I agree that the application of criteria is stretched.  Perhaps criteria for alternate forms of stress is warranted given that certain populations are bad enough that treadmill is a risk.  Toe claudication?! :) !?  Why is Texas more thorough than elsewhere?  When a patient is standing and flexing their calves, what's going up and down, toes or heels.  

Sent from my iPhone

On Sep 4, 2014, at 12:01 AM, jeremy orlikoski <[log in to unmask]> wrote:

I almost always have my patient raise whichever toes that they have left. I thought the examination was to look for claudication in the digits..? Because here in Texas we are very thorough. I mean what good do "heel raises" do? All the criterias have been set for treadmill walking just like all the carotid velocity correlation was done at 60 degrees ONLY. There can not be any deviation from set criteria.

Jeremy Orlikoski

On Sep 3, 2014, at 9:07 PM, "William OKeefe" <[log in to unmask]> wrote:

Really....are they really "toe-ups"?   Come on guys, do you stand there and watch your patients raise and lower their toes?
The maneuver is called heel raises.
Not getting' on you Steve....

William O'Keefe
St. Mary's Hospital 
Heart & Vascular Center
Duluth, Minnesota


 


On Wed, Sep 3, 2014 at 8:47 PM, Steven Knight <[log in to unmask]> wrote:
I don't believe that the provacative maneuvres mentioned in the 93923 CPT description refer to toe ups but to thoracic outlet testing. To be safe, I would stick to 93922 (single level).

Steve Knight BSc RVT RDCS
CVI Vascular Lab
Division of Vascular and Endovascular Surgery
Beth Israel Deaconess Medical Center
110 Francis Street, Ste 5B
Boston, MA
02215

Direct line: 617-632-9962
[log in to unmask]
________________________________________
From: UVM Flownet [[log in to unmask]] On Behalf Of Nancy Williams [[log in to unmask]]
Sent: Wednesday, September 03, 2014 3:24 PM
To: [log in to unmask]
Subject: Re: ABI WITH EXERCISE

93923 actually reads: Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more levels), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia)

We utilize the 93923 code for these ABI’s with toe raises (provocative maneuvers) as well.

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Audrey Fleming
Sent: Wednesday, September 03, 2014 3:13 PM
To: [log in to unmask]
Subject: Re: ABI WITH EXERCISE

Why would you charge a multi-level for a post exercise ABI?

From: Steve Flieder <[log in to unmask]<mailto:[log in to unmask]>>
To: [log in to unmask]<mailto:[log in to unmask]>
Sent: Wednesday, September 3, 2014 3:02 PM
Subject: Re: ABI WITH EXERCISE

93923....multi-level physiologic

Steve Flieder
Lifeline Vascular Access
Three Hawthorn Parkway
Vernon Hills, IL 60061

Phone:  617-510-2190
[log in to unmask]<mailto:[log in to unmask]>

P Go Green!  Please print this e-mail only if completely necessary

This email and the documents accompanying it may contain confidential information belonging to the sender that may be legally
privileged. This information is intended only for the use of the individual or entity named above. The authorized recipient of this
confidential information is prohibited from disclosing this information to any other party. If you have received this transmission in error, please delete from any computer.


From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Audrey Fleming
Sent: Wednesday, September 03, 2014 1:45 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ABI WITH EXERCISE

There is no CPT code for toe-ups or hall walking.

From: Patricia Rudibaugh <[log in to unmask]<mailto:[log in to unmask]>>
To: [log in to unmask]<mailto:[log in to unmask]>
Sent: Wednesday, September 3, 2014 1:43 PM
Subject: ABI WITH EXERCISE

After seeing that CPT code 93924 cannot be used for hallway walking or "toe-up" exercise, only treadmill or hyperemia when completing an ABI with exericse test, does anyone still use the toe-up technique? If so, which CPT code is used?


Thanks in advance

Patty

To unsubscribe or search other topics on UVM Flownet link to:
http://list.uvm.edu/archives/uvmflownet.html
To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html
CONFIDENTIALITY NOTICE: THIS MESSAGE IS CONFIDENTIAL, INTENDED FOR THE NAMED RECIPIENT(S) AND MAY CONTAIN INFORMATION THAT IS (I) PROPRIETARY TO THE SENDER, AND/OR, (II) PRIVILEGED, CONFIDENTIAL, AND/OR OTHERWISE EXEMPT FROM DISCLOSURE UNDER APPLICABLE STATE AND FEDERAL LAW, INCLUDING, BUT NOT LIMITED TO, PRIVACY STANDARDS IMPOSED PURSUANT TO THE FEDERAL HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 ("HIPAA"). IF YOU ARE NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS TRANSMISSION IN ERROR, PLEASE (I) NOTIFY US IMMEDIATELY BY REPLY E-MAIL OR BY TELEPHONE AT (855.472.9822), (II) REMOVE IT FROM YOUR SYSTEM, AND (III) DESTROY THE ORIGINAL TRANSMISSION AND ITS ATTACHMENTS WITHOUT READING OR SAVING THEM. THANK YOU.
-DaVita Healthcare Partners Inc.-
To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html

To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html
To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html

This message is intended for the use of the person(s) to whom it may be addressed. It may contain information that is privileged, confidential, or otherwise protected from disclosure under applicable law. If you are not the intended recipient, any dissemination, distribution, copying, or use of this information is prohibited. If you have received this message in error, please permanently delete it and immediately notify the sender. Thank you.

To unsubscribe or search other topics on UVM Flownet link to:
http://list.uvm.edu/archives/uvmflownet.html



--
Best regards,

William O'Keefe
Frenel Solutions
830-643-4637 v
866-376-6645 f
To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html
To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html
To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html