October 28, 2021
We have an office-based vein center and have heard that something called LCDs should be followed before a procedure is performed. We’re not sure what these are or if they are important and, if so, how to integrate them into our office processes.
An LCD is a Local Coverage Determination. These are medical coverage policies developed by regional Medicare carriers, Medicare Administrative Contractors (MAC), to determine whether there is medical necessity for a vein procedure. Every MAC and every private payor have published detailed criteria that must be met before veins can be considered symptomatic enough to justify interventions such as endovenous ablation. These criteria typically include conservative therapy requirements, vein size, number of ultrasounds performed, details of the ultrasounds, CEAP classification, and much more. If these criteria are not followed, payors can demand refunds upon case review. This can occur months or even years after the intervention is performed, even if it was pre-certified. We have seen significant refund demands from practices where policies were not followed, often because the practices were unaware that policies existed or were unsure of how to integrate them into daily practice.
Whether you are a “vein only” center or have vein procedure as part of a larger patient population, you cannot afford to ignore these payor policies.
To learn more about these coverage policies and how to integrate them as part of your EM, ultrasound, and procedure documentation, contact us to set up a telephone consultation.
*This response is based on the best information available as of 10/28/21.