by AJ Riviezzo
First Coast Service Options (who services Florida and Puerto Rico Medicare Part B patients) and Novitas Solutions (who services Colorado, New Mexico, Oklahoma, Texas, Arkansas, Louisiana, Mississippi, Delaware, DC, Maryland, New Jersey, and Pennsylvania) have proposed new Local Coverage Determinations (LCD’s) likely effective 1/1/2021. While not all of our readers will be directly impacted by these two LCD’s, it is important to know in which direction things may be changing. Both policies are essentially identical as these two organizations are acting more and more like one pending any official merger.
Conservative Management: For the first time that I can recall, these policies now state that ‘compression therapy does not cure the underlying venous pathology’. Further, there are no requirements for conservative therapy management. A major change!
Covered Indications: In as brief as possible, the covered indications include –
1. An evaluation including H&P, CEAP, VCSS score, and
2. A duplex scan of the deep and superficial venous systems showing a vein size of 3 mm and reflux of 500 milliseconds or greater, and
3. A CEAP score of C2 to C6, and
4. The documentation supports signs and/or symptoms that interfere with ADL’s and/or quality of life.
Editor’s Note – Excellent documentation of the disease impact on ADL’s will become increasingly important to justify treatment.
Perforator Veins: These are specifically addressed as allowed for treatment if underlying severe skin changes and/or venous leg ulceration.
US Guided Foam Sclerotherapy: This will be considered medically reasonable and necessary for symptomatic patients with C2 to C6 disease of both tributaries (36470 and 36471) and saphenous veins (coding dependent upon sclerosant used).
Modalities: RF, laser, chemical adhesives, and MOCA are all considered reasonable and necessary for ablation of incompetent saphenous veins. Varithena is covered in the sclerotherapy section above and their codes are listed in the Group 1 set.
Phlebectomy: Is also considered medically reasonable and necessary for bulbous tributaries above and below the knees AFTER treatment of the saphenous veins.
In short, this is the most user-friendly policy I have reviewed. It is clear and concise.
A copy of the proposed Novitas policy can be found HERE.
American Physician Financial Solutions, LLC | | aj@apfsbilling.com | https://www.apfsbilling.com
1125 Kelly Johnson Blvd., Suite 300
Colorado Springs, CO 80920
Hello,
On the LCD, it states; “The plan of care, for a 90 day episode of care, is based on the treating physician’s assessment.” Are they implying that the patient must be evaluated and treated within 90 days?
Thanks
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