I agree, I just find that the standards, are so far apart. Its almost like saying the heart is more important "so spend this amount of time on it" whereas, a carotid is not important "put 3 on in the next hour." This is the message sent from IAC, whether or not ICAEL and ICAVL are independant of eachother.

Date: Thu, 22 Jan 2009 09:46:31 -0800
From: [log in to unmask]
Subject: Re: ICAEL vs ICAVL
To: [log in to unmask]

This needs to be addressed in ICAVL and on capitol hill.  There are TWO huge issues involving TIME and REIMBURSEMENT.  We do not get to differentiate between upper and lower extremity vein studies (they are one CPT)  yet we still have to do them when they are ordered. It does happen in patients who have had multiple lines, fistulas or coagulopathy.  The same applies when we do preop evaluations for fistulas and have to map the arm veins bilaterally and assess the arterial side – also only paid for ONE as vein and artery are rarely allowed on the same day/same patient.  Add to this issue the time it takes to perform these types of tests (not to mention preop venous reflux studies). 


Time definitely needs to be allowed for and the reimbursement disparities need addressed.  ECHO continues to unbundle and get paid for multiple CPT’s per case while vascular is not only bundled but the bundled codes are bundled!!!  It takes longer to perform these types of exams and we get paid less.  Many radiology based ultrasound labs call themselves a vascular lab and cranks out 15 minutes worth of photos and our reimbursements are linked to that rather than reality.  THIS NEEDS FIXED. We need a new tiered system like OB ultrasound…….level 1 and level 2 vascular studies.  Where one level is more basic and shorter in duration and the other level is advanced and longer (ie REAL vascular lab).  The reimbursements should be linked to the amount of work & level of clinical skills involved in performing the procedure.   Perhaps we could start with all PREOP studies being considered a higher level requiring more time and more reimbursement.  I guess that brings in new CPT codes and the RUC committee etc etc. …. But hey, that did not stop the cardiologists.   bj


Bonnie Johnson RDMS, RVT, FSVU

Vascular Laboratory Manager

Heart & Vascular Institute

El Camino Hospital, Mt. View, CA

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Rita Zeak
Sent: Thursday, January 22, 2009 7:09 AM
To: [log in to unmask]
Subject: Re: ICAEL vs ICAVL


There are time suggestions or guidlines listed in SVU, for our vascular exams. Rita

-----Original Message-----
From: JASON r <[log in to unmask]>
To: [log in to unmask]
Sent: Thu, 22 Jan 2009 9:52 am
Subject: Re: ICAEL vs ICAVL

Possibly, but then again, think about the bilateral Art Duplex with multiple areas of stenosis bilaterally, this take a fair amount of time to complete in ICAVL standards. However, since there is not minimum time standard "we" should be able to breeze through that in lets say 15 minutes, with an ABI.... lolol :)

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