For Medicare (and Disney), Florida has long been special ... generally for
very different reasons, although both seem to believe in magic ... works for
Disney but not so much for the Medicare program ...

Has the evil empire (First Coast) actually put that into their LCD?  If so,
it is time for an LCD change request (maybe copying pertinent professional
associations - requesting comment on any such position?)  If not, have they
provided any documentation of such an edit - if so, then they are back to
having secret edits (for special people - i.e., certain supplier types?),
which would violate the heck out of transparency (not that they can't put
folks on prepayment audits, but arbitrary and capricious decisions (e.g.,
edits specific to a supplier type) are, if I recall correctly, very much
outside of their contract ... 

Do they show a vascular surgeon on the CAC yet?  I recall suggesting this
some time ago but do not recall one being on the committee ... if so, this
may be a less offensive back channel to get them to back off ...   

Time for a Change ...

/fww 

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Bill
Schroedter
Sent: Wednesday, September 10, 2014 6:15 AM
To: [log in to unmask]
Subject: Re: CPT codes

Thanks Frank for that superb, detailed explanation.  And clear evidence of
the expertise that you bring to the field.  I can only add "except in
Florida" where 93922,23,24 are in practice, essentially mutually exclusive
with duplex codes.  Or at least without going through a redetermination and
a reconsideration. Go figure. 

Thanks again, 

Bill 


William B Schroedter, BS, RVT, RPhS, FSVU Technical Director Quality
Vascular Imaging, Inc Venice, Florida
(941) 408-8855
www.qualityvascular.com
www.compressionsocks.pro 




-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Franklin W.
West
Sent: Wednesday, September 10, 2014 8:59 AM
To: [log in to unmask]
Subject: Re: CPT codes

Steve,

I agree with that duplex codes typically would include 93931 and 93926 given
the evaluation is limited to the extremities.  I further agree to 93922 is
appropriate given the physiologic examination is limited to single level
ABIs (along with the other caveats associated with this code).  I also agree
that 93925 (in place of 93926)  could be appropriate if a complete bilateral
duplex evaluation is medically necessary, ordered and performed.  However,
many locations in which I've worked (and seen) included treadmill stress in
the physiologic assessment given the patient is ambulatory, meaning 93924
would be more appropriate to capture the increased expense.  

Also, while some lab protocols compare Doppler in the proximal graft with
the distal graft and, assuming similar and normal, do not assess the graft
in the thorax, abdomen or pelvis (these I would agree are consistent with
duplex scenario you describe), others evaluate either the entire length of
the graft or require checking at specified locations, in which case 93931/26
fail to capture the work.  For those in this situation, depending on the
definitions provided in their institutional protocols, etc., other codes
might serve to capture this otherwise unclaimed, and thus unpaid, direct
expense (notably including clinical staff time, equipment time and
supplies).

Unfortunately, Tom does not describe what is included in evaluations at his
institution and thus my hesitation to provide specific recommendations lest
they not be appropriate to his situation.  I do agree that, at a typical
minimum, 93931, 93926 and 93922 might be appropriate assuming evaluation
limited to the extremities (basically anastomoses and immediate adjacent
segments confined to the limbs).   

All the best,

/fww

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Steven
Knight
Sent: Tuesday, September 9, 2014 3:02 PM
To: [log in to unmask]
Subject: Re: CPT codes

Tom,
Typically we use the 93931 code for the inflow portion and a 93926 or 93925
for the outflow depending on how much of the legs need to be evaluated.
Ankle pressures and waveforms are usually ordered as well so we would
include 93922.



Steve Knight BSc RVT RDCS
Senior Vascular Technologist
[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
www.bidmc.org



-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Tom
Sent: Thursday, September 04, 2014 10:34 AM
To: [log in to unmask]
Subject: CPT codes

Curious what CPT code everyone
Is using for Axillary to fem bypass grafts. Also fem to fem bypass grafts.
Need help please.

Sent from my iPhone

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