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Many phlebology practices are adding arterial studies to their roster of services. For some patients it makes sense to ensure (or at least know) the patient’s arterial disease status prior to treating the venous system. One must, however, be careful to not be overly fond of scanning all patients all the time. The reasons Medicare lists for performing a bilaterial ABI (ankle/brachial indices) are very exacting. The indications for the evaluation are:
- Claudication of less than one block or such severity that interferes significantly with the patient’s occupation or lifestyle
- Rest pains (typically including the forefoot), usually associated with diminished or absent pulses, which become increasingly severe with elevation and diminishes with placement of the leg in a dependent position Diagnosis 729.5, Pain in limb, should only be billed when the patient’s symptoms meet this criteria.
- Tissue loss defined as gangrene or pre-gangrenous changes of the extremity or ischemic ulceration of the extremity occurring with diminished or absent pulses
- Aneurysmal disease
- Evidence of thromboembolic events
- Blunt or penetrating trauma (including complications of diagnostic and/or therapeutic procedures)
- Lower extremities surgical procedure where vascular disease is clinically suspected.
- For the patient with chronic renal failure and for whom an A/V fistula is planned
- For radial artery evaluation in a patient scheduled for CABG
Should the patient not meet the above indications, any arterial studies would be considered inappropriate and unnecessary.
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