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This is so true. I have found myself worrying more over what I provide for the insurers than what I provide to the reading physicians. My docs will tell me sometimes “I don’t want to see that” and I tell them “Never mind you and your needs. Your surgery schedulers need that!”

And yes, I am almost certain that whomever is reviewing is confusing our request for phlebs with EVLA. It is maddening how frequently this is occurring…to the point where I’m pretty sure I’m developing a tick!

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Dr Jason Roberts
Sent: Friday, January 24, 2014 7:03 AM
To: [log in to unmask]
Subject: Re: Non saphenous vein reflux

Carolyn
Unfortunately we get this all the time as well. Sometime it makes sense to give insurers exactly what they are looking. And sometimess this may be in the best interest of the patient


Dr Jason Roberts
[log in to unmask]<mailto:[log in to unmask]>
954-801-2496
"Try not to become a man of success, but rather a man of value"
-Albert Einstein-


-------- Original message --------
From: Carolyn Semrow
Date:01/24/2014 6:22 AM (GMT-05:00)
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: Non saphenous vein reflux
Of course it may be due to the Letter of Medical Necessity and the treatment plan which generally is a request for several ambulatory phlebectomy session separated by time for system stabilization. It sounds like the claim reviewer is confusing a request for phlebectomy with  EVA. That would be the only reason why they would deny for lack of SFJ reflux.  The in depth explanation of Duplex findings is absolutely necessary we also include the anatomical drawing worksheet showing the status of each vein & location of reflux & obstruction as part  of the Letter of Medical Necessity(LMN) documentation and in some cases photographs of the limb.  Remember claim reviewers are not vascular specialist they might not even have a background in medicine. The most common CVD preauthorization request they receive is for EVA. The LMN may be written in such a manner that in a quick scan of the document it appears to be a request for EVA authorization. It's a new year, codes have changed you might check the ambulatory Phlebectomy code & LCD.

Carolyn M Semrow, RVS

"A master, in the art of living, draws no sharp distinction
between his work and his play, his labor and his leisure,
his mind and his body, his education and his recreation.
He hardly knows which is which. He simply pursues his
vision of excellence through whatever he is doing and leaves
others to determine if he is working or playing. To himself
he always seems to be doing both."
Francois-René Chateaubriand (1768-1848)




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From: Nancy Williams <[log in to unmask]<mailto:[log in to unmask]>>
To: [log in to unmask]<mailto:[log in to unmask]>
Sent: Thursday, January 23, 2014 8:38 PM
Subject: Re: Non saphenous vein reflux

Thanks, this is great. I appreciate you sharing. I'm sure you are correct about the interpretation. Again, to all who read my previous comment I hope you can appreciate that my frustration is with the insurers who seem to be asking me to provide information and documentation not relevant to the procedure being requested and not to Jason who graciously responded only to be harangued by me for his trouble. My twin sister will tell you in all seriousness, sometimes I am an @$$...it does not go unnoticed.

Nancy Williams

> On Jan 23, 2014, at 9:30 PM, "Registered Vascular Solutions" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> Nancy,
>
> It most likely has to do with the verbiage in the interpretation.  We have no problems (and we get a lot from other vein centers that are not happy).  I agree most of the time the SFJ is preserved as well as the epigastric and very often an incompetent accessory that the previous practice ignored.
>
> You can state that the right great saphenous vein has been closed previously from the saphenous-femoral junction to the proximal calf, however significant reflux is visualized in the native great saphenous vein in the proximal, mid and distal calf as well as tributaries of the great saphenous vein.  There is proximal tibial perforator measuring 4.3 mm. With a reflux time of 1,240 msec. The native great saphenous vein measured 5.6 mm. in the proximal calf and has a reflux time of 4,350 msec. Associated tributaries are visualized at a, b and c.........
>
>

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