Is heparin started prior to the formal interp? Or is the patient
     sent home?  When clinical decisions are based upon the
     "preliminary" interpretation, do you give the professional
     component to the technologist?

     Gotta agree with Bob. If it is emergent anough to get the
     technologist out of bed, it should be emergent enough to get the
     doc out of bed. Preferrably, the vascular specialist to see the
     patient prior to even ordering an test. I am not completely sure
     about the rules (maybe someone can help me here) but I believe
     there is some requirement for payment that the interpretation be
     contemporaneous. That is, if the patient has already been treated
     and/or clinical decisions made, billing for that interpretation
     is considered fraudulent, or at least that is the way I
     understand it.

     To take a stab at the question Bob asks, "what should be
     done?"........well, let me answer it this way. I think that the
     only emergent test is one where the vascular surgeon is tapping
     his fingers waiting to take the patient to the OR. Otherwise, it
     can be done at 7 AM during normal operating hours.


     Bill Schroedter
     Venice,FL.


______________________________ Reply Separator _________________________________
Subject: Re: On Call Interpretations
Author:  UVM Flownet <[log in to unmask]> at Internet
Date:    4/8/99 11:18 AM


     Dr. Holtz

     I am afraid you've hit my pet peeve button.

     It is my understanding that "legally", a preliminary report remains
     such until ALL data (worksheets; photos; VCR, etc) obtained from the
     exam has been provided to the reading physician for interpretation.

     After ALL of this material has been made available to the reading
     physician, and a formal report dictated, the preliminary report
     process is complete.

     What has been done nationally is to use the preliminary report process
     to defer formal interpretations under the pretence that sonographers
     have to decide what images to capture in order to complete the exam as
     defined by protocol.

     Unfortunately, patients are not deferred treatment until the formal
     interpretation process has been complete.

     "On call" procedures, by my definition, are examinations that are of
     an emergent nature and can not wait until normal hours of operation.
     It is bad enough to delay the formal report process during normal
     (non-emergent?) working hours.

     Does it matter?  Do sonographers give better "preliminary reports"
     than physicians give formal interpretations?  Are all sonographers
     certified?  Are all reading physicians qualified?  Would you want your
     mother or wife treated, or not treated, for a vascular issue on the
     bases of a preliminary report?

     Questions that make blood boil and my pet peeve button SCREAM.

     This issue is not what IS done, but what SHOULD be done.

     Bob Scissons, RVT
     Toledo, Ohio



______________________________ Reply Separator
_________________________________
Subject: On Call Interpretations
Author:  "[log in to unmask]" [SMTP:[log in to unmask]] at PHS
Date:    4/7/99 10:10 PM


  Please give me some input as to how the on call vascular procedures are
read.
      Our hospital is a 200 bed general hospital with a dedicated vascular
lab.
       We have two vascular surgeons alternating weeks reading. The
radiologists read some carotids.
        The technologists give a prelm. report and a formal reading is done
the next day.
          What is done at other hospitals????  Of comparable size?
        Thanks in advance for your input.
                                                      Richard A. Holtz D.O.