External Counterpulsation for Severe Angina (ECP)(Coverage Issue Manual 35-74)

ECP is a non-invasive outpatient treatment, reimbursed by the Medicare Program when specific diagnoses and criteria are met, as established in the National Coverage Decision and published in the Coverage Issues Manual. In order to assure accurate reimbursement for this service, it is subject to pre-payment medical review. Medical records are requested and reviewed prior to rendering a reimbursement decision.

A major reason for denial of this procedure is failure in the documentation to indicate direct supervision of the procedure by a physician. One of the criteria in this national coverage decision is that "This procedure must be done under direct supervision of a physician." The additional development request (ADR) specifically asks for evidence that the physician provided "direct supervision" during the procedure. Failure of the documentation to reflect that the physician provided direct supervision while this procedure was performed will result in a denial of those services.

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