Intermittent pneumatic compression (IPC) boots are generally accepted as a method for preventing deep venous thromboses (DVT) and complications of venous stasis in persons after trauma, orthopedic surgery, neurosurgery, or who for other reasons are unable to walk.
Full Answer
Is there a pneumatic compression device for deep venous thrombosis?
Pneumatic compression devices for prophylaxis of deep venous thrombosis (DVT) A pneumatic compression device was applied to 155 patients with a normal Doppler venous examination who underwent a general surgical procedure of at least 1 hr in duration.
Does Aetna Insurance cover pneumatic compression devices?
Aetna considers full-leg or half-leg pneumatic compression devices for home use medically necessary durable medical equipment (DME) for the treatment of chronic venous insufficiency of the legs of members who have venous stasis ulcers that have failed to heal after a 6-month trial of conservative therapy directed by the treating physician.
Are Medicare rules changing for pneumatic compression devices?
“The Medicare rules are about to change substantially regarding coverage for pneumatic compression devices for US citizens with lymphedema and chronic venous insufficiency. This is very troubling news.” Thus began our discussion with Jonathan Ross, President of Bio Compression Systems, Inc., a U.S. manufacturer of pneumatic compression devices. Mr.
Does Medicare cover compression devices for lymphedema?
“The Medicare rules are about to change substantially regarding coverage for pneumatic compression devices for US citizens with lymphedema and chronic venous insufficiency.
Does Medicare cover leg compression devices?
Original Medicare does not recognize compression socks/stockings as durable medical equipment (DME) and therefore does not provide coverage for the legwear. However, some Medicare Advantage plans provide some coverage for over-the-counter medical expenses, which may include compression socks and stockings.
Is E0676 covered by Medicare?
The appliance(s) and any other accessories, options, and supplies used with PCD E0676 are included in the payment for HCPCS code E0676 at the time of initial issue and must not be billed separately to Medicare.
Does Medicare cover E0650?
A PCD coded as E0650 or E0651 used to treat lymphedema that does not meet all of the requirements above is not eligible for reimbursement. Claims will be denied as not reasonable and necessary. A PCD coded as E0650 or E0651 used to treat edema from causes other than lymphedema is not eligible for reimbursement.
Does Medicare pay for compression boots?
According to the Center for Medicare and Medicaid Services, "Pneumatic compression devices are covered only when prescribed by a physician and when they are used with appropriate physician oversight, i.e., physician evaluation of the patient's condition to determine medical necessity of the device, assuring suitable ...
What is the difference between E0651 and E0652?
In an E0651 device the pressure is usually set by a single control on the distal segment. A segmented device with calibrated gradient pressure (E0652) is characterized by a manual control on at least three outflow ports which can deliver an individually determined pressure to each segmental unit.
What is a pneumatic compression device?
Pneumatic compression devices consist of an inflatable garment for the arm or leg and an electrical pneumatic pump that fills the garment with compressed air. The garment is intermittently inflated and deflated with cycle times and pressures that vary between devices.
Is E0218 covered by Medicare?
Water circulating cold pad with pump (E0218) will be denied as not reasonable and therefore not covered by Medicare.
Is E0676 covered by insurance?
Deep Venous Thrombosis Prevention A PCD that provides intermittent limb compression for the purpose of prevention of venous thromboembolism (E0676) is a preventive service. Items that are used for a preventative service or function are excluded from coverage under the Medicare DME benefit.
How much does Flexitouch plus cost?
Tactile Medical braces for new Medicare rules that will tighten access to its pneumatic compression pump. Tactile Medical's Flexitouch system is used to self-manage lymphedema and nonhealing venous leg ulcers. It ranges in price from $1,200 to $5,000 depending on the model.
Is A6531 covered by Medicare?
Medicare coverage is limited to either 30-40mmHg Ready to Wear Circular Knit Compression Stockings, Knee High only (HCPCS: A6531), and Gradient Compression Wrap, Non-Elastic, Below Knee, 30-50mmHg Velcro Compression Binders (HCPCS A6545).
Do you need a prescription for compression socks?
Compression stockings with higher levels of compression are prescribed by doctors. The prescription will include the specific strength you need. By law, no prescription is required, but most pharmacies won't dispense higher-level compression wear without a prescription.
How much do prescription compression socks cost?
You can buy them over the counter, but if your doctor prescribes them, your insurance may cover the cost. You can buy them at medical supply companies, online, and in many drug stores. They can cost from around $10 to as much as $100 per pair, depending on what kind you get.
What is a compression pump?
Compression pumps consist of an inflatable boot and a pneumatic pump that fills the boot with compressed air. The boot is intermittently inflated and deflated, with cycle times and pressure that vary between devices. In addition to compression, elevation of the limb, avoidance of standing for long periods of time, and frequent ulcer cleaning and dressing changes play a major role in the treatment of CVI with venous ulcers.
How is CVI distinguished from lymphedema?
CVI is distinguished from lymphedema in that lymphedema is when the lymphatic system is not able to clear fluid from the interstitial tissues of the body and return it to the bloodstream via a system of lymphatic vessels and lymph nodes.
What causes venous insufficiency in the lower extremities?
Chronic venous insufficiency (CVI) of the lower extremities is a condition caused by abnormalities of the venous wall and valves, leading to obstruction or reflux of blood flow in the veins. 1 The venous system in the lower extremities is composed of a superficial venous system, a deep venous system within fascia, and a connecting perforating system. The blood flows from the superficial to the deep system through perforating veins upward toward the heart; valves impede reflux. Two major pumps propel the blood centrally: the cardiac pump and the muscle pump. During muscle contraction (systole), the muscles exert high pressure on the deep venous system and milk the blood toward the proximal veins. When muscles relax, the diastole phase, the pressure falls in the deep system and blood flows from the superficial veins to the deep veins through the communicating veins due to pressure differences. One-way valves in the veins impede an outward flow through the perforators and prevent reflux during diastole. The venous circulation is a complex system that depends on the functions of muscle, valve and veins.
Does Medicare cover pneumatic compression pumps?
Medicare has covered pneumatic compression pumps for the treatment of lymphedema since 1986 . In 1995 Medicare expanded coverage of pneumatic compression pumps for the treatment of venous insufficiency that results in ulceration of the lower extremity after standard wound care treatment has been tried unsuccessfully for 6 months.
Is compression necessary for CVI?
There is wide consensus in the literature that compression is a necessary part of treatments for CVI and venous ulcers. Compression facilitates wound healing, reduces venous dermatitis, improves lipodermatosclerosis and counteracts venous hypertension. There are a number of methods that can be used to apply compression: elastic bandages, Unna boots, compression bandages or stockings which provide gradient pressure, compression pumps and orthotic devices. Stockings, bandages other similar systems provide static compression compared to the intermittent compression provided by pneumatic compression devices. Static compression is thought to help reduce the pressure in the veins by aiding venous return. 3
Can you use pneumatic compression pumps for edema?
Our current policy covers the use of pneumatic compression pumps for patients with refractory edema from chronic venous insufficiency with significant ulceration of the lower extremities that have received standard therapy but have failed to heal after 6 months of continuous treatment. After review of all available published literature, we have found sufficient evidence to show that standard care for the treatment of chronic venous insufficiency, which results in ulceration, can be successfully treated by elevation, exercise and compression therapy. Therefore, we conclude that our current policy is appropriate and will not be changed at this time.
Is intermittent pneumatic compression a major therapy?
Treatment with intermittent pneumatic compression devices are a major therapy ( not adjunct to surgery)
Why might I need to use intermittent pneumatic compression devices?
You might need to use IPC devices if you have a high risk of getting a DVT. Anything that slows the movement of blood through your veins increases your risk of DVT. A variety of conditions can increase your chance of getting a DVT, such as:
What is the best treatment for DVT?
Smoking. Obesity. Older age. IPC is one way to help prevent DVT. A blood-thinning medicine such as warfarin is also used to treat people who are at high risk for DVT. These medicines may work better than compression devices in preventing DVT.
What is an IPC device?
What are intermittent pneumatic compression devices? Intermittent pneumatic compression (IPC) devices are used to help prevent blood clots in the deep veins of the legs. The devices use cuffs around the legs that fill with air and squeeze your legs.
How to put on IPC cuff?
A healthcare provider will show you how to put on your IPC cuff. They often use Velcro straps to close. The cuff can be put on over or under your clothes, whichever is more comfortable. When fastened around your leg, the cuff should feel snug, but it shouldn’t hurt. You should be able to place a finger between the cuff and your leg.
How to prevent DVT?
Your provider may give you other instructions about ways to prevent DVT. These may include drinking plenty of water and getting physical activity. Follow all of your healthcare provider’s instructions.
What are the risks of getting a DVT?
A variety of conditions can increase your chance of getting a DVT, such as: Recent surgery, which decreases your mobility and increases inflammation in the body, which can lead to clotting. Medical conditions that limit your mobility, such as an injury or stroke. Long periods of travel, which limit your mobility.
Is DVT a common condition?
DVT is a common condition, especially in people over age 65. Post-thrombotic syndrome affects a large number of people who have had DVT. It can happen in men and women of any age.
How many local coverage determinations are there in DME?
Now that the immediate threat is over, we should not wait for the next shoe to drop. There are four Local Coverage Determinations (LCDs) in effect in the four DME Regions. There is a process whereby changes to LCDs can be proposed to the Medical Directors and the Coverage Advisory Committees for each region. Are we preparing proposals to change these LCDs in a way that makes medical sense for lymphedema patients? Who is leading the effort?
Does Medicare cover massage therapists?
I am an MLD therapist. However, I am a massage therapist, certified in MLD. This means that Medicare won't cover me (to my knowledge). So, this new rule may be very challenging for clients having to find therapists, that are covered by Medicare. Unless they are in a more populated area, or near a cancer facility that has nurses/PTs/OTs on staff which are certified, it can become a very costly venture to have to pay for all of those sessions out of pocket.
Does Medicare have a local coverage determination?
New Local Coverage Determinations (LCDs) are being put in place for all four Medicare regions that will overwrite the National Coverage Determinations (NCDs) that are currently in place for pneumatic compression devices. While a LCD should never restrict a NCD, the new policy does just that. Below are some highlights of the changes that are scheduled to go into effect on November 1, 2014:
Who supplies DVT prevention devices?
These DVT prevention devices can be supplied by a durable medical equipment (DME) supplier. The DME supplier, in many cases, will provide the compression devices and sleeves for patients for which the physicians prescribe these devices for preventing DVT. Consistent billing procedures are highly important for the DME supplier.
What is a DVT device?
Medical Billing for Compression Devices used for DVT Prevention. DVT, widely known as Deep Vein Thrombosis is a condition where blood clots/clot form in a deep vein located in the thighs and legs. This is a very serious condition because it can very easily break loose and move to the lungs.
What is compression device?
The compression devices consist of inflatable equipment for the leg and a pneumatic pump that fills it with compressed air. Many surgeons leverage DVT prevention either during and/or after surgery via using pneumatic compression devices and sleeves. These DVT prevention devices can be supplied by a durable medical equipment (DME) supplier. The DME supplier, in many cases, will provide the compression devices and sleeves for patients for which the physicians prescribe these devices for preventing DVT. Consistent billing procedures are highly important for the DME supplier. Should claims fail to be submitted appropriately it means that the DME supplier will not get paid. Note that there is a lot that revolves around DVT that must be accounted for effectively and accurately.
How does a DME billing specialist work?
The details provided by the physician and DME supplier include the appropriate device and/or Soft goods provided to the patient and the patient diagnosis codes. The codes are then fed to the patient encounter form or a superbill. The medical billing specialist then transfers the information into the medical billing software. Then, claims are sent to the insurance company. Depending on the insurance company and procedure, many of the claims might need to be sent via paper with a prior authorization completed. Should the claim be rejected, the specialist follows up and tries to find out why it was rejected. There are times where an appeal has to be written and accompanied by supporting details to the insurance company. If you notice, this is so much work that must be handled with utmost caution and done by a professional.
Prevention
- Intermittent pneumatic compression (IPC) devices are used to help prevent blood clots in the deep veins of the legs. The devices use cuffs around the legs that fill with air and squeeze your legs. This increases blood flow through the veins of your legs and helps prevent blood clots. IPC is one way to help prevent DVT. A blood-thinning medicine suc...
Causes
- The veins in your legs have tiny valves that help keep blood moving back up toward the heart. But a DVT may damage one or more of these valves. This causes them to weaken or become leaky. When this happens, blood starts to pool in your legs. This can also happen if you are immobile for a long period of time. Normally, muscles in the leg help blood move up in the veins when the mu…
Epidemiology
- DVT is a common condition, especially in people over age 65. Post-thrombotic syndrome affects a large number of people who have had DVT. It can happen in men and women of any age.
Symptoms
- DVT is a serious medical condition that can cause swelling, pain, and tenderness in your leg. In some cases, a deep clot in a leg vein can break free and stick in a vessel in the lung. This can cause a blockage in the vessel called a pulmonary embolism. Pulmonary embolism can cause severe shortness of breath and even sudden death.
Function
- While using an IPC device, your calf or whole leg is enclosed in a cuff. The cuff fills with air and squeezes the leg, much like a blood pressure cuff. Then the cuff deflates and relaxes. The process then repeats over and over. The compression helps move blood through your veins towards your heart. IPC also promotes the natural release of substances in your body that help p…
Medical uses
- IPC is used most often for people who have just had surgery. It may also be used after a stroke or to help treat lymphedema.
Risks
- All procedures have risks. The risks of this procedure include: Some people with certain health conditions should not use IPC devices. For example, people with leg ulcers, burns, or peripheral vascular disease have a higher risk for problems. Older adults may be more at risk for skin breakdown. Talk with your provider about the risks that most apply to you and any concerns you …
Types
- There are many types of IPC devices. Yours might cover your calf, or it might go around your whole leg. Some inflate all over the leg with the same pressure. Others may first apply pressure to the lower and then the upper part of the leg. Some inflate quickly, and others inflate slowly.
Treatment
- A healthcare provider will show you how to put on your IPC cuff. They often use Velcro straps to close. The cuff can be put on over or under your clothes, whichever is more comfortable. When fastened around your leg, the cuff should feel snug, but it shouldnt hurt. You should be able to place a finger between the cuff and your leg. Next, you attach the cuff to the compression machi…
Results
- You can remove your IPC cuff when you need to shower. Check your skin when the device is off and alert your provider if there are any areas of tenderness, swelling, warmth, redness, or skin breakdown. Make sure to put it back on as soon as possible. The more you use it, the more you will lower your risk of DVT and pulmonary embolism.