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In a message dated 12/3/98 8:12:46 PM Pacific Standard Time, [log in to unmask]
writes:

<< The question posed by Jean Primozich, of why not take just take ankle
 pressures and then scan, is important, for technical and reimbursement
issues. >>
Robert,
        I have been to one of your lectures a few years back and you are not an
average tech! On the subject of duplex versus physiologic studies or just
plain ABI's: I reside in North Carolina, I am not an insurance specialist, by
any means, but I do know that we have had no problems with billing and payment
for our services. We do segmental pressures of the abnormal limb(s) and then
duplex of the affected limb(s). Depending on the high thigh pressure we begin
the exam either at the aorta or at the CFA. In my experience doing this, if
the overall ABI is greater than .75, I have not found significant disease by
duplex (generally, of course there are exceptions). Exercise testing is always
done if clinically indicated (we do if the ABI is greater than .60)  but I do
feel that the duplex exam is necessary. At our institution we do not
substitute duplex for physiologic stress testing, I cannot speak for others.
I have never billed for ABI and duplex, as I don't think that would go over to
well with the insurance company, but in NC at our facility we successfully
bill for segmental pressures and duplex. The duplex of course allows us to
localize the level of disease (which does not always correlate with
segmentals) and whether or not the vessel is completely occluded versus
stenosis or stenoses in tandem.
        On the flip side of the coin, you are correct, our surgeons always do
angiograms prior to surgical or non surgical intervention. However, having the
velocity measurements of the pre op (pre stent) exam are very useful post
procedure since we do not utilize the segmentals post intervention ( in cases
of unfavorable outcomes).  I do disagree with you on the length of time for
the duplex exam, we have three Vascular Technologists at our institution and
we all complete the exams in the same general time frame, which is
approximately 45 - 60 minutes bilaterally. This time frame includes the
segmental exam and the duplex in abnormal cases from the aorta down. To
clarify this somewhat, we do not completely evaluate every centimeter of every
calf artery, just a general description of the TP trunk and whether the flow
at the ankle is monophasic, biphasic or triphasic to give an overall status of
the runoff vessels.
        My mentors wanted to "prove" the accuracy of duplex and as you stated it is
very accurate, maybe more so than angio. I guess that is where my attitude
comes from also! LOL. I just cannot imagine doing it any other way, I am
fortunate that I don't have to....
        This reply is not meant to disagree with anything you wrote, I just wanted to
clarify my previous post and to possibly obtain some feedback from other
Vascular Technologists. You are an excellent lecturer and I wish you well in
your new position with Nicolettevascular.
Kelly Estes RDMS, RDCS, RVT