CODING AND REIMBURSEMENT CONCEPTS Doing the Right Thing

DIAGNOSTIC ULTRASOUND The Diagnostic Ultrasound (93970 typically) must be ordered by a physician You cannot order a Diagnostic Ultrasound via standing orders The payer only expects one primary diagnostic ultrasound to be performed during that patient’s course of treatment Subsequent diagnostic ultrasounds are a 93971 even if bilateral

HISTORY AND PHYSICAL Be sure to match the policy requirements against the content in your H and P Do not overcode – Rarely will a phlebology patient’s H&P be higher than a 99203 Document HOW the patient’s ADL’s are being impacted Conservative therapy management is more than compression stockings Do NOT take patient’s word If 90 day program, do check in with the patient at day 45

ABLATIONS Accurately report what was done that day Do not ‘stack’ claims and bill on separate days for additional payment Try to not perform ablations on subsequent days Do not unbundle (bill separately for) the supplies used Tumescence is not anesthesia Second access should only be billed for a second vein You cannot bill for an office visit the same day as a procedure

OFFICE VISITS Rarely rise above a 99212, hardly ever above a 99213 Do record an office visit/note at the end of conservative treatment program Unless you cannot turn it off, do not ‘carry’ notes from the H&P into your follow up visits

PHLEBECTOMY AND SCLEROTHERAPY Be sure to select the appropriate code for number of stab incisions Do not code for reimbursement, If you performed a phlebectomy, it is not a ligation and division If you performed sclerotherapy using Varithena, it is not an ablation If your sclerotherapy technician is injecting spider veins, it is NOT medically necessary services

FOLLOW UP ULTRASOUNDS All diagnostic and post-procedure ultrasounds require a documented interpretive report If you are performing a post-procedure ultrasound, the code for that is 76970 rather than 93971 The 76970 has a couple differences than the 93971 code Clearly for post-procedure Pays a bit less Can be performed with the next ablation if opposite leg It is not diagnostic which is being reviewed with more scrutiny

AFTERCARE PROGRAM Medicare and some commercial payers are reviewing for unnecessary care If the patient is asymptomatic, there is no need for an office visit and/or ultrasound at the six month and one year marks A call is recommended

DIAGNOSIS CODING Read the diagnosis codes and understand them Do not ‘auto-pilot’ your code selection If varicose vein disease with ulcer code selected, you then need to have an ulcer code noting location, size and depth of ulcer Diagnosis codes need to match your clinical documentation

THANK YOU I will be available for questions during the next break.