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So do I  and could have easily come up with references for Doppler Segmental Pressures, but Dawn specifically asked for PVR references.  Fortunately JVU made it easy  they noted in the past issues on the SVU/JVU website the 2 special waveform issues. Thank you JVU for making my search easy.
 
Carolyn M Semrow, RVS
 

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From: "Milliken, Debra K" <[log in to unmask]>
To: [log in to unmask]
Sent: Thursday, June 13, 2013 3:30 PM
Subject: Re: PVR waveform analysis

Still do Doppler waveforms and pressures as physiologic, not PVR waves
From: UVM Flownet [[log in to unmask]] on behalf of Carolyn Semrow [[log in to unmask]]
Sent: Thursday, June 13, 2013 3:12 PM
To: [log in to unmask]
Subject: Re: PVR waveform analysis

Joe,
I must respectfully disagree, many Vascular Surgeons & Cardio Thoracic Surgeons still want & request physiologic studies and prefer to follow patients with mild & moderate PAD with physiologic rather than imaging.
 Additionally, in the Medicare LCD for PAD, physiologic studies are expected to be the first NIV study.  Duplex Imaging is deemed Medically Necessary if 1 of the following is present & documented in the patients medical records : Limb ischemia & the patient is a candidate for invasive procedure, rest pain, severe claudication that significantly interferes with lifestyle or occupation, aneurysmal disease, evidence of thromboembolic event, blunt trauma, tissue loss or post intervention follow-up. It is not considered medically necessary for vague or minor symptoms, decreased or absent pulses or edema as only presenting symptom. 
The difference between Medicare & private insurance is that Medicare pays bills submitted without documentation however they may ask for documentation to be sent  or make a site visit  to examine or seize all Medicare patient records for review. If the patient's MR  don't contain the appropriate documentation for the billed procedure Medicare send you a bill for reimbursement. In our lab to ensure medical necessity is documented & part of the MR we performed a disease specific Hx & PE prior to performing an evaluation. 
 
 
 
Dawn,
 
In Journal of Vascular Ultrasound there were 2 special issues devoted to waveforms Dec 2011 &June 2012
Plethysmograhic Waveform Devices    AMKupinski JVU 35(4): 208-213 2011
 
Lower-Extremity Arterial Plethysmography Evaluation   M McPharlin JVU 36(2) 135-142,2011
 
I hope this helps
 
 
 
Carolyn M Semrow, RVS

 
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From: "Schneider, Joseph MD" <[log in to unmask]>
To: [log in to unmask]
Sent: Thursday, June 13, 2013 10:39 AM
Subject: Re: PVR waveform analysis

I would gently and respectfully suggest that most labs have abandoned PVR because it is entirely qualitative and there has been little investigative work in this area for the last 30 years.  I would suggest the following as a helpful reference at least for historical context:
 
Rutherford RB, Lowenstein DH, Klein MF. Combining segmental systolic pressures and plethysmography to diagnose arterial occlusive disease of the legs. Am J Surg 1979;138:211-218.
 
All the best
Joe
 
 
 
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Robert Ross
Sent: Wednesday, June 12, 2013 10:42 PM
To: [log in to unmask]
Subject: Re: PVR waveform analysis
 
Vascular Reference Guide          
by Gail P. Size, BS, RVT, RVS, RPhS, FSVU,
Laurie Lozanski, BS, RVT
and
Troy Russo RVT, RVS, RDCS, RDMS
  Vascular Reference Guide
Code: IU400
Price: $152.95
 
Physiological Testing Techniques and Interpretation with CME Examination
Code: UV100
Price: $55.00
by Robert P. Scissons, RVT
This is a "must read" for anyone involved with the noninvasive assessment of vascular disorders. This extensively illustrated text provides a wealth of detailed, easy-to-understand information about performing accurate physiological testing procedures in the vascular laboratory. Physiological testing is a vital, primary tool for the initial assessment of peripheral arterial and venous circulatory disorders. Indirect, physiological test procedures offer a relatively inexpensive, technically simple, and highly reproducible means for evaluation of patients with suspected or known arterial occlusive disease or venous insufficiency.
The principles of physiological testing are presented in a detailed, descriptive manner related to examination protocols.
 
•Overview of arterial and venous disease
•Differential diagnosis of extremity pain
•Stress testing
•Arterial and venous hemodynamics
•Recording devices: problems, limitations, and controversy
•Testing protocols for upper and lower extremities
Waveform and pressure analysis pp. 43-79
•Diagnostic criteria for all test procedures
•Illustrated case studies
•Reimbursement guidelines
•Vascular website links"
 
Additional exams may be ordered for $35.00
 
This edition now has 7.75CME credits
 
 
-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Dawn Stirrat
Sent: Wednesday, June 12, 2013 7:26 PM
To: [log in to unmask]
Subject: PVR waveform analysis
 
Hello my vascular gurus! 
 
I was having a discussion with a friend about pvr waveforms and how there are so many ways to describe them.  Does anyone have a good reference that describes them?
 
thanks,
Dawn
 
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