Conservative Treatment Changes

Documenting Stockings
by Cheryl Nash and AJ Riviezzo
In the past the patient report regarding the wearing of compression stockings was sufficient. Unfortunately, a passing ‘nod’ is no longer sufficient by a growing list of payers. With the Phlebology requirements becoming more and more payer specific, a trend has been emerging that may change the way you document conservative treatment.

In the past if a patient stated that they had worn compression stockings and tried other forms of conservative treatment, (leg elevation, exercise, NSAIDS, etc.) this information alone was sufficient to support medical necessity. The trend in the clinical guidelines now state that the medical record includes physician office notes indicate failure of medically supervised conservative management, including but not limited to compression stocking therapy for . (Excerpt from Cigna Medical Coverage Policy #0234).

The terms about this type of requirement vary. It is sometimes called medical management, supervised trial, or ordered by the treating physician. It all translates to the same end result. You must place the patient in compression hose and follow the patient’s conservative therapy for the (typically) 90 days.

Obviously this causes some issues in scheduling timelines for treatment, but after the initial stall with these payers, this should even out. When doing a supervised trial, the patient should be brought back into the office at intervals to assess the success or failure of the conservative treatment and at the end of the trial. If appropriate, a new diagnostic US to clearly show that the symptoms and disease has not changed would be indicated. (Please check your payer policy to ensure that there are no limitations on this service as well.)

You may also want to consider selling the compression hose in your office. While some payers do not cover the stockings, others do. By selling, and then submitting the claim to their insurance plan, you have another record that the patient did indeed have the hose with them when leaving your office.

While this has language has been around for a while, it was mainly confined to isolated local payers. With this addition to Cigna’s policy, as well to various Medicare guidelines and several of the Blues plans, it has now “made the big time”.

As always, we at American Physician cannot stress enough; check your payer’s policies often to ensure you are meeting their guidelines!