AVF APP Session: Billing, Edema Workup, and Compression
Coding and Scope of Practice
A vein surgeon covers CMS contractors, coverage policies, CPT and ICD coding, and the difference between incident-to and shared or split visits, noting documentation must show which provider performed the substantive portion. State scope-of-practice rules and payer variation are flagged as ongoing complications.
Ultrasound Guidelines for Reflux
A sonography director reviews reflux thresholds by vein type, patient positioning, and a duplex protocol covering patency, diameter, and spectral Doppler at each mapped site, plus pitfalls from edema, wounds, and patient tolerance that compromise study quality.
Systematic Leg Edema Workup
Nurse practitioners present edema pathophysiology by mechanism, then a stepwise imaging algorithm from deep venous duplex to reflux testing to CT or venography, illustrated by a May-Thurner case resolved with iliac stenting, and stress calling old clot chronic post-thrombotic change, not chronic DVT.
Pumps, Lymphedema, and Compression
Later talks cover choosing basic versus advanced pneumatic pumps by documented findings, distinguishing lymphedema from lipedema on exam, and selecting compression garments by stiffness and tolerance rather than default Ted hose.
