Department of Health and Human 
Services

OFFICE OF

INSPECTOR GENERAL

POCKET DOPPLERS

MANAGEMENT ADVISORY REPORT 
,.v 
Jrc Richard P. Kusserow 
INSPECfOR GENERA 
ltd3a  MAY 1991  .:. - ----..-- --. - .. - ------_.. --...__.._-_.__._-- . -__ _. - -
OFFICE OF INSPECfOR GENERA

The mission of the Office of Inspector Geperal(OI!3), as 
mandated by Public Law 95-452 
as amended, is to protect the integrity of the Department of Health and Human Servces
(HHS) programs as well as the health and welfare of 
beneficiaries served by those programs.
This statutory mission is carried out through a nationwide network of audits
, investigations 
and inspections conducted by three OIG operating components: the Office of Audit 
Services, the Offce of Investigations, and the Office of Evaluation and Inspections. The
OIG also informs the Secretary of HHS of program and management problems and 
recommends courses to correct them. 
OFFICE OF AUDIT SERVICE 
The OIG's Office of Audit Services (OAS) provides all auditing servces for HHS
, either by
conducting audits with its own audit resources or by 
overseeing audit work done by others.
Audits examine the performance ofHHS programs and/or its grantees and contractors in
carryng out their respective responsibilities and are intended 
toprdvide independent
assessments of HHS. programs and operations in 
order to reduce waste, abuse, and 
mismanagement and to promote economy and efficiency throughout the Department. 
OFFICE OF INTIGATIONS 
The OIG's Office of Investigations (01) conducts criminal , and administrative
, civil
investigations of allegations of wrongdoing in HHS programs or 
to HHS beneficiaries and of 
unjust enrichment by providers. The investigative efforts of 01 lead 
to criminal convictions 
administrative sanctions, or civil money penalties. The 01 also oversees State Medicaid fraud 
control units which investigate and prosecute fraud and patient abuse 
in the Medicaid 
program. 
AN 
OFFICE OF EVALUATION  INSPECfONS 
The OIG's Office of Evaluation and Inspections (OEI) 
conducts short-term management and
program evaluations (called inspections) that focus on issues of concern to the Department 
the Congress, and the public. The findings and recommendations contained in these 
inspection reports generate rapid, accurate, and up-to-date information on the effciency, 
vulnerability, and effectiveness of departmental programs. 
This report was prepared by the Philadelphia regional office under the direction 
of Joy Quill, Regional Inspector General and Robert A. Vito, Deputy Regional Inspector
General. Project Staff: 
Robert A Katz Project Leader 
Cynthia R. Hansford 
W. Mark Krushat (Headquarters) 
Wayne A Powell  ,."

Department of Health 
and Human 
Services

OFFICE OF

INSPECTOR GENERAL

POCKET DOPPLERS

MANAGEMENT ADVISORY REPORT 
( J  Richard 
P. Kusserow 
INSPECTOR GENERAL 
ltd3a  OEI-03-91-00461  PUROSE 
This report quantifies Medicare reimbursement for in-office ultrasound tests of arteries 
and veins conducted with inexpensive screening devices, popularly known as "Pocket 
Dopplers." This report is being provided for informational purposes only to advise the 
Health Care Financing Administration (HCF A) of potential savings resulting from its 
recent decision to prohibit reimbursement for Pocket Dopplers. 
BACKGROUN 
Pocket Dopplers are unsophisticated screening devices used by many medical 
practitioners to perform ultrasound tests of arteries and 
veins. A hand-held device, often 
shaped like a ballpoint pen, the tyical Pocket Doppler operates on a 9-volt battery. 
When activated, the instrument transmits a high frequency soundwave into the tissues. 
Analog waveform sounds (comparable to a stethoscope), reflected from internal organs 
or the flow of blood, change in frequency by an amount proportional to blood 
flow 
velocity. The reflected sound results in an audible signal. Typically, the Pocket Doppler 
is nondirectional (i.  , it is incapable of determining the direction of blood flow) and 
produces audio signals only. Such tests can be conducted in less than 5 minutes. These 
devices are marketed as diagnostic ultrasound equipment and generally cost under 
000. 
Approximately 15 manufacturers produce and market Pocket Dopplers. Industry sources 
estimate that at least 100 000 units are in active use in the medical community. About 
000 new units were sold in 1990. 
Diagnostic ultrasound tests are usually conducted using "mid-level" equipment. This 
equipment costs from $15 000 to $60 000 and offers a wide range of sophisticated 
options, such as two-dimensional displays, computerized analysis, and color-
flow imaging. 
More sophisticated devices produce video pictures of blood flow 
velocities in 
combinations of red, blue, and green. Changes in the intensity of color and blood flow 
velocity can indicate an irregularity, such as a blockage. 
Nationally, Medicare in-office allowances for four major procedure .codes used in 
diagnostic vascular ultrasound tests surpassed $88 milion in 1989, an increase of more 
than 31 percent over 1988. These tests reflect an increased frequency in allowed servces 
of approximately 25 percent for this I-year period.  Our previous draft report (Low-Cost Ultrasound Equipment, OEI-03-88-01401) reviewed 
the appropriateness of Medicare reimbursement-for diagnostic tests conducted with such 
inexpensive screening devices. As a result of this study, we recommended that HCF A 
prohibit payment for tests conducted with Pocket Dopplers. The HCF A concurred with 
this recommendation. However, accurate information regarding potential savings was not 
available. 
METIODOLOY 
This report is based on a two-stage random sample consisting of 480 servces from 
Medicare carriers. We selected 60 servces per carrier from 1988 Part B Medicare 
(BMA) 
Annual Data  bilings for in-office diagnostic vascular tests. We limited the 
servces to four commonly used procedure codes by practitioners of these tests. The 
codes are: 93910 (noninvasive studies of lower extremity arteries); 93950 (noninvasive 
studies of lower extremity veins); 93860 (noninvasive studies of carotid arteries); and 
93890 (noninvasive studies of upper extremity arteries). These procedure codes

represent only a portion of the number of codes for which Pocket Doppler servces could 
be biled. 
After receiving identifyng information from the carriers, we wrote to the practitioners 
requesting detailed data on the tyes of equipment used to conduct the tests. We 
reviewed the responses against pertinent information from scientific publications 
manufacturers' catalogs , and related technical materials to determine if Pocket Dopplers 
were used to conduct the tests. We consulted with a Registered Vascular Technologist 
who reviewed responses and assisted us in making determinations. 
FININGS 
Pocket Dopplers accounted for 7 percent of frequently performed in-office 
ultrasound servces in 1988.

Six-five percent of the providers in our sample (314 of 480) responded to our letters. 
Based on our analysis, 7 percent of the servces (22 responses) were performed with 
Pocket Dopplers. Medicare allowed $1 600 for these 22 servces. 
The number of allowed servces for the four procedure codes in our sample totaled 
561 800 in 1988. Applying the 7 percent usage rate and the 65 percent response rate, we 
calculate Pocket Dopplers were used for approximately 25 000 servces in 1988.  ,,- - - - -. - -  ---  - - - - -  ---  - - - --- --- - - - -- - - - - - - - - - - - - - - - -  -- - - -- - ---  - - - - - - - - - - - - - - - - -  --  - - - - - - - - - - - - - - - - -  --  - - - - - - - - - -  ---- 
If non-respondent usage rates were the same as respondent rates, total servces 
conducted by Pocket Dopplers could have been as high as 39 
000 in 1988. 
Medicare allowed between $2 and $2.9 milion for Pocket Doppler servces in 
1988. 
The average Medicare allowance for Pocket Doppler servces in 1988 was $73.00. Based 
on our projection, we estimate that Medicare allowed $2 milion for Pocket Doppler 
servces in 1988. If non-respondents and respondents had the same usage rate, an 
additional $900 000 could have been allowed for 1988. 
By prohibiting payment for Pocket Doppler servces, we estimate savings of $30 
millon in Medicare allowances will be realized over a 5-year period. 
The HCFA has agreed to prohibit separate 
coverage for Pocket Doppler servces. 
assume this coverage decision will be effective by 1992. 
Our savings calculations are very conservative. In our calculations, we applied the 65 
percent response rate and the 7 percent Pocket Doppler usage rate to the 700 700 
allowed servces for the four procedure codes in 1989. Non-respondents were not 
included in our calculations even though there is no reason to suspect the usage rate for 
non-respondents differs from respondents. We assumed an annual 20 percent increase in 
the number of servces -- the actual annual increase from 1987 to 1989 was between 25 
and 30 percent. The 1988 average allowed amount of $73 per servce was used in all 5 
years. We omitted possible reimbursement increases because of recent legislative 
changes designed to minimize such increases. 
As shown in the chart below, we estimate that savings of $30 millon in Medicare 
allowances will be realized over the next 5 years. 
PROJECTED MEDICARE ALLOWANCES

FOR POCKET DOPPLERS 1992- 1996 
1992  1993  1994  1995  1996 
TOTAL SERVCES  210,810  1.452.972  1.743.566  092.279  510 735 
POCKE OOPPLE SERV.  55.092  66. 110  79,332  95. 199  114.238 
MEDICARE ALLOWANCES  $4.021.716  $4,826.030  $5,791.236  $6.949.527  $8.339.374 
TOTAL' MEi5icA-RE'-AiC6wiNCES'- $29 927:8831