I tend to agree ...


While not precisely on point, some pertinent clinical issues are included in the article noted below (ran across in Medscape).


Am J Med. 2010 May;123(5):426-31.

Silent pulmonary embolism in patients with deep venous thrombosis: a systematic review.


Included were 28 prospective studies involving 5,233 patients with DVT.

Pooled data showed that 1,665 patients (32%) had silent PE (a conservative estimate because many of the included studies used stringent criteria to diagnose PE).

From five studies, silent PE occurred more often among patients with proximal DVT (36% of 546 patients) than among those with distal DVT (13% of 113 patients).

Silent PE was associated with a greater risk for recurrent PE.

Of 488 patients with silent PE, 25 (5.1%) had recurrent PE vs 7 (0.6%) of 1093 without silent PE.

The prevalence of silent PE increased with age (14% of those < 40 years, 22% of those aged 40 - 70 years, and 40% of those aged ≥ 70 years).


To the above mix add the abysmal accuracy in the diagnosis of DVT based on history and physical examination, as well as the roughly 2% morbidity associated with the use of Lovenox in DVT (IMHO, a nasty drug that should only be used when medically necessary - but I am biased by loss of a family member due to ICH secondary to anticoagulation - a razors edge to walk in the best of cases - one of the best examples of a drug that can be a life-saver but is also a life-taker). 


We all get tired and never want to do cases that are not necessary.  However, I would also note that 'fraud' is a very strong term (e.g., requiring intent).  Personally I would suggest that John is likely correct - in the absence of certainty, while it may not be the best use of resources, I doubt that a request for a diagnostic test typically represents intentional fraud.  But I've been wrong before :-)




-----Original Message-----

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of John H Toptine

Sent: Thursday, May 27, 2010 1:43 PM

To: [log in to unmask]

Subject: Re: Fraudulent Claims


I am sure they are looking at it from a cover my A$$ perspective.

All they need is 1 patient to die from a pulmonary embolus from a

undiagnosed DVT and have the family sue for a Multi Million Dollar verdict

How many Venous exams would need to be ordered to cover that expense???


That is why a Hospital charges $3000 for a study and  Medicare pays $300

That is medicine in 2010


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