A Growing Trend
by Cheryl Nash and AJ Riviezo
Some payers are requiring a rule out of peripheral artery disease to be contained in the history and physical prior to granting an authorization. One way to add this element is through a pedal pulse examination. Another is to have your RVT (or you as the case may be) perform an ultrasound peripheral arterial examination. The codes for these studies are 93925 bilaterally and 93926 for a single leg examination. The relevant diagnosis code is 459.81 - venous insufficiency.
One concern to consider is the amount of time each patient will be spending prior to any real treatment if you couple an ultrasound arterial examination with a venous examination and the history and physical. Some patients may not be willing to spend that much time being 'worked up'. Discussing the reasons for the amount of time and what each elements helps determine will assist in alleviating this concern.
Friday, October 22, 2010
Marketing Thought...
Lunch and Learn with Bariatric Surgeons
by AJ Riviezzo, MBA
When establishing your referral base of physicians, one specialty niche to consider targeting is bariatric surgeons. Patients who receive lap band and other bariatric surgeries frequently have venous insufficiency surface as an issue. Their weight issues were masking the signs and symptoms until they have lost a sufficient amount of weight. A course of stockings to meet conservative therapy guidelines may be required as many of these patients have likely not been wearing compression stockings.
There are some bariatric surgeons who also dabble in phlebology so please ensure you are not marketing to a competitor.
by AJ Riviezzo, MBA
When establishing your referral base of physicians, one specialty niche to consider targeting is bariatric surgeons. Patients who receive lap band and other bariatric surgeries frequently have venous insufficiency surface as an issue. Their weight issues were masking the signs and symptoms until they have lost a sufficient amount of weight. A course of stockings to meet conservative therapy guidelines may be required as many of these patients have likely not been wearing compression stockings.
There are some bariatric surgeons who also dabble in phlebology so please ensure you are not marketing to a competitor.
Quick Information Regarding Ablation of Other Elements
Quick Information Regarding Ablation of Other Elements
by AJ Riviezo, MBA
We are frequently asked if one can perform an RF or laser ablation for a tributary, anterior accessory or perforator - and receive payment for the work.
The answer is, like most everything regarding insurance, perhaps.
First, the vein to be ablated must meet the minimum guidelines that are in place by the payer for the saphenous veins. For example, they may require the vein to be at least 3mm in diameter, showing evidence of reflux, and the patient has to have met conservative treatment guidelines.
Second, please note that many payers believe this procedure should be performed concurrently with an ablation of the saphenous vein. The codes for a second insertion/ablation are 36476 and 36479 for RF or laser. You should have a progress note stating why the patient needs this ablation versus alternative treatment, and why you are recommending this to be a staged procedure.
Next, should you determine that there is a need to stage the procedure and not perform it during the ablation of the saphenous vein, we recommend reviewing the patient insurance carrier's guidelines regarding ablations. Some, like Anthem Blue Cross/Blue Shield, are very clear that they will not authorize the service. Their guidelines note usage of sclerotherapy to resolve these issues after an ablation of the saphenous vein. You will not have to review these guidelines every time but we do recommend reviewing them at least quarterly to check for any changes. Some payers, like Blues of Illinois, changes their guidelines at least once per year.
If you have an authorization (if required), the CPT code used for these ablations is the same as for a saphenous ablation - 36475 for RF ablation and 36478 for laser ablation. Documentation of the procedure is essentially the same save for noting as to why this is a staged procedure.
by AJ Riviezo, MBA
We are frequently asked if one can perform an RF or laser ablation for a tributary, anterior accessory or perforator - and receive payment for the work.
The answer is, like most everything regarding insurance, perhaps.
First, the vein to be ablated must meet the minimum guidelines that are in place by the payer for the saphenous veins. For example, they may require the vein to be at least 3mm in diameter, showing evidence of reflux, and the patient has to have met conservative treatment guidelines.
Second, please note that many payers believe this procedure should be performed concurrently with an ablation of the saphenous vein. The codes for a second insertion/ablation are 36476 and 36479 for RF or laser. You should have a progress note stating why the patient needs this ablation versus alternative treatment, and why you are recommending this to be a staged procedure.
Next, should you determine that there is a need to stage the procedure and not perform it during the ablation of the saphenous vein, we recommend reviewing the patient insurance carrier's guidelines regarding ablations. Some, like Anthem Blue Cross/Blue Shield, are very clear that they will not authorize the service. Their guidelines note usage of sclerotherapy to resolve these issues after an ablation of the saphenous vein. You will not have to review these guidelines every time but we do recommend reviewing them at least quarterly to check for any changes. Some payers, like Blues of Illinois, changes their guidelines at least once per year.
If you have an authorization (if required), the CPT code used for these ablations is the same as for a saphenous ablation - 36475 for RF ablation and 36478 for laser ablation. Documentation of the procedure is essentially the same save for noting as to why this is a staged procedure.
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