Use this page to view details for the Local Coverage Determination for Non-Invasive Vascular Studies.
www.cms.gov
WEAK PULSES IS NOT AN INDICATION TO ORDER ABI/PVR. EVER.
Indications:
Non-invasive peripheral arterial examinations, performed to establish the level and/or degree of arterial occlusive disease, are medically necessary if (1) clinical evidence of limb ischemia is present and (2) the patient is a candidate for invasive/surgical therapeutic interventions. Acute ischemia is often characterized by the sudden onset of severe pain, coldness, numbness and pallor of the extremity. Chronic ischemia can be manifested by intermittent claudication, pain at rest, diminished pulse, ulceration, and gangrene.
A routine history and physical examination, which includes ankle/brachial indices (ABIs), can readily document the presence or absence of ischemic disease in the majority of cases. An ABI is not a reimbursable procedure by itself; rather, ABI may be reimbursed when derived from a more comprehensive procedure which includes a permanent chart copy of the measured pressures and waveforms in the examined vessels.
An ABI should be abnormal, e.g., <0.9 at rest,
and accompanied by other appropriate indications before proceeding to additional studies.
Peripheral artery studies may be considered
medically necessary if the following signs and symptoms are present:
- Claudication of such severity that it interferes significantly with the patient’s occupation or lifestyle, or claudication with inability to stress the patient;
- Rest pain (typically including the forefoot), usually associated with absent pulses, which becomes increasingly severe with elevation and diminishes with placement of the leg in a dependent position;
- Tissue loss defined as gangrene or pre-gangrenous changes of the extremity, or ischemic ulceration of the extremity occurring in the absence of pulses;
- Aneurysmal disease;
- Evidence of thromboembolic events;
- Blunt or penetrating trauma (including complications of diagnostic and/or therapeutic procedures); and/or
- Follow-up of grafts or other vascular intervention
Pre-surgical conduit assessment of the upper extremity/radial artery(ies) may be performed prior to use in coronary artery bypass grafting (CABG) or as other arterial conduits.
Limitations:
Peripheral artery studies may
not be considered medically necessary if specific clinical descriptions are not provided. Vague and anatomically imprecise terms such as “burning of the feet”,” pain in the limb”, and “edema” should be avoided, and more precise anatomic and pathologic descriptions included.
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, if the physician/provider can document medical necessity in the patient’s medical record.
In general, non-invasive studies of the arterial system are to be utilized when invasive correction is contemplated or severity of findings dictate non-invasive study follow-up, but not for following non-invasive medical treatment regimens. The latter may be followed with physical findings and/or progression or relief of signs and/or symptoms. Screening of the asymptomatic patient is not covered by Medicare.
But I am waiting until I’m completely out of the practice and received my bonus check before doing anything
