This Is MS Multiple Sclerosis Knowledge & Support Community

Hi all,

I have just been informed by our billing department that Medicare has started to deny payment for venoplasty when paired with the vein compression code.

Please check with your provider before you undergo the procedure.

Sorry for the news.

oh, wow.
Thanks for letting us know.



What a fix we are in.

Does venous angioplasty need to be paired with the venous compression code?
Are there other codes that can be used??

Naturally, I'm concerned about BC/BS catching on in MN....

Anyone know the vein compression code?

an old list....

PROCEDURE CODES:
Venogram: 36011,76937,75825,75820,37250,35476,37205
Angiogram w/ Angioplasty: 36247, 75630,75710,35470,37205
We are seeing patient to rule out vein compression, stenosis, venous insufficiency.

Possible Diagnosis codes:
780.71 Chronic Fatigue Syndrome
459.2 Vein Compression
459.81 Venous Insufficiency
784.0 Headaches
780.71 Chronic Fatigue Snydrome
729.81 Swelling of limb(s)
784.2 Swelling of Head & Neck
780.4 Dizziness/ Vertigo Nos
V331.83 Mild Cognitive Impairment
729.5 Pain in limb(s)

Thanks Cece.

459.2 - Compression of vein, Stricture of vein, Vena cava syndrome (inferior) (superior)

I think "Stricture of vein" is the relevant item, but I could be wrong.

As I recently discovered a negative compression test on a vein can reasonably be interpreted to mean there is a clot or other hard obstruction (like a scar -- remember, 'multiple sclerosis' is supposed to mean 'many scars').

If insurance companies are saving money by denying angioplasty to anyone who fails this test they are playing a game that will end in up in unnecessary hardship for many who need it. Of course the codes have not been invented yet to discriminate based on pre-existing diagnosis or disability, or maybe they have, but attempts have been made to remove them.

Why don't they just make us all go down to the local 'MS' Clinic to get our arms tattooed? It would make the paperwork so much simpler.

I wonder if 'compression of vein' means something is compressing on the vein that balloon angioplasty might relieve, i.e., muscle, artery, bone.

From Cece's list, I don't know why doctors aren't coding for 'venous insufficiency' which is what our problem is: 459.81 Venous Insufficiency.

This is a bad time for me cognitively, so I could be far off base.

It's surprising but when you look at the list most of those possible diagnoses (sp?) it could be anyone of us if we didn't have lesions. Except maybe the swelling parts.

This is so frustrating when you see the uses for venograms and it covers a fair number of issues that pwMS have. The neuro's can't quantify most of these in the first place and these are things that they just allow us to have.

My neuro can't quantify fatigue but he believes me when I tell him how exhausted I am but if it improves because of improved blood flow it is placebo.

Sorry for the rant, I'm in a bit of a mood this morning.

Dr. Cumming---Can you explain? Is it just the vein compression code? If it is I like Happypoet wonder why the venous insufficiency code isn't used.
When did it become effective? Thanks.

nellie wrote:Dr. Cumming---Can you explain? Is it just the vein compression code? If it is I like Happypoet wonder why the venous insufficiency code isn't used.
When did it become effective? Thanks.

I am waiting to hear more details.

Since we use the 459.2 code for many other types of vein disease, I am guessing there are identifying these procedures by looking for anyone that has had a MS diagnosis. That is the only way they code discriminate (AFAIK).

Is that legal in your country too? I really think the tattoo would have symbolic significance, but they could also just do a little database magic and I'm sure most of us would be easily identifiable. I'm really surprised that is not the case already, when a pre-existing condition regime existed for so many years. What's going on, here, privacy? Equality?

DrCumming wrote:Hi all,

I have just been informed by our billing department that Medicare has started to deny payment for venoplasty when paired with the vein compression code.

Please check with your provider before you undergo the procedure.

Sorry for the news.

I do not believe Medicare or any other insurer is acting legally when denying this treatment for pwMS. That is clearly discrimination, since having ms is irrelevant to the venous insufficiency.
The question is what can be done. A couple of thoughts. Since it is in the financial interest of our vascular clinics to have this worked out, would it be possible for them to contact Medicare (for starters) and present the data that shows clearly the venous insufficiencies must be corrected and this is not an attempt to treat MS?
Another option is for patients to take this data to the insurers but this obviously will take much longer.
There is always the legal route, but could get expensive unless there was class action.
And lastly, there is our congresspeople offices.
I do not think patients should just roll over for this. It is wrong to deny coverage for venous insufficiency.
My thoughts...d.

Here's what we know of Medicare's thought process from the letter to Dr. Mehta's group last December:

Re: Venogram and Venoplasty for Multiple Sclerosis
Dear Dr. Roddy:

I have received your Octover 21, 2010 letter requesting coverage and billing for the performance of venograms and venoplasties in patients with multiple sclerosis (MS).

[…edited out trial information] All services (diagnostic and therapeutic) associated with such a trial are also non-covered and non-reimbursable, including testing that might be required to determine whether the beneficiary is eligible for entry into such a trial.

Your have also requested coverage and reimbursement for Medicare-coverage and reimbursement for these same services outside of a clinical trial. Included with your letter were the following articles from the medical literature:

* Zamboni, P, Consorti G, Galeotti R., Gianesini S, et al, "Venous Collateral Circulation of the Extracranial Cerebrospinal outflow Routes", Current Neurovascular Research 2009, 6:204-212
* Zamboni, P, Galeotti R, Menegatti E, Malagoni AM, et al, "A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency, " Journal of Vascular Surgery 2009, 50:1348-1358
* Zamboni P, Galeotti R,Menegatti E, Malagoni AM, et al, "Chronic cerbrospinal venous insufficiency in patients with multiple sclerosis," Journal of Neurology Neurosurgery and Psychiatry 2009, 80:392-399

The first article describes the venous circulation in detail. The second describes the prevalence of venous obstruction in patients with MS and the third article reports results of venoplasty in such patients. These last two articles report a small study population (65 beneficiaries) and it is unclear whether these are even a different study population. The group is subdivided into three sub-groups of relapsing-remitting, primary progressive and secondary progressiv forms of the disease, further reducing the statistical and clinical significance. The treatment reults reported varied with the type of MS identified. The authors state the importance of additional longitudinal studies before accepting venoplasty as standard treatment for MS.

You have provided one article reporting a single site study with treatment of 65 patients, stratified into even smaller groups, followed for onley 12-18 months. However the trial that you alternatively proposed is to enroll 600 patients. It appears that diagnostic venography and venoplasty is not yet standard of care and remains investigational.

Therefore these services remain Medicare non-covered and non-reimbursable, even when performed outside of a clinical trial. All diagnostic tests for the purpose of identifying MS patients with venous obstruction (eg ultrasound, contrast venography, etc) as well all services related to the treatment of such obstructions (eg venoplasty) and all related services are considered not reasonable or necessary, and will be denied.

I regret that my response could not have been more favorable.

Sincerely,
Paul G. Deutsch