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ENDOVENOUS ABLATION THERAPY

Peter Posted Tue 30th of April, 2013 18:51:27 PM

WE HAD A PATIENT AND WE PERFORMED ENDOVENOUS ABLATION THERAPY CPT "36478" AND BILLED MEDICARE. DOCTOR COULD NOT FIND THE VEIN SO WE STOPPED WITH THE PROCEDURE AND BILLED OUT WITH THE MODIFER. DOCTOR IS WANTING TO KNOW IF WE DO ANOTHER TEST WILL MEDICARE PAY FOR IT. I LOOKED UP THE LCD GUIDLINES AND CAN NOT FIND ANYTHING ABOUT THIS. THANK YOU SO MUCH

SuperCoder Answered Wed 01st of May, 2013 19:36:10 PM

Everything I’m finding says one pre-procedure test is covered. It doesn’t sound as if the patient’s health status has changed to allow an argument that a repeat test is medically necessary.

NGS L25519
Duplex ultrasound is often used in conjunction with other non-invasive physiologic testing to define the anatomy and physiology of the varicose vein network prior to injection or surgical intervention. There is adequate evidence that the pre-procedural ultrasound is helpful, and Medicare will cover a pre procedure Duplex scan (CPT code 93970 or 93971) used in conjunction with other non-invasive physiologic testing (CPT code 93965) to determine the extent and configuration of the varicosities. NGS expects that these studies will be performed by the provider planning to provide the therapy. NGS WILL ALLOW THIS STUDY ONCE PER PROVIDER OR PROVIDER GROUP.

WPS L30143
Doppler ultrasound or duplex studies are often used to map the anatomy of the venous system prior to the procedure. There is adequate evidence that pre-procedural ultrasound is helpful, and MEDICARE WILL COVER ONE ULTRASOUND OR DUPLEX SCAN PRIOR TO THE PROCEDURE to determine the extent and configuration of the varicosities when it is medically necessary.

Palmetto L28309
Duplex ultrasound is often used in conjunction with other non-invasive physiologic testing to define the anatomy and physiology of the varicose vein network prior to injection or surgical intervention. There is adequate evidence that the pre-procedural ultrasound is helpful, and Medicare will cover a pre-procedure Duplex scan (93970 or 93971) used in conjunction with other non-invasive physiologic testing (93965) to determine the extent and configuration of the varicosities. This A/B MAC expects that these studies will be performed by the provider planning to provide the therapy. THIS A/B MAC WILL ALLOW THIS STUDY ONCE PER PROVIDER OR PROVIDER GROUP.

FCSO L29298
ONE PREOPERATIVE DOPPLER ULTRASOUND STUDY OR DUPLEX SCAN WILL BE COVERED.

CGS L31849
CGS WILL ALLOW THIS STUDY ONCE PER PROVIDER OR PROVIDER GROUP.

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