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					              ABI TESTING
Is my practice following
the standards of care in
       this area?
                              Don Self
                           www.donself.com

                                          If you
                                          don’t
                                         want to
                                         wait for
                                            the
                                        timings,
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                                        proceed
1. Identify Standards of Care
2. Determine Patient Need
3. Review the Profitability
PROGNOSIS – How bad is it?




     Rev Cardiovase Med 2002;3(Suppl 2):S2-S6.
     When Does Medicare Cover ABI?
•   250.70 - 250.73 DIABETES WITH PERIPHERAL CIRCULATORY DISORDERS, TYPE II OR
    UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED - DIABETES WITH PERIPHERAL
    CIRCULATORY DISORDERS, TYPE I [JUVENILE TYPE], UNCONTROLLED
•   353.0              BRACHIAL PLEXUS LESIONS
•   410.00 - 410.02* ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED -
    ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL SUBSEQUENT EPISODE OF CARE
•   410.10 - 410.12* ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL EPISODE OF CARE UNSPECIFIED -
    ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL SUBSEQUENT EPISODE OF CARE
•   * 410.20 - 410.22 ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL EPISODE OF CARE UNSPECIFIED -
    ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL SUBSEQUENT EPISODE OF CARE
•   410.30 - 410.32* ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL EPISODE OF CARE UNSPECIFIED
    - ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL SUBSEQUENT EPISODE OF CARE
•   410.40 - 410.42* ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL EPISODE OF CARE UNSPECIFIED -
    ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL SUBSEQUENT EPISODE OF CARE
•   410.50 - 410.52* ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL EPISODE OF CARE UNSPECIFIED -
    ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL SUBSEQUENT EPISODE OF CARE
•   410.60 - 410.62* TRUE POSTERIOR WALL INFARCTION EPISODE OF CARE UNSPECIFIED - TRUE POSTERIOR WALL
    INFARCTION SUBSEQUENT EPISODE OF CARE
•   410.70 - 410.72* SUBENDOCARDIAL INFARCTION EPISODE OF CARE UNSPECIFIED - SUBENDOCARDIAL
    INFARCTION SUBSEQUENT EPISODE OF CARE
•   410.80 - 410.82* ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES EPISODE OF CARE UNSPECIFIED -
    ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES SUBSEQUENT EPISODE OF CARE
•   411.0 - 411.1*    POSTMYOCARDIAL INFARCTION SYNDROME - INTERMEDIATE CORONARY SYNDROME
•   411.81*           ACUTE CORONARY OCCLUSION WITHOUT MYOCARDIAL INFARCTION
•   411.89*     OTHER ACUTE AND SUBACUTE FORMS OF ISCHEMIC HEART DISEASE
              More Medicare Diagnosis
•   412*        OLD MYOCARDIAL INFARCTION
•   413.0 - 413.1* ANGINA DECUBITUS - PRINZMETAL ANGINA
•   413.9*          OTHER AND UNSPECIFIED ANGINA PECTORIS
•   414.00 - 414.07* CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT -
    CORONARY ATHEROSCLEROSIS OF BYPASS GRAFT (ARTERY) (VEIN) OF TRANSPLANTED HEART
•   414.10 - 414.12* ANEURYSM OF HEART (WALL) - DISSECTION OF CORONARY ARTERY
•   414.19*          OTHER ANEURYSM OF HEART
•   414.8*            OTHER SPECIFIED FORMS OF CHRONIC ISCHEMIC HEART DISEASE
•   435.2            SUBCLAVIAN STEAL SYNDROME
•   440.0            ATHEROSCLEROSIS OF AORTA
•   440.20 - 440.24 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES UNSPECIFIED -
    ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH GANGRENE
•   440.30 - 440.32 ATHEROSCLEROSIS OF UNSPECIFIED BYPASS GRAFT OF THE EXTREMITIES -
    ATHEROSCLEROSIS OF NONAUTOLOGOUS BIOLOGICAL BYPASS GRAFT OF THE EXTREMITIES
•   440.4           CHRONIC TOTAL OCCLUSION OF ARTERY OF THE EXTREMITIES
•   441.00 - 441.03 DISSECTION OF AORTA ANEURYSM UNSPECIFIED SITE - DISSECTION OF AORTA
    THORACOABDOMINAL
•   441.1 - 441.7    THORACIC ANEURYSM RUPTURED - THORACOABDOMINAL ANEURYSM WITHOUT RUPTURE
•   442.0            ANEURYSM OF ARTERY OF UPPER EXTREMITY
•   442.2 - 442.3    ANEURYSM OF ILIAC ARTERY - ANEURYSM OF ARTERY OF LOWER EXTREMITY
            More Medicare Diagnosis
•   442.82         ANEURYSM OF SUBCLAVIAN ARTERY
•   443.0 - 443.1 RAYNAUD'S SYNDROME - THROMBOANGIITIS OBLITERANS (BUERGER'S
    DISEASE)
•   443.21 - 443.24 DISSECTION OF CAROTID ARTERY - DISSECTION OF VERTEBRAL ARTERY
•   443.29          DISSECTION OF OTHER ARTERY
•   443.81 - 443.82 PERIPHERAL ANGIOPATHY IN DISEASES CLASSIFIED ELSEWHERE -
    ERYTHROMELALGIA
•   443.89          OTHER PERIPHERAL VASCULAR DISEASE
•   443.9        PERIPHERAL VASCULAR DISEASE UNSPECIFIED
•   444.0 - 444.1   EMBOLISM AND THROMBOSIS OF ABDOMINAL AORTA - EMBOLISM AND
    THROMBOSIS OF THORACIC AORTA
•   444.21 - 444.22 ARTERIAL EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY - ARTERIAL
    EMBOLISM AND THROMBOSIS OF LOWER EXTREMITY
•   444.81          EMBOLISM AND THROMBOSIS OF ILIAC ARTERY
•   444.89          EMBOLISM AND THROMBOSIS OF OTHER ARTERY
•   444.9           EMBOLISM AND THROMBOSIS OF UNSPECIFIED ARTERY
When Does Medicare Cover ABI?
•   445.01 - 445.02 ATHEROEMBOLISM OF UPPER EXTREMITY - ATHEROEMBOLISM OF LOWER EXTREMITY
•   445.81          ATHEROEMBOLISM OF KIDNEY
•   445.89          ATHEROEMBOLISM OF OTHER SITE
•   446.5           GIANT CELL ARTERITIS
•   446.7           TAKAYASU'S DISEASE
•   447.0 - 447.2   ARTERIOVENOUS FISTULA ACQUIRED - RUPTURE OF ARTERY
•   447.5 - 447.6   NECROSIS OF ARTERY - ARTERITIS UNSPECIFIED
•   447.8 - 447.9   OTHER SPECIFIED DISORDERS OF ARTERIES AND ARTERIOLES - UNSPECIFIED DISORDERS OF
    ARTERIES AND ARTERIOLES
•   449             SEPTIC ARTERIAL EMBOLISM
•   585.3 - 585.6   CHRONIC KIDNEY DISEASE, STAGE III (MODERATE) - END STAGE RENAL DISEASE
•   707.10 - 707.15 UNSPECIFIED ULCER OF LOWER LIMB - ULCER OF OTHER PART OF FOOT
•   707.19         ULCER OF OTHER PART OF LOWER LIMB
•   707.8         CHRONIC ULCER OF OTHER SPECIFIED SITES
•   710.1         SYSTEMIC SCLEROSIS
•   719.45         PAIN IN JOINT INVOLVING PELVIC REGION AND THIGH
•   729.5*       PAIN IN LIMB
•   729.71 - 729.72 NONTRAUMATIC COMPARTMENT SYNDROME OF UPPER EXTREMITY - NONTRAUMATIC
    COMPARTMENT SYNDROME OF LOWER EXTREMITY
•   747.60          ANOMALY OF THE PERIPHERAL VASCULAR SYSTEM UNSPECIFIED SITE
•   747.63 - 747.64 UPPER LIMB VESSEL ANOMALY - LOWER LIMB VESSEL ANOMALY
•   785.4           GANGRENE
       More Medicare Diagnosis
•   789.30 - 789.37 ABDOMINAL OR PELVIC SWELLING MASS OR LUMP UNSPECIFIED SITE - ABDOMINAL
    OR PELVIC SWELLING MASS OR LUMP GENERALIZED
•   894.0 - 894.2   MULTIPLE AND UNSPECIFIED OPEN WOUND OF LOWER LIMB WITHOUT COMPLICATION
    - MULTIPLE AND UNSPECIFIED OPEN WOUND OF LOWER LIMB WITH TENDON INVOLVEMENT
•   903.00 - 903.02 INJURY TO AXILLARY VESSEL(S) UNSPECIFIED - INJURY TO AXILLARY VEIN
•   903.1 - 903.5   INJURY TO BRACHIAL BLOOD VESSELS - INJURY TO DIGITAL BLOOD VESSELS
•   903.8 - 903.9   INJURY TO OTHER SPECIFIED BLOOD VESSELS OF UPPER EXTREMITY - INJURY TO
    UNSPECIFIED BLOOD VESSEL OF UPPER EXTREMITY
•   904.0 - 904.3   INJURY TO COMMON FEMORAL ARTERY - INJURY TO SAPHENOUS VEINS
•   904.40 - 904.42 INJURY TO POPLITEAL VESSEL(S) UNSPECIFIED - INJURY TO POPLITEAL VEIN
•   904.50 - 904.54 INJURY TO TIBIAL VESSEL(S) UNSPECIFIED - INJURY TO POSTERIOR TIBIAL VEIN
•   904.6 - 904.9   INJURY TO DEEP PLANTAR BLOOD VESSELS - INJURY TO BLOOD VESSELS OF
    UNSPECIFIED SITE
•   996.1           MECHANICAL COMPLICATION OF OTHER VASCULAR DEVICE IMPLANT AND GRAFT
•   996.62          INFECTION AND INFLAMMATORY REACTION DUE TO OTHER VASCULAR DEVICE
    IMPLANT AND GRAFT
•   996.70 - 996.78 OTHER COMPLICATIONS DUE TO UNSPECIFIED DEVICE IMPLANT AND GRAFT - OTHER
    COMPLICATIONS DUE TO OTHER INTERNAL ORTHOPEDIC DEVICE IMPLANT AND GRAFT
       More Medicare Diagnosis
•   996.80 - 996.87 COMPLICATIONS OF UNSPECIFIED TRANSPLANTED ORGAN - COMPLICATIONS OF
    TRANSPLANTED ORGAN INTESTINE
•   996.90 - 996.96 COMPLICATIONS OF UNSPECIFIED REATTACHED EXTREMITY - COMPLICATION OF
    REATTACHED LOWER EXTREMITY OTHER AND UNSPECIFIED
•   997.2        PERIPHERAL VASCULAR COMPLICATIONS NOT ELSEWHERE CLASSIFIED
•   998.11 - 998.13 HEMORRHAGE COMPLICATING A PROCEDURE - SEROMA COMPLICATING A PROCEDURE
•   998.2           ACCIDENTAL PUNCTURE OR LACERATION DURING A PROCEDURE NOT ELSEWHERE
    CLASSIFIED
•   998.30 - 998.33 DISRUPTION OF WOUND, UNSPECIFIED - DISRUPTION OF TRAUMATIC INJURY WOUND
    REPAIR
•   V43.4           BLOOD VESSEL REPLACED BY OTHER MEANS
•   V45.81 - V45.82 POSTSURGICAL AORTOCORONARY BYPASS STATUS - PERCUTANEOUS TRANSLUMINAL
    CORONARY ANGIOPLASTY STATUS
•   V58.49          OTHER SPECIFIED AFTERCARE FOLLOWING SURGERY
•   V58.73          AFTERCARE FOLLOWING SURGERY OF THE CIRCULATORY SYSTEM NOT ELSEWHERE
    CLASSIFIED
•   V67.09          FOLLOW-UP EXAMINATION FOLLOWING OTHER SURGERY
Quotes from: PQRI Measure #126: Diabetes Mellitus:
Diabetic Foot and Ankle Care, Peripheral Neuropathy –
               Neurological Evaluation
• “Evaluation of neurological status in patients with
  diabetes to assign risk category and therefore have
  appropriate foot and ankle care to prevent ulcerations
  and infections ultimately reduces the number and
  severity of amputations that occur.”
• “Treatment of infected foot wounds accounts for up to
  one-quarter of all inpatient hospital admissions for
  people with diabetes in the United States.”
• “Approximately 45-60% of all diabetic ulcerations are
  purely neuropathic”
• “Over the age of 40 years old, 30% of people with
  diabetes have loss of sensation in their feet.”
Determine Patient Need




     When you realize how many of your
 patients have P.A.D. you may be surprised!
   NORMAL &
ATHEROSCLEROTIC
    ARTERY

 WHICH ONE
 DO YOUR
  PATIENTS
   HAVE?
NATIONAL INSTITUTES OF HEALTH

• Smoking is the main risk factor for P.A.D.
• On average, smokers who develop P.A.D. have
  symptoms 10 years earlier than nonsmokers
  who develop P.A.D.
• If you have P.A.D., your risk for coronary artery disease, heart
  attack, stroke, and transient ischemic attack (“mini-stroke”) is
  six to seven times greater than the risk for people who
  don’t have P.A.D.     If you have heart disease, you have
    a 1 in 3 chance of having blocked leg arteries.

•   http://www.nhlbi.nih.gov/health/dci/Diseases/pad/pad_what.html
NATIONAL INSTITUTES OF HEALTH
 NATIONAL INSTITUTES OF HEALTH




•HOW MANY SMOKERS DO YOU SEE IN AN AVERAGE DAY?
•HOW MANY PATIENTS WITH DIABETES DO YOU SEE?
•HOW MANY PATIENTS WITH HYPERTENSION DO YOU SEE?

•HOW MANY ABI’S DO YOU PERFORM A DAY?

•ARE YOU PERHAPS MISSING SOME PATIENTS WITH PAD?
                         P.A.D.
“ 23% of Americans age 65 and older (4.5 to
  7.6 million) have PAD. As the population
  ages, the prevalence could reach 28% in
  those age 70 and older” American Heart
 Association. Heart Disease and Stroke Statistics—2004. 2004;
 Dallas.



   DO YOU KNOW WHICH OF YOUR
       PATIENTS HAVE P.A.D.?
         P.A.D.




DO YOU SEE PATIENTS IN THESE
       AGE GROUPS?
                    PREVALENCE
• “20% of Caucasian Americans, 50 & Older
  have Peripheral Arterial Disease”
• “25% of Black Americans, 50 & Older have
  Peripheral Arterial Disease”
• “25% of Latino Americans, 50 & Older
  have Peripheral Arterial Disease”

Prevalence of and risk factors for peripheral arterial disease in the United
   States. Results from the National Health and Nutrition Examination Survey,
   1999–2000. Circulation. 110: 2004; 738-743.
 DO YOU KNOW WHO HAS IT?
7,000 AT-RISK patients, in primary care offices,
  were tested by the Program
44% of those previously undiagnosed patients
  tested were DIAGNOSED with P.A.D.
A national survey of peripheral arterial disease detection, awareness, and
  treatment. JAMA. 286: 2001; 1317-1324. The PARTNERS (Peripheral Arterial
  Disease Awareness, Risk, and Treatment: New Resources for Survival) program
  has evaluated 7000 at-risk individuals seen in primary care practices
             ASYMPTOMATIC
• Most patients with PAD are asymptomatic
  or present with atypical symptoms beyond
  those of classic intermittent claudication
 Circulation. 91: 1995; 1472-1479


• Among symptomatic patients, 11% to 33%
  report classic intermittent claudication, and
  up to one third fail to communicate their
  symptoms to their health care provider. J
 Vasc Surg. 31: 2000; S1-S296.
            My Question to You!
• When do you want to detect it?

  1.   Before the patient has symptoms?
  2.   At early onset of symptoms?
  3.   Before the patient has amputations?
  4.   When it’s too late to save a foot?


  It really is YOUR call – but if it is your own
          parent, when would you want it
                   diagnosed?
       WHY THE PUSH TO EBM?
33%   of diabetics over 50 have P.A.D. (NIH 06-5835)
33%   of heart disease pts over 50 have P.A.D. (NIH 06-5835)
25%    of black people over 50 have PAD (NIH 06-5835)
20%    of Americans over 50 have P.A.D.(NIH 06-5835)


  MEDICARE WOULD RATHER PAY YOU
  $114 FOR AN ABI THAN PAY $4,000 FOR
   A TOE AMPUTATION OR $7,000 FOR A
   FOOT. WHAT IS YOUR TOE OR FOOT
               WORTH?
 IF MEDICARE WANTS IT
 FOR THOSE DIAGNOSIS,
ISN’T IT A GOOD IDEA TO
 USE THE ABI FOR YOUR
 PATIENTS WITH THOSE
 DIAGNOSIS TO DETECT
  P.A.D. BEFORE IT’S TOO
          LATE?
 OK – IT’S A GOOD IDEA – BUT
WITH ALL OF THE REDUCTIONS,
CAN I AFFORD TO DO THEM FOR
         MY PATIENTS?


             Let’s Review the
              Profitability of
                   ABIs!
Don Self sells Summit Doppler
          Vista ABIs
         •Portable – room to room
         •Automated cuff inflation/deflation system
         •Automatic ABI & TBI calculation
         •Built-in printer for waveforms, pressures and indices
         on adhesive-backed label paper – although most
         clients prefer the USB to computer capability
         •Bi-Directional Waveforms (required by Medicare)
         •Printable Waveforms (required by Medicare)
         •Typical ABI (93922) takes 8 minutes
         •Segmental ABI (93923) usually takes 14 minutes
         •Stress ABI (93924) takes a bit longer
         •All shipping & training included


         $7,490 Cash or Lease
  RETURN ON INVESTMENT
• $7,490 on a 5 year, $1.00 buyout
  lease (as recommended by most
  CPAs) = Monthly Lease $155

• Typical Medicare Allowed in 2011 =
  – 93922       $114.50
  – 93923       $177.07
  – 93924       $ 221.18
 1 Pt Test a day = 388% A-ROI
(based on only 93922 reimbursement, 5 days p/w)

 •   $114.50 Medicare Allowed
 •   Gross Monthly Income $ 2,576.15
 •   Less Lease Cost      $ 154.88
 •   Consumable ($0.25) $       5.63
 •   Net Monthly Profit $ 2,421.27
 •   Net Annual Profit    $ 29,055.23
 •   Net 5 Year Profit    $145,276.16

 •    Break Even = 1.35 tests a month
 2 Pt Test a day = 801% A-ROI
(based on only 93922 reimbursement, 5 days p/w)

  •   $114.50 Medicare Allowed
  •   Gross Monthly Income $ 5,152.30
  •   Less Lease Cost      $ 154.88
  •   Consumable ($0.25) $       11.25
  •   Net Monthly Profit   $ 4,997.42
  •   Net Annual Profit    $ 59,969.00
  •   Net 5 Year Profit    $299,845.01

  • Break Even = 1.35 tests a month
3 Pt Test a day = 1213% A-ROI
(based on only 93922 reimbursement, 5 days p/w)

  •   $114.50 Medicare Allowed
  •   Gross Monthly Income $ 7,728.44
  •   Less Lease Cost      $ 154.88
  •   Consumable ($0.25) $       16.88
  •   Net Monthly Profit   $ 7,573.56
  •   Net Annual Profit    $ 90,882.77
  •   Net 5 Year Profit    $ 454,413.86

  • Break Even = 1.35 tests a month
Medicare has been Increasing
     Payments for ABIs
       WHO CAN DO THE TEST?
  Some Medicare carriers require either provider or a
    certified tech do the doppler, while some do not. If
  your physician does it – consider whether 8 minutes of
                the physician time is worth it.


• OV - 99213 = 15 minutes = avg: $ 72
• ABI -93922 = 8 minutes = avg: $ 114

(if your physician, NP or PA has to do it, why not let them do only
     the doppler as that is only about 3 minutes…, while the M.A.
                           does the rest of it?)
    Next step is to contact Don
• We will, without charge or obligation – ask
  you about your patient flow, insurance mix,
  and check your state for Medicare
  requirements & advise you.
• If you wish us to, we’ll get your doctor’s tax
  id, social and get approval from one of our
  leasing specialists
• We’ll schedule the delivery, training and
  you’ll be testing within a couple of weeks
DON SELF & ASSOCIATES, INC


     WWW.DONSELF.COM

   DONSELF@DONSELF.COM

      903 372-7529 - CELL

				
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Description: Printable W 9 Tax Forms Pa document sample