# SPY Elite- Vascular flow test



## EricaR (Jun 24, 2015)

Hello,

I have an MD who wants to bill 15860, intravenous injection of agent (eg, flourescein) to test vascular flow in flap or graft.  He is performing a robotic LAR.  This is his dictation:

"In order to be sure I had adequate perfusion in the proximal colonic segment, immunofluorescent angiographic evaluation of colonic flap was performed.  This was done by injection ICG intravenously by the anesthetist.  Using fluorescence to confirm I had good blood flow.  I had immunofluorescence angiographic evidence of adequate perfusion to the proximal bowel before transecting the bowel and performing anastomosis."

I would like any input in regards to this situation, for one I feel 100% that if he is not injecting then he can't bill, his response was "The anesthetist is giving the medication at my direction.  They are not an MD, they are working for me at that moment." 

Also, wouldn't this be inclusive.  Seems to me that making sure there was good vascular flow would be an inherent part of this surgery.  You can't have a successful procedure without making sure there is good vascular flow, correct?

Any input is really appreciated.


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