Wiki Help with Carotid Surveillance & Follow up Arterial Studies

[dmccullers]

I have a couple of things that I am having a hard time finding guidelines for.

1. Carotid Stenosis Surveillance: How often should a patient have a Carotid Ultrasound if there is <50% stenosis?

2. Follow-Up Arterial Studies: How often can a patient have an LEA (arterial study) after they have received intervention and are not asymptomatic?
We are currently doing a study every 6 mos for 2 years. We want to make sure that is the correct guideline. Would we still be able to use Claudication as the diagnosis?


Looking through the CMS website is a nightmare!!! Any help would be great.

Thanks

 

[madcomic2000]

This is from WPSGHA LCD policy L35753

Re-evaluation of existing carotid stenosis. Patients demonstrating a diameter reduction of greater than 50% with symptoms and those patients with > 60% with no symptoms are normally followed on an annual basis. If patients become symptomatic of carotid disease repeat duplex scans are allowed without regard to the above schedule.

Follow-up after a carotid endarterectomy (outside the global period). These patients are normally followed with duplex ultrasonography on the affected side at 6 weeks, 6 months, and annually thereafter unless symptoms develop. During the first year, follow-up studies should be on the ipsilateral side unless signs and symptoms or previously identified disease in the contralateral carotid artery provide indications for a bilateral procedure.

Multiple cerebrovascular procedures may be allowed during the same encounter given the physician/non-physician can demonstrate medical necessity as documented in the patient’s medical record.

Preventive and/or screening services unless covered in Statute are not covered by Medicare.

 

[madcomic2000]

This is from WPHGHA LCD policy L35761

Utilization Guidelines
Each patient’s condition and response to treatment must medically warrant the number of services reported for payment. Medicare requires the medical necessity for each study reported to be clearly documented in the patient’s medical record.

Frequency of follow-up studies will be carefully monitored for medical necessity and it is the responsibility of the physician/provider to maintain documentation of medical necessity in the patient’s medical record.

Generally, it is expected that noninvasive vascular studies would not be performed more than once in a year, excluding inpatient hospital (21) and emergency room (23) places of services.

Only one preoperative scan is considered reasonable and necessary for bypass surgery. If a more current preoperative scan is indicated for a patient with multiple comorbidities having difficulty being stabilized for surgery or a change in condition, the medical record would need to support the medical necessity of the second scan.

In the immediate post-operative period, patients may be studied if re-established pulses are lost, become equivocal, or if the patient develops related signs and/or symptoms of ischemia with impending repeat intervention.

The frequency of medically necessary follow-up noninvasive vascular studies post-angioplasty is dictated by the vascular distribution treated.

Pre-surgical conduit mapping of the radial artery(ies) should only be accompanied by vein-mapping studies when the arterial studies demonstrate a non-acceptable conduit or an insufficient conduit is available for multiple bypass procedures.

Duplex scanning and physiologic studies may be reimbursed during the same encounter if the physiologic studies are abnormal and/or to evaluate vascular trauma, thromboembolic events or aneurysmal disease. The documentation must support the medical necessity.

Assessment of the Ankle brachial indices (ABI) only is considered part of the physical examination and is not covered according to Title XVIII of the Social Security Act section 1862 (a) (7) which excludes routine physical examinations and services from Medicare coverage.

Preventive and/or screening services unless covered in Statute are not covered by Medicare.