Nathan K Itoga

I 💯 percent agree with this! There is minimal training for this. I was glad I went to a coding course in training. I am still learning… billing properly (matching icd to cpt, with appropriate modifiers) & resubmission for insurance payment denials sucks the soul out of me.

1/ Additional evidence that the health plans’ #MedicareAdvantage plans are engaged in systemic denials, downcoding &/or prior authorization abuses that drive these hospitals out of network w/ MA. Contrast this to traditional Medicare where denials and prior authorization are a fraction of the MA plans—no wonder. 29 health systems dropping Medicare Advantage plans | 2025 beckershospitalreview.com/finance/20-hea… #

This is fascinating 🤨

@AlanLumsdenMD So many options - ecmo, tpa, ac, cdt all options. Can ask same questions for dvt. Come back to Hawaii vascular meeting in a couple years and can discuss more 🤙

@AlanLumsdenMD Need more info for your patient above - right heart strain (can’t see rv in the pre images) elevated biomarkers? The decision is complex and PERT team evaluable is invaluable.

CTPE taken 4 weeks apart - remarkable clearing of saddle embolus! Angiovac - Inari - Penumbra? Nope! Heparin/Eliquis!!!!! Can we quantitate thrombolysis capability? Are we now overtreating PE?

@farkomd @EdjohnHarris @StanfordVasc @elgeorge_vascmd Dr EJ Harris - you da man! Happy retirement 🤙

That’s a pretty strong legacy @EdjohnHarris Thank you for all you’ve done for us and enjoy your retirement! @StanfordVasc @elgeorge_vascmd

Best comment of the night. Funding for venous care will now get increased funding by $1 billion bc Trump has venous insufficiency. -Dr Kistner

Hawaii Vascular 2025! Awesome meeting 🤙 At the beautiful Kahala hotel 🌈 @DukeVascular @UWVascsurg @usc_vascular

1/So in patient hospitals will receive a +2.4% in Medicare, SNFs +2.8%, respectively, & the entire list of other entities receiving a couple of positive points on their fee schedule in ‘26. Physicians continue to receive a -2.83% in ‘25 w/ larger potential cuts looming in ‘26. The current situation is both untenable and unsustainable. Don’t get mad—get busy with advocacy and let’s get Congress to pass HR 879, to reverse the current cut & add ~+2.0%. There are 155 bi partisan cosponsors in the House.

Took a class from him at Stanford. Brilliant. He took time to meet with the groups to answer meaningful research questions. Give credit to him for standing up during the pandemic with his thoughtful and thorough analysis. Tough job ahead - look forward to his leadership. 🤙

I watched this twice - brilliant

Your 40-hour workweek is a scam. Microsoft Japan proved it: Their 4-day work week SKY-ROCKETED productivity by 40%. Here's the 100-year-old lie about work:

Excellent meeting @farkomd in person - just as entertaining and engaging as his Twitter posts. 🤙 see you again on the ⛳️

@farkomd I like your controversial posts but this one doesn’t have too many opinions. Tcar with schockwave - heard about it but haven’t done it - too expensive. See you in Hawaii next week

It’s a high grade stenosis with contralateral occlusion. Presents with severe headache, visual changes and eye pain. MRI with ipsilateral small stroke. And she is much too young too look this old. On BMT. How would you manage this? Let the discussion. Begin

So per @RANDCorporation hospital in patient reimbursements were over 250% & out Pt over 280% versus Medicare in ‘22. Was there mention that the Medicare physician fee schedule is down over 60% since RBRVS in ‘92? Also, the previous posts here of the @FAIRHealth study showing a 14% reduction in network & ~10% drop in OON reimbursement in the past 4.5 yrs? Context matters!beckershospitalreview.com/finance/privat…

@farkomd @canuc_57 🤙 looking forward to meet when you make it out to Hawaii 🌊 🏄‍♂️

@n_itoga @canuc_57 We are actually friends.

It’s Ridiculous

@canuc_57 @farkomd 🍿private practice vascular surgeon here - this is the stuff I randomly check on Twitter for. I don’t know both surgeons personally, but I learned that it’s ok to think differently and I appreciate both sides being passionate.🤙

@farkomd Interesting: “segments of radiopaque monofilament thread used in surgical sponges” is described as a technique of marking proximal grafts. Darn it wasn’t my original idea after all. Frank you should write this journal and protest. I’ll just let you wallow in your biased victory.

Novices seek praise. Recognizing strengths builds confidence to keep going. Experts crave criticism. Seeing shortcomings reveals avenues to keep growing. Preferring corrections to compliments is a sign of skill. The better you get, the more determined you become to get better.

Great catching up with my @StanfordVasc Ohana, at @WestVascular. Many people missing from this pic. Glad to see my braddhas right here, respect and admire these guys a lot. (Ignore my rabbit 🐇 face 😂 )