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Indications for Medical Necessity

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Home DVT Unit Indications for Prescribed PT:

(Must select one of the following):

⃝     Patient is being prescribed the E0676 DVT home program to provide compression for patients that need home prophylaxis.
⃝     To stimulate circulation and reduce the chances of deep venous thromboses for members who are unable to walk or bedridden due to trauma, orthopedic surgery, neurosurgery or other circumstances preventing ambulation.
⃝     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.

 

Clinical Note Requirements: Dictation must be exactly as shown above for the indication chosen.

Home DVT Unit

E0676

Most common ICD-10 codes:

I82.402 - Acute embolism and thrombosis of unspecified deep veins of left lower extremity

I80.X - Phlebitis and thrombophlebitis
I81.X - Portal vein thrombosis
I82.X  - Other venous embolism and thrombosis
I83.X - Varicose veins of lower extremities
I85.X - Esophageal varices
I86.X - Varicose veins of other sites
I87.X - Other disorders of veins
I88.X - Nonspecific lymphadenitis
I89.X - Other noninfective disorders of lymphatic vessels and lymph nodes

Additional DX Codes

RX/DWO

DVT Document Requirements: Signed/Dated RX, Clinicals with Indications. Up to date patient demographics with insurance information.

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