are suggesting to engage carries a huge club.  I would not
> > advocate the misuse of a CPT code which I clearly think this is an
> example.
> > I congratulate you on your sucess, but one must realize the peril of
> > submitting false claims even if you think you're entirely in the right.
> >   Brian Stockard
> >
> > -----Original Message-----
> > From: Robert T. Kane [mailto:[log in to unmask]]
> > Sent: Monday, February 05, 2001 4:49 PM
> > To: [log in to unmask]
> > Subject: Re: CPT coding for vascular testing
> >
> >
> > Dr. Conti,
> > Based on my previously stated experience with the Medicare appeals
system
> I
> > believe your statement is incorrect.These appeals were made to a Federal
> > Judge in the Social Security system who ruled color could be paid.
> Although
> > these rulings were just recently adjudicated and were three years in the
> > system, we will continue to appeal even though the color definition has
> > changed. As I had mentioned previously Judge Sullivan saw the inequity
in
> > the reimbursement and, by his order, unbundled the Correct Coding
> > Initiative. Since the inequity still exists we will continue to appeal
> until
> > it the doesn't exist anymore. In order to appeal you must use a code
that
> > most accurately describes the service you are performing thus we bill
> 93325
> > (under the conditions previously stated).
> > It would be nice to start a movement where everyone would appeal this
> issue.
> > If this happened, there is no doubt from my experience that some action
> > would result. The Carriers would have to respond to all of the appeals
and
> > the ALJ's, who are logical people, would continue to see the economic
> > discrimination. As a service ot anyone who desires, we are willing to
> share
> > our experience and the aforementioned decisions.
> > The other fellow.
> >
> > Robert T Kane
> > Phoenix Cardiovascular
> > Doylestown PA