Kim, Nancy, Tom, et al.,

I appreciate your desire to keep this on-list.  However, as I noted
previously, an acceptable answer cannot be provided on the basis of the
presented information to date.  This is not a case of a "simple" fem-pop
(all within a single limb) or even aorto-bifemoral bypass grafts, where
everything just takes a relatively short detour around the offending
segment.   Also, given each of you likely have variation in protocols (i.e.,
what you actually do), risk tolerance, etc., which result in differences in
submitted claims, email-based descriptions and answers are likely not
practical and, in this case, a single answer will not be appropriate for
all.  

I would be happy to speak with anyone but would suggest you be ready to
discuss the details of the bypass graft(s) being evaluated, performed
examinations (i.e., protocols) and risk tolerance (risk tolerance assessment
should take less than 15 min.).  Substantial variation exists and the
current available information is insufficient to provide recommendations (my
risk tolerance would not allow it & yours should not).

There are reasons that CPT can be confusing in this case ... just think of
the poor RBCs, thinking they are off to supply an arm with oxygen rich
nutrition when suddenly, out of nowhere, they are sucked into a synthetic
tube sending them to a leg ... it must be confusing ... ;-)    (BTW, anyone
know who did the first Axillofemoral bypass graft? (must have had a tough
night sleeping to dream of this one - or Axillofemorofemoral bypass graft -
or axillobifemoral bypass graft - or even femorofemoral bypass ??? ... under
the category of "those were the days" ... in the late '70s, I watched
(worked on) what must have been one of the first CABG (LAD) with no pump run
- Lester had skills - worked well)) ... 

/fww



Franklin W. West, BSN, RN, RVT, RVS, CHC, FSVU
Chief Complaince Officer
Director, Practice Support, Complaince and Heath Policy
Society for Vascular Ultrasound
4601 Presidents Drive
Suite 260
Lanham, MD 20706-4831
(301) 459-7550 x106 (office)
[log in to unmask]
www.svunet.org


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