| by Cheryl Nash |
| A significant change in Anthem’s Policy SURG00037 is welcome news for providers this year. Language has been added allowing ablation of the AAGSV that was previously considered experimental.
The new policy has added AAGSV to the treatment parameters governing GSV and SSV, stating “Endoluminal radiofrequency ablation or endoluminal laser ablation, of the great saphenous vein (GSV), anterior accessory great saphenous vein (AAGSV), or small saphenous veins (SSV) is considered medically necessary when the following criteria are met:”
The policy goes on to define the requirements for medical necessity as well as adding limits to the number of retreatments allowed.
“A. Junctional (saphenofemoral for GSV and AAGSV; saphenopopliteal for SSV or its equivalent for individuals with variant anatomy) incompetence (that is, reflux with retrograde flow of 0.5 second duration or greater) based on vein anatomy is confirmed by Doppler or duplex ultrasound evaluation and report; and B.Previous endoluminal radiofrequency ablation or endoluminal laser ablation for refluxing varicosities of the same named vein, on the same extremity, has not been performed within the previous 6 weeks nor more than 3 times in the previous 12 months“
The language needs to be read carefully and charting must meet these requirements for approval of services performed in 2020.
Other items in the policy to be aware of is the very clearly outlined conservative therapy language (at least 6 weeks) and compromised activities of employment or activities of daily living that must be met in lieu of there being an ulceration secondary to stasis dermatitis or hemorrhage. We highly recommend rereading this policy in its entirety; the new policy can be found at: |
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