By: Lorna Simons, CPC
Medco Consultants, Inc
Have you performed, documented and billed out non-obstetric pelvic ultrasounds with pelvic dopplers only to find the doppler is getting denied? Ask yourself the following questions:
1) Did the patient have a diagnosis, sign or symptom of arterial or venous disease documented, treated/managed and coded?
Medical necessity for non-invasive vascular studies are based on whether or not the outcome of the study will affect the treatment/ management. Make sure to document and code the diagnosis, sign or symptom that led to the performance of the doppler.
Many Local Coverage Determinations (LCD) note abdominal pain or tenderness is not an indication for an initial diagnostic study unless there is a high likelihood that the pain is caused by a vascular disorder. Refer to the LCD for your area for specific direction.
2) Who performed the doppler?
The LCD for your geographic area will indicate who can perform a pelvic doppler. Both the NGS LCD L33627 and CGS LCD L34045 for Non-Invasive Vascular Studies state only the following providers can perform these studies:
- Providers who are “competent in diagnostic vascular studies”
- Providers under the general supervision of providers credentialed in vascular technology
- Ultrasound techs certified in vascular technology
Facilities accredited in vascular technology
3) Do you have a valid referral/order?
You must have a referral or order with clear indication of why the study is necessary on file for the service to be performed. If you are the provider performing the service you must clearly document in the treatment note why the study is necessary. Valid orders include the following:
- The patient’s name
- The test requested
- Clinical indications for the test
- The legible name, signature and date (Signature stamps are not acceptable)
If you have all of the above with the imaging and report, the studies shouldn’t be denied.
- National Government Services Local Coverage Determination (LCD): Non-Invasive Vascular Studies (L33627)
- Wisconsin Physicians Service Insurance Corporation LCD: Non-Invasive Abdominal / Visceral Vascular Studies (L35755)
- CGS Administrators, LLC LCD: Non-Invasive Vascular Studies (L34045)