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In the following situation, what would be appropriate for billing:
35 y.o. Patient referred to the lab for leg cramps at night.  4+ pulses
bilat.  Normal ABI.  Waveforms triphasic. 
Is it appropriate to bill for the ABI since an ABI is considered part of
a physical and not billable, but that's the only reason the person is
referred to our facility?
Thanks,
Nancy

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Kemil
Pilotte
Sent: Tuesday, April 08, 2008 8:05 AM
To: [log in to unmask]
Subject: Re: lower arterial evaluations....

In our lab we will stop with a ABI and TBI only if the following
conditions
are met:
	1. The patient does not claudicate/fatigue less than 1 block
	2. The patient is not diabetic
	3. The ABI and the TBI are both normal
	4. The patient is not post invasive

Ideally, high thigh cuff pressures and waveforms are informative.
Unfortunately, they are not very reliable because of the 
Practical problem of trying to fit 2 12cm cuffs on most patients thighs,
just not enough room or the lab lacks an appropriate size cuff for
persons
With big thighs and overweight. 

Kemil Pilotte
Tech Dir DCOH 
Echovascular Lab
[log in to unmask] 

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Don
Ridgway
Sent: Monday, April 07, 2008 4:35 PM
To: [log in to unmask]
Subject: Re: lower arterial evaluations....

(I should have finished before sending my previous reply.)

There are no criteria for calf/brachial index or low-thigh/brachial
index-just high-thigh and ankle. That's one thing.

And a lower pressure and index proximal to a higher ABI is a technical
problem somewhere, not a diagnostic finding. You can't get energy back
once
having lost it.


Don Ridgway






  ----- Original Message ----- 
  From: Kristy Peeler 
  To: [log in to unmask] 
  Sent: Monday, April 07, 2008 12:53 PM
  Subject: Re: lower arterial evaluations....


  I have reading MDs who want multilevel pressures recorded even when
the
ABIs are WNL and they will read indices at every segmental level.
(Segmental waveforms and PVR is already included in the exam). 

  This is new to me.  I'm thinking the slightly lower indices proximal
to
the normal ABIs are more likely due to cuff size artifact rather than a
disease process. In the case of a normal ABI patient with hypertension,
I
would rather not inflate a high thigh cuff, if I even could. Does this
extra
information make the interpretation less reliable?

   

  Can I get some feedback from other labs and their policies on this?

   

  Thanks,

  Kristy 

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