rmjanowitz
Contributor
According to Medi-Cal (CA Medicaid) guidelines for custom compression stockings (A6549), a patient must have symptomatic venous insufficiency or lymphedema to meet the criteria for coverage.
Specifically:
Per the documentation, the patient has bilateral varicose veins in the lower extremities (as well as a mention of some pain in both legs). The doctor is going with a Dx of I83.893. No mention of a diagnosis of venous insufficiency. As far as I know, someone can develop venous insufficiency from varicose veins, but varicose veins by itself doesn't mean a diagnosis of venous insufficiency. Is that the correct way of looking at this? Or would criteria written like this be referring to varicose veins as (definitionally) a type of symptomatic venous insufficiency? Specifically, varicose veins are caused by a weakening (insufficiency) of venous structures that allow blood to pool in the legs?
Any help would be great. I'm assuming if I bill this as authorized, it will be denied as non-covered due to Dx.
Specifically:
Criteria
The recipient requires one or both of the following:
Custom made compression stockings to treat symptomatic venous insufficiency or lymphedema in one or both lower extremities (A6545 and A6549)
Per the documentation, the patient has bilateral varicose veins in the lower extremities (as well as a mention of some pain in both legs). The doctor is going with a Dx of I83.893. No mention of a diagnosis of venous insufficiency. As far as I know, someone can develop venous insufficiency from varicose veins, but varicose veins by itself doesn't mean a diagnosis of venous insufficiency. Is that the correct way of looking at this? Or would criteria written like this be referring to varicose veins as (definitionally) a type of symptomatic venous insufficiency? Specifically, varicose veins are caused by a weakening (insufficiency) of venous structures that allow blood to pool in the legs?
Any help would be great. I'm assuming if I bill this as authorized, it will be denied as non-covered due to Dx.