The process suggested here is a methodology to aggressively diagnosis arterial disease and amounts to no more than screening for peripherial arteial disease. This is outside the scope of the traditional vascular lab whose goals (referencing a presentation by Marsha Neumyer) are to confirm arterial occlusive disease and to determine if arterial disease is the cause of the patient's symptoms. (The other two goals have nothing to do with this converstion). Bearing that in mind, for diagnostic purposes one should only stress patients with claudication symptoms. Medicare in the states I have worked is even more restrictive in that the patients accepted for arterial examinations must have abnormal ABI's or true claudication symptoms and be candidates for intervention.

I do believe there is a time and place for screening, however the fee charged should reflect a screening procedure and Medicare must not be billed for it.

I realize this did not directly answer your inquiry, but I have an additional comment. One does not use post exercise ABI's but instead looks for a decrease in the post exercise ankle pressure as compared to the pre exercise ankle pressure (and measure the recovery time). The protocol for exercise studies uses treadmill walking for a limited time, at a limited speed with limited elevation. A nonsymptomatic patient with normal ABI's would usually have to be pushed well beyond those limits to show a drop in post exercise ankle pressures.