Rosen Vein Lecture 105: Diagnosis, part 2…The Ultrasound Exam

  • superficial venous insufficiency

Diagnosis: The Ultrasound
Don’t freak-out…this is not going to be an in-depth, headache-provoking foray into the vagaries of ultrasound physics. [whew!]

Simply put, an ultrasound probe puts out sound waves that either pass through or bump into things. Think of a submarine under water or a radar above ground…sending out signals with a transmitter and then picking up the signals that return with a receiver. It turns out that the same probe that generates the sound waves also picks up the returning signals and then sends the info to a computer (nowadays the size of a laptop…probably before we know it the size of a postage stamp given the rapidity at which technology advances) and this computer puts the information together as a picture that physicians can interpret.

Not only can we tell the size and location of veins, but also how they function…including, no ESPECIALLY, valve function.
Best of all, it’s completely non-invasive and painless. The only thing you have to put up with is the gooey gel that ultrasonographers must use to help obtain the highest quality images. Women are used to this from their obstetric ultrasounds. Men…it’s high time you joined the party! Bring on the goo!

What do we look for?
1) Anatomy: Every patient is unique, but we can typically spot the major players of the Deep & Superficial Venous Systems as well as any obvious perforators. (See Vein Anatomy Lecture for a refresher).
2) Pathology/Pathophysiology:
a)Size: abnormal if
-GSV>3mm
-SSV>2mm
-Perforators>4mm
…again, size is not really as big a deal as whether or not the valves function properly and only allow one-way, upward flow rather than…

b)Incompetence: Reflux
By squeezing the area of the extremity below the vein we are investigating, we simulate what the “muscle pump” ordinarily does when we walk around and we send a jet of blood going up the vein past the valves in question. The ultrasound machine helps us detect if blood is trickling back down the leg (suggesting an incompetent valve) and for how long the trickle lasts.
The backwards, wrong way flow is considered abnormal if the flow lasts:
-In the Great or Small Saphenous Veins: greater than 0.5 seconds (or 500msec)
-In a Perforator: >0.35 seconds

If abnormal flow is detected in a segment or multiple segments of a vein, we have found a target vein for our treatments.

Most insurance carriers, including Medicare, typically cover consultation appointments…including ultrasound examinations.

At Rosen Vein Care, we are all about transparency..about every aspect of your care, including the financial side. Covered diagnostic and treatment procedures typically have some amount of out-of-pocket responsibility on the part of patients. This amount can differ greatly from patient to patient (though typically Medicare patients have less that they need to spend…a real plus for people with fixed incomes. I had to deal with such things with my parents and I have great empathy for what my patients have to contend with).

I strongly encourage patients to call their insurance carriers to ask for a “guestimate” of what their out-of-pocket costs may be. It typically relates to how much of your deductible still needs to be met, your copays, your co-insurance amount, etc. Most, if not all, insurance cards have a customer service number on the card. Call them and ask them what you would expect to pay for a new consultation appointment as well as an ultrasound. The codes for new consultations are typically 99204 or 99244. The codes for ultrasounds are typically 93971 (if only one leg is looked at) and 93970 (both legs; assume that we’ll look at both).

However, I don’t necessarily have to do an ultrasound on all my new patients; I only reserve them for patients whose symptoms, history and exam suggest that it would be likely to find an underlying problem (high pre-test probability) AND to help tailor a treatment regimen to solve each patient’s unique problems.

[As for what we do once we find the problem…stay tuned to future episodes of Rosen Veinblog!]

Meanwhile, if you have questions that need answering, varicose/spider veins that need treating and chronic lower extremity discomfort that needs addressing…schedule your consultation appointment with me by calling 847-272-8346 today!

Maria, my assistant, is standing by awaiting your call. We can typically get patients in for consultation appointments within a few business days. 

See you soon!