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Old 11-18-2011, 06:53 PM
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Default Non-Invasive Arterial Testing in the Office
Question:


As an aside, in Minnesota, it is my understanding that Medicare will only pay for a PADnet test if there is a diagnosis of "intermittent claudication".

Therefore, we are doing less and less testing as few meet this narrow criteria, and many of these are already being followed up by a vascular specialist.

Tom Silver, DPM
Golden Valley, MN


Answer:


The WPS LCD for Minnesota ("Noninvasive Vascular Testing" L28586) specifically lists the following indications as supporting the medical necessity of peripheral arterial studies: claudication, ischemic rest pain, tissue loss seen with ulceration, aneurysmal disease, thromboembolic events, blunt or penetrating trauma, complications of procedures, or anticipation of a surgical procedure where vascular disease is suspected. They include a list of ICD-9 codes which describe these conditions. The complete LCD is posted on the WPS website at

http://www.codingline.com/_gd/ld2cr1g

[NOTE: if a vascular specialist has already confirmed a diagnosis of [peripheral arterial disease, then a second diagnostic test may not be considered ‘medically necessaryŢ regardless of symptoms]

Linda Doran
BioMedix
Saint Paul, MN

7/2/11

I would be hard pressed to think of a situation (except two exceptions, see below) whereby another physician (MD/DO type) is referring the patient to you simply for vascular testing. It would seem much more likely it would be a referral for the exam and treatment of the wound, ulcer, etc.

It is possible if you were in a small town, that the MD/DO might be referring the patient to you for testing, and they would then refer the patient to the "big city" for vascular reconstruction. Another exception would be where a fellow podiatrist might be performing wound care or contemplating foot surgery on a patient and wants feedback on the patient's vascular status.

In most cases I would not endorse the performance of wound care unless I could assess the patient's vascularity via testing in my office.


As for regulatory compliance, this situation is not the same as DME, because filing orders for DME from another physician makes you a supplier who is not exempt from other supplier regulations (accreditation and Surety Bond).

However, if you are only performing the exam, and not rendering any treatment, you would be simply following the orders of another physician. You would be obligated to have some documentation (notes of a phone call, fax, email, hand written, etc.) of that order should you be audited.

You also would be required to comply with all the other requirements of the LCD for your carrier.

Paul Kesselman, DPM
Woodside, NY
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