November 2002


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"Franklin W. West" <[log in to unmask]>
Reply To:
UVM Flownet <[log in to unmask]>
Mon, 25 Nov 2002 07:56:47 -0800
text/plain (91 lines)
Shawn - no ICD-9 code exists for >60% stenosis - you are correct, this is
rather obviously a local carrier issue ... however, the carrier might be
inclined to perform a medical review audit if there is a relatively high
volume (relative is as compared to other suppliers) ... thus you need to be
able to document medical necessity (not all that difficult, but must be
done) ...

Terri - re 1:  federal regulatory requirements for reports are almost
nonexistent (this is rather correctly viewed by many at CMS as a standards
of practice issue - although the abuse folks always point out that if it
isn't documented, it wasn't done) ... however, ICAVL provides excellent
guidance ... & on a more practical level, if a case has to be appealed, more
clinical information in the final report is desired given it typically
serves as the basis for the review of the initial denial, & may thus get the
claim paid without the heartache of a 'Fair Hearing' ... overall, I would
recommend using the ICAVL requirements as a minimum ...

Re 2:  same as above ...

Re 3:  it, of course, depends ... most carriers allow V67.00 for follow-up
studies (& I'll assume this applies in your case) ... in this case, V67.00
would be used as the primary (first) ICD-9 code - & other codes could be
used to further describe the clinical situation ... however, the condition
that prompted the surgery would not necessarily be required ... denials of
these studies are more commonly due to frequency ... CATCH 22:  the same
does not apply to preoperative studies (for which CMS does have a rule in
place) ...

Franklin W. West
425.398.7774 (voice)
425.486.8976 (fax)
[log in to unmask]

-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]On
Behalf Of shawn
Sent: Saturday, November 23, 2002 12:57 AM
To: [log in to unmask]
Subject: Re: Coding Questions - Frank West

Add to this
The correct Dx code for a 60% (or better) carotid stenosis. Our medicare
carrier has authorized a TCD on any person with a 60% (or better) carotid
stenosis. I have only seen the codes for stenosis in general - no
definition of the degree of the stenosis.

--- Terri Tallman <[log in to unmask]> wrote:
> I have a few coding questions for vascular testing when doing post op
> follow ups.
> 1.  Does the indication on our report have to state the reason for the
> surgery or can we just have the surgical history? ie Lower extremity
> bypass.  Can report have indication "11/22/02 Right Femoral to popliteal
> bypass graft" or must it state "11/22/02 Right Femoral to popliteal
> bypass
> graft for rest pain".
> 2.  Does the report always have to state Peripheral Arterial Disease or
> Carotid stenosis for an indication along with the surgical history or is
> stating arterial bypass history or CEA history self explanatory of
> disease?
> 3.  For the post op coding.  Can the V67.00 be used only for 1st post op
> scan or according to medicare guidelines of 6wk, 6mo, 1yr?  Am I correct
> that you code V67.00 and the condition that prompted the surgery?
> Thanks
> Terri Lucas Tallman, AS, RVT
> Space Coast Sonography, Inc.
> Melbourne, FL
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