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Wiki Venous duplex

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shellk@musc.edu

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Florence, SC
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We have been having all of our venous duplex claims come back as not medically necessary. We I look up the LCD with Medicare the only codes listed are varicose vein codes. We are unable to file with swelling of limb, pain in limb, DVT, pre-op surgery, which are the main reasons for this tests. Has anyone heard anything about this?
 
When I look up the LCD there are a lot of dx codes that are allowed with the venous duplex. We use leg pain quite often an get paid. We will receive some denials stating medical necessity and we appeal with notes and get paid.
 
This is the LCD for South Carolina. We use to get paid for all these dx but about 2 weeks ago everything began getting denied. I called Medicare and she directed me to the LCD which I had already pulled up and it was the same dx that are acceptable for Ablations and sclerotherapies - and that's it!
 
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