1. CODING AND REIMBURSEMENT CONCEPTS
Doing the Right Thing

2. 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 even if bilateral

3. 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

4. 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

5. 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

6. 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

7. 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 rather than 93971
The has a couple differences than the 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

8. 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

9. 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

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