by AJ Riviezzo


As noted above, there are several other reasons besides conservative therapy requirements not being met which can cause an audit to go badly. A recent reason is the Care Plan. While the care plan may seem to be a straight forward result of good decision making by the practitioner, the audit folks in the payer community have found ways to make this not so straight forward.


Presumption of Failure: We have had some audits fail because the full plan of care (ablations, phlebectomies, sclerotherapy sessions) were noted in the History and Physical or perhaps on the Diagnostic Ultrasound interpretive report. The auditors noted that this presupposed the conservative therapy that was also being ordered was assumed to fail without concern about the process or true end results. As such, we now recommend that the full plan of care, after failure of conservative treatment, be documented in a progress note which also closes the conservative therapy window.


Clear and Concise: The treatment plan needs to list out in detail what is to be treated. It must be supported by the diagnostic ultrasound and the History and Physical. It is not uncommon to read about the need, for example, the AASV to be treated in the plan of care, but the diagnostic ultrasound does not support the plan due to vein size, lack of significant reflux or any impact by the vein on the patient’s Activities of Daily Living. These concerns are even more significant when the treatment being planned is in regards to perforators or accessories. These veins cannot be treated without supporting documentation.


Time Frame: Most all payers expect the course of treatment to begin and end within a ninety-day window. A care plan that notes what the practitioner would like to perform at the six-month, one-year and two-year marks is outside of those expectations. Be sure your care plan is for the acute needs of the patient and not outlining a rather extensive aftercare plan.


With likely very little modification to what you are charting currently, it should be relatively easy to meet these documentation recommendations.


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