query for CHF type from ECHO report

Unknown

We are learning that insurances are no longer allowing ECHO's to be done bi-yearly but have gone to an annual ECHO for monitoring CHF in a patient. Is this sufficient data to use as query potential for type of CHF when an ECHO is a year old?
Thoughts or references appreciated.

Tina Simpson, BSN, RN, CCDS
Clinical Denial Coordinator
WRMC-Batesville, AR

paxneros

I have no official advice or information to offer but one of our
Pulmonologist actually informed us that we could use an ECHO up to a year
old. Our physician consultant agreed with this advice. I usually check old
medical records for ECHOs to print and attach to CHF queries.

Norma T. Brunson, RHIA, CDIP, CCS, CCDS

Unknown

Clarification on frequency of echos in general:


Routine (yearly) re-evaluation of patients with heart failure (systolic or diastolic) in whom there is no change in clinical status are not considered medical necessary. The key here is change in clinical status. It is just that echos can be performed more than once a year and payable by third party payers, provided the physician in/his office note and orders appropriately documents the change in patient status, i.e., signs and symptoms.

sbaine

The only thing I would add is the check the American Heart Associations information and Cardiology fellows infection on best practices data.This can help guide you.CMS Core Measures does not specify how new the ECHO has to be just that the documentation notes that an LVS function has been performed or to be ordered in the outpt setting upon dc.