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Vein Ablation Denials Show Importance of Pre-Procedure Progress Notes

A hospital’s recent reversal of claim denials of varicose vein ablation is an object lesson in the importance of including pre-procedure progress notes and other essential documentation when responding to an auditor’s documentation request, a compliance officer said.

“It’s just a matter of getting the right information” in the hands of auditors, said Peter Hughes, interim director of audit and compliance at Englewood Health in New Jersey. “It’s easier said than done, but it shouldn’t be.” There are complications, however, related to whether the physician who performs the procedure is part of the hospital’s physician network.

The recovery audit contractor (RAC) audited endovenous radiofrequency ablation (ERFA) and endovenous laser treatment (EVLT) for lower extremity varicose veins. According to the CMS website, “claims for ERFA and EVLT for Lower Extremity Varicose Veins [that] are not deemed to be medically necessary will be denied based on the guidelines outlined in the respective MAC Jurisdiction LCD(s).”[1]

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