No longer living in denials

December 25, 2012 by MassDevice

By Westby G. Fisher, MD, FACC

Westby Fisher

I received this notice, dated 1 March 2012, from our billing department after a denial for reimbursement following a successful right ventricular outflow tract ablation I performed:

"Paul Rossi DO, a Cigna Medical Director, reviewed Use of an intracardiac electrophysiological 3-dimensional mapping system in the diagnosis, treatment, or management of ventricular arrhythmias or any other condition because there is insufficient scientific evidence to support use and determined the service(s) is not a covered benefit as indicated below:

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Service referenced: Electrophysiological 3-Dimensional Mapping and Catheter, electrophysiology, diagnostic/ablation, 3D or vector mapping

The use of an intracardiac electrophysiological 3- dimensional mapping system is considered medically necessary when used to guide supraventricular arrhythmias.  Based upon current available information, coverage cannot be approved to support the use of intracardiac electrophysiological 3-dimensional mapping in the diagnosis, treatment, or management of ventricular arrhythmias or any other condition because there is insufficient evidence to support its use.  At the present time, it is considered non-standard testing and falls under the category of experimental/investigational/unproven."

These denials are part of life for doctors - it's all part of the game.  But the era of social media is upon us, and with it, revenge.

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