In the bureaucratic system that exists, the left hand often doesn't know
what the right is doing.  In this case, the AMA, et al. have recognized the
therapeutic value of thrombin injection of pseudoaneurysm as being
consistent with contemporary medical practice and being performed by many
physicians in clinical practice in multiple locations.  While the FDA may
not have caught up with this yet, procedure codes thus exist that are
covered by Medicare - although we may not have a mechanism to cover the
thrombin, "Injection procedure (eg, thrombin) for percutaneous treatment of
extremity pseudoaneurysm" is covered as are the associated diagnostic and
guidance procedures.  But then, off label uses are common ...

********************
Franklin W. West
PVI
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 Michael, Dwight
Sent: Tuesday, November 19, 2002 10:33 AM
To: [log in to unmask]
Subject: Re: Renal Artery Duplex with Ultrasound Contrast

I'm inquiring about this NOW.  Thanks for "waking me up" regarding this
issue.  It's such a wide practice that I just never thought about it.  Many
"Things" that have become a standard of practice, (i.e., thrombin injection
for pseudo) are "off label", that I just didn't think about it.  Neither did
my medical director.  Thanks again.  As prevalent as this practice is, I've
probably opened up a can of worms by soliciting input from QA/Risk
Management. We've just used "informed" consent in the past.  But even with
that is it truly "informed".  Does anyone show the patient the box that says
in big. bold, letters, "NOT FOR INJECTION".

-----Original Message-----
From: Hodge, Megan D. [mailto:[log in to unmask]]
Sent: Tuesday, November 19, 2002 10:13 AM
To: [log in to unmask]
Subject: Re: Renal Artery Duplex with Ultrasound Contrast

Dwight:  what is your hospital policy for  "off label uses" for products
approved in different departments?
Do you require just a consent ? or do you need an IRB?

> -----Original Message-----
> From: Michael, Dwight [SMTP:[log in to unmask]]
> Sent: Tuesday, November 19, 2002 9:53 AM
> To:   [log in to unmask]
> Subject:      Re: Renal Artery Duplex with Ultrasound Contrast
>
> Contrast for vascular is an "off label" use, like using thrombin for
> pseudoaneurysm repair.  Except that thrombin is specifically labeled "NOT
> FOR INJECTION".
>
> -----Original Message-----
> From: Hodge, Megan D. [mailto:[log in to unmask]]
> Sent: Tuesday, November 19, 2002 8:44 AM
> To: [log in to unmask]
> Subject: Re: Renal Artery Duplex with Ultrasound Contrast
>
> yes.. in echo contrast is reimbursable.  in vascular... it has not even
> been
> approved and I have found some of the contrast companies won't even
> consider
> vascular contrast unless your institution has an IRB.
>
>       Is that true with those who are using it for vascular now ?
>
> > -----Original Message-----
> > From: Stanley, Jeff [SMTP:[log in to unmask]]
> > Sent: Tuesday, November 19, 2002 8:33 AM
> > To:   [log in to unmask]
> > Subject:      Re: Renal Artery Duplex with Ultrasound Contrast
> >
> > Do you eat the charge for using contrast for both renal art and echo
> > studies?  Or just renal art studies?  The echo sonographers here are
> > looking
> > into contrast agents for the echo studies and are trying to find out
> about
> > reimbursement.  I asked the echo supervisor and she said that she has
> > found
> > ICD-9 and CPT codes for using contrast agents  ???
> >
> > Jeff Stanley BS,RVT
> > The Heart Group
> > Diagnostics-Vascular Lab
> > 4230 Harding Road, Suite 330
> > Nashville, Tennessee 37205
> > (615) 565-6580
> > [log in to unmask]
> >
> > -----Original Message-----
> > From: Michael, Dwight [mailto:[log in to unmask]]
> > Sent: Tuesday, November 19, 2002 6:52 AM
> > To: [log in to unmask]
> > Subject: Re: Renal Artery Duplex with Ultrasound Contrast
> >
> > NO!  We have to eat the charge.
> >
> > -----Original Message-----
> > From: Kelly Estes [mailto:[log in to unmask]]
> > Sent: Monday, November 18, 2002 7:14 PM
> > To: [log in to unmask]
> > Subject: Re: Renal Artery Duplex with Ultrasound Contrast
> >
> >
> > Michael
> >
> >     How do you bill for it? Is it being reimbursed if you are billing?
> >
> > Kelly Estes RDMS, RDCS, RVT
> > Technical Director
> > MMG Cardiology/Carolinas Healthcare Center
> > Charlotte, NC
> >

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