Honestly, this factfinder is just another example of why the SIS frustrates me so much. Every one of their factfinders are some variation of this:
"Gee, it sure would be nice to know what to do in this situation, so here's what other people say. That may be reasonable, but you might want to spend a lot of time and money getting consults from other specialties in every individual patient case too just in case. We're definitely not saying what YOU should do, that's your own decision."