>In a message dated 12/3/98 8:12:46 PM Pacific Standard Time, [log in to unmask]
>writes:
>
><< The question posed by Jean Primozich, of why not take just take ankle
> pressures and then scan, is important, for technical and reimbursement
>issues. >>
>Robert,
> I have been to one of your lectures a few years back and you are not an
>average tech! On the subject of duplex versus physiologic studies or just
>plain ABI's: I reside in North Carolina, I am not an insurance specialist, by
>any means, but I do know that we have had no problems with billing and payment
>for our services. We do segmental pressures of the abnormal limb(s) and then
>duplex of the affected limb(s). Depending on the high thigh pressure we begin
>the exam either at the aorta or at the CFA. In my experience doing this, if
>the overall ABI is greater than .75, I have not found significant disease by
>duplex (generally, of course there are exceptions). Exercise testing is always
>done if clinically indicated (we do if the ABI is greater than .60) but I do
>feel that the duplex exam is necessary. At our institution we do not
>substitute duplex for physiologic stress testing, I cannot speak for others.
>I have never billed for ABI and duplex, as I don't think that would go over to
>well with the insurance company, but in NC at our facility we successfully
>bill for segmental pressures and duplex. The duplex of course allows us to
>localize the level of disease (which does not always correlate with
>segmentals) and whether or not the vessel is completely occluded versus
>stenosis or stenoses in tandem.
> On the flip side of the coin, you are correct, our surgeons always do
>angiograms prior to surgical or non surgical intervention. However, having the
>velocity measurements of the pre op (pre stent) exam are very useful post
>procedure since we do not utilize the segmentals post intervention ( in cases
>of unfavorable outcomes). I do disagree with you on the length of time for
>the duplex exam, we have three Vascular Technologists at our institution and
>we all complete the exams in the same general time frame, which is
>approximately 45 - 60 minutes bilaterally. This time frame includes the
>segmental exam and the duplex in abnormal cases from the aorta down. To
>clarify this somewhat, we do not completely evaluate every centimeter of every
>calf artery, just a general description of the TP trunk and whether the flow
>at the ankle is monophasic, biphasic or triphasic to give an overall status of
>the runoff vessels.
> My mentors wanted to "prove" the accuracy of duplex and as you
stated it is
>very accurate, maybe more so than angio. I guess that is where my attitude
>comes from also! LOL. I just cannot imagine doing it any other way, I am
>fortunate that I don't have to....
> This reply is not meant to disagree with anything you wrote, I just
wanted to
>clarify my previous post and to possibly obtain some feedback from other
>Vascular Technologists. You are an excellent lecturer and I wish you well in
>your new position with Nicolettevascular.
>Kelly Estes RDMS, RDCS, RVT
>
>Please remove me from E-mail list.