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UVMFLOWNET  January 2014

UVMFLOWNET January 2014

Subject:

Re: ABI interpretation

From:

Derek Butler <[log in to unmask]>

Reply-To:

UVM Flownet <[log in to unmask]>

Date:

Fri, 24 Jan 2014 15:25:27 +0000

Content-Type:

multipart/mixed

Parts/Attachments:

Parts/Attachments

text/plain (262 lines) , image001.jpg (262 lines)

Thanks to all in this discussion- we all know we cannot internalize protocols to add more imaging- the initial ? to this thread was a bit confusing as well as initial replies- was being a lil sarcastic in asking if we could tack on charges-as thought the duplex should require an abi value at no charge.

Have a good weekend all
________________________________________
From: UVM Flownet [[log in to unmask]] on behalf of Dawn [[log in to unmask]]
Sent: Thursday, January 23, 2014 10:37 AM
To: [log in to unmask]
Subject: Re: ABI interpretation

WPS, who is the medicare carrier for most states does not address this at all in their LCD.  In South Carolina there is both PGBA and WPS as Medicare providers for Part A services.  B is only Palmetto GBA, which is least restrictive.

As far as only being able to do one on one day, that is incorrect.  If there are signs and symptoms or treatment is being considered, it WILL cover duplex and ABI on the same day....stated on the WPS LCD.  As Carolyn said, read your LCD.  Too bad Rita Shugart is not on this string.....

Good day




-----Original Message-----
From: Carolyn Semrow <[log in to unmask]>
To: UVMFLOWNET <[log in to unmask]>
Sent: Thu, Jan 23, 2014 9:25 am
Subject: Re: ABI interpretation

Every region has different criteria for what is considered medically necessary. To assure you are in compliance go to your Medicare provider's website and look up he LCD for peripheral arterial testing. In our region they grouped all the codes in one document then explained when each was considered medically necessary & what they will not cover. It is quite an extensive document. I'd suggest you download it and print it out. Also when in doubt you can always get guidance from your Medicare provider or your hospital billing specialist. However when it ask my hospital billing specialist they just send me a copy of the LCD with no other comment

Carolyn M Semrow, RVS


"A master, in the art of living, draws no sharp distinction
between his work and his play, his labor and his leisure,
his mind and his body, his education and his recreation.
He hardly knows which is which. He simply pursues his
vision of excellence through whatever he is doing and leaves
others to determine if he is working or playing. To himself
he always seems to be doing both."
Francois-René Chateaubriand (1768-1848)





The HTML graphics in this message

From: Dawn <[log in to unmask]<mailto:[log in to unmask]>>
To: [log in to unmask]<mailto:[log in to unmask]>
Sent: Thursday, January 23, 2014 6:03 AM
Subject: Re: ABI interpretation

Derek,
As long as you are in the guidelines for both exams, you may charge for both.  Quoting now from Palmetto GBA:

"Extremity Arterial Studies:

1. Following invasive vascular procedures, when reestablished pulses are lost or become equivocal in the immediate postoperative period, or if the patient develops signs and/or symptoms of ischemia for which repeat intervention is considered.

2. Following lower extremity autogenous vein or synthetic graft bypass surgeries, a study is usually performed at 3-month intervals during the first year, at 6-month intervals during the second year, and annually thereafter.

3. A patient who is being followed medically develops new or worsening symptoms and/or signs on physical examination.

4. It is appropriate for follow-up studies post-angioplasty, with or without stent placement to be performed at three months, six months and one year. Subsequent studies may be considered medically necessary if there is clinical evidence of recurrent vascular disease evidenced by signs (i.e. decreased ABI from previous exam) or symptoms (i.e. recurrence of claudication)."


The one thing I have learned though is that appropriateness criteria is not developed for stents over 1 year.  The Dr. I work for now will only order a duplex of stents when there are changes.
I have worked in hospitals that charge for the ABI when they incorporate ALL aspects of what Medicare states.  Other hospitals will not charge if they only do the leg that was intervened on or only use hand held Doppler.  At this point, it IS legal to charge for it as long as you follow guidelines and do what is right.

Take care,
Dawn Stirrat, RVT
McLeod Vascular Associates


-----Original Message-----
From: Audrey Fleming <[log in to unmask]<mailto:[log in to unmask]>>
To: UVMFLOWNET [log in to unmask]<mailto:[log in to unmask]>


Sent: Wed, Jan 22, 2014 8:27 pm
Subject: Re: ABI interpretation

It has been my understanding that internal protocols cannot be used to "upcharge" exams. This used to happen with venous duplex exams. The referring doctor ordered the symptomatic leg, the department said "our protocol is to always do bilateral", there fore we always charge for a bilateral. So the end results were exams were being performed that were not ordered - bilateral vs unilateral- and charges were being created for exams that had not been ordered.

There are several other examples but you get the picture. I believe the results were that you can do whatever you want as an internal protocol, but you can only charge for what you have a written order for.

From: Derek Butler <[log in to unmask]<mailto:[log in to unmask]>>
To: [log in to unmask]<mailto:[log in to unmask]>
Sent: Wednesday, January 22, 2014 5:58 PM
Subject: Re: ABI interpretation

Hey Guys –

This is a logistical / Legal question and not an attempt to emphasize arterial duplex, physiologic studies and what they bring to the table (no pun). ☺

Is it possible that if a physician orders a bilateral arterial duplex and we perform an ABI on a separate system (not with a pocket Doppler) to include PVR , CW tracing and ABI that we could get away with tacking on a charge by adding it to our protocol?

Meaning --> Can we put in ‘our’ protocol that we always do a single level PVR, ABI / TBI with CW tracings on a separate system (93922) whenever an Arterial duplex is requested (92925 / 6)? And if so, does the arterial duplex have to be positive in order to bill 92922 in conjunction with 93923/4?

I have always known to include the ABI values with an arterial duplex but did not think we had ‘the power’ to tack on another charge for a tracing, PVR and ABI automatically– If this is possible I see no reason to always get an extra charge no?

Does not seem right for every pt scenario – and if so, how can a lab separate which ones can be paid and which ones cannot if it is not on the original order from a physician requesting ‘just a duplex’ – many reasons, calcified vessels, focal interest etc.

Just to note: almost all referring doc’s here do not understand completely what we do – most are not vascular trained.

If I tell my boss that we can get an extra charge on every duplex then he will make it so – Not sure if I agree beyond just the ABI values if a duplex is ordered . Trust me – I see the value in PVR’s, seg’s, TBI’s cold immersion etc etc.

Just a logistical / legal question -

Derek

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of William Beymer
Sent: Wednesday, January 22, 2014 4:01 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ABI interpretation

I agree that the ABI 93922 is billable (assuming you meet the requirements of the vessel specific ABI AND document a diagnostic waveform on separate non-imaging equipment).  And I think I understand what Derek is saying about only including an ABI value along with their duplex as part of that study.  My follow up question regarding some of the comments related to the physician’s order is: if you have a written policy for your department/lab saying “when performing a color flow duplex of the lower extremity arteries it is our policy to also perform an ABI to assess the collateral circulation” would that suffice?

Bill

From: UVM Flownet [mailto:[log in to unmask]]<mailto:[mailto:[log in to unmask]]> On Behalf Of Derek Butler
Sent: Wednesday, January 22, 2014 3:50 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ABI interpretation

If we receive an order for an Arterial Duplex, we must perform the ABI and have it reported in the final report. If the order only states arterial duplex, then we cannot bill for an single level evaluation (CW Doppler tracings – PVR ant ankle – and ABI) – that is where I believe the confusion is coming from.

If the doctor orders both an ABI and a duplex then yes, of course there are separate reports etc – been at it > 20 years – know this stuff quite well.

I believe the original question was how to include an ABI into a duplex request? The standards indicate under IAC that it is necessary to provide an ABI value in a report under a duplex order.

No?



From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Estes, Kelly M
Sent: Wednesday, January 22, 2014 3:25 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ABI interpretation

We also perform a single level physiologic study with CW Doppler waveforms on a separate non imaging device with archived waveforms. Our reports are separated for each billable procedure (93922, 93925/6 and 93978/9).

Kelly Estes
Manager, Vascular Laboratory
Novant Health Heart and Vascular Institute
301 Hawthorne Lane, Suite 200
Charlotte, NC 28204
Phone 704-316-5100 x 14713
Fax 704-316-9392

From: UVM Flownet [mailto:[log in to unmask]]<mailto:[mailto:[log in to unmask]]> On Behalf Of Steven Knight
Sent: Wednesday, January 22, 2014 1:08 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ABI interpretation

Derek, it was my impression that you could charge for an ABI in addition to an arterial duplex study but it must be done on a separate device (i.e. plethysmograph), not an imaging device. And the waveforms must be archived.
Does anybody support or refute that? I’d like to hear from you.

As for interpretation. We don’t interpret the ABI’s on our duplex report even though they are reported. We interpret them on a separate physiological test report. I think it’s best practice to have a separate interpretation for each billable procedure (93978/9, 93925/6, 93922). We report out the aortoiliac segment on a separate report from the lower extremity, even though there is some overlap. The ABI’s appear on the aortoiliac AND the lower arterial but the interp is reported separately as an additional report.

Steve Knight BSc RVT RDCS
Senior Vascular Technologist
[log in to unmask]<mailto:[log in to unmask]>

Beth Israel Deaconess Medical Center
CardioVascular Institute
Division of Vascular and Endovascular Surgery

110 Francis Street
Boston, MA 02215

(617) 632-9962 Phone
(617) 632-7977 Fax
http://www.bidmc.org/

[BIDMC logo]

From: UVM Flownet [mailto:[log in to unmask]]<mailto:[mailto:[log in to unmask]]> On Behalf Of Derek Butler
Sent: Wednesday, January 22, 2014 12:50 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ABI interpretation

I should follow up this thread that the ABI can demonstrate changes b/w the arterial duplex exams for the clinician –

The thread went silent – any follow up



From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Derek Butler
Sent: Wednesday, January 22, 2014 9:39 AM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ABI interpretation

I meant 93925 – it is made clear to me that when doing a Duplex an ABI is required, for which you cannot charge for since you are doing a duplex, if an ABI is ordered alone, then yes of course you can charge 93922 for single level and 93923 / 4 for multiple level / exercise treadmill.

Is it the typo that got you curious?

Derek

From: UVM Flownet mailto:%5bmailto:[log in to unmask] On Behalf Of William Beymer
Sent: Wednesday, January 22, 2014 8:35 AM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ABI interpretation

Derek,
I am curious where you found the limitation of not charging 93922 along with 92935/6?  Also, are you saying that the ABI done for this purpose no longer has to be a “vessel specific” ABI, as is currently required for 93922/3?  So it could be performed only with PPG to acquire the pressures?  Can you please provide a reference for this?

Bill

From: UVM Flownet mailto:%5bmailto:[log in to unmask] On Behalf Of Derek Butler
Sent: Wednesday, January 22, 2014 8:16 AM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ABI interpretation

Hi Melma,

If you are referring to the arterial duplex exam, an ABI must be included in the final report in addition to the duplex, although you cannot charge 93922 along side with 92935 / 6. No pvr or cw Doppler waveforms need to be documented, just an ABI value bilaterally.

Is this what you mean?

Derek Butler

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Melma Evangelista
Sent: Tuesday, January 21, 2014 5:44 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: ABI interpretation

I received a correspondence  from ICAVL requiring our lab to include ABI interpretation in our Arterial Lower extremity report.

How do you incorporate ABI interpretation in your lab report. Your response would be highly appreciated.


Thanks in advance.

Melma Jean Evangelista
Technical Director
St.  Michael's Hospital
30 Bond Street Toronto
M5B1W8
[log in to unmask]<mailto:[log in to unmask]>
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