Each opinion is assigned a Miscellaneous 3d citation as well as a unique Slip Opinion citation that is paginated to permit pinpoint page references. They are cited as follows:
Recurrent superficial thrombophlebitis; or Severe and persistent pain and swelling interfering with activities of daily living and requiring chronic analgesic medication.
Surgical ligation including subfascial endoscopic perforator vein surgery SEPS or endovenous ablation procedures are considered medically necessary for the treatment of incompetent perforating veins with vein diameter measured by recent ultrasound of 3. Initially, endovenous ablation therapy of the first vein and of the second and subsequent veins in each affected extremity is considered medically necessary when criteria are met.
In order to authorize additional endovenous ablation, there should be documentation that the member continues to have symptoms and ultrasound showing persistent junctional reflux.
Additional endovenous ablation therapy may also be necessary for treatment of accessory saphenous veins as noted above. These procedures are considered cosmetic for all other indications. The term endovenous catheter ablation EVCA is a non-specific term that refers to the several catheter based minimally invasive alternatives Cjs 230 week 7 appendix a surgical stripping such as radiofrequency endovenous occlusion VNUS procedure and endovenous laser ablation of the saphenous vein ELAS.
In assessing the medical necessity of EVCA, reference should be made to the specific technique that is being employed. Aetna considers liquid or foam sclerotherapy endovenous chemical ablation e. Since ultrasound-monitored or duplex-guided techniques for sclerotherapy have not been shown to definitively increase the effectiveness or safety of this procedure, these tests are only considered medically necessary when initially performed to determine the extent and configuration of varicose veins.
Ultrasound- or radiologically guided or monitoring techniques are of no proven value when performed solely to guide the needle or introduce the sclerosant into the varicose veins.
The number of medically necessary sclerotherapy injection sessions varies with the number of anatomical areas that have to be injected, as well as the response to each injection. A set of injections is defined as multiple sclerotherapy injections during a treatment session.
Ambulatory phlebectomy or transilluminated powered phlebectomy is considered experimental and investigational for treatment of junctional reflux as these procedures have not been proven to be effective for these indications.
Ambulatory phlebectomy and the TriVex system is considered cosmetic for veins less than 2. Transilluminated powered phlebectomy has not been proven to be superior to other methods of varicose vein removal.
Therefore, the TriVex procedure should be billed as any other varicose vein removal procedure. Initially, up to two multiple stab phlebectomy incisions in each affected extremity i.
Additional multiple stab phlebectomy incisions are considered medically necessary for persons with persistent or recurrent symptoms. A set of stab phlebectomy incisions is defined as multiple stab phlebectomy incisions during a treatment session.
Aetna considers photothermal sclerosis also referred to as an intense pulsed light source, e. YAG laser has been shown to be effective for the treatment of telangiectasias and reticular veins, treatment of these small veins is considered cosmetic.
Aetna considers endomechanical or mechanicochemical ablation MOCA e. Aetna considers valvular reconstruction medically necessary for chronic venous insufficiency. Aetna considers micronized purified flavonoid fraction for the treatment of varicose veins experimental and investigational because its effectiveness has not been established.
Aetna considers the VeinGogh Ohmic Thermolysis System experimental and investigational because of insufficient evidence of its effectiveness.
Aetna considers the use of medical adhesive also referred to as cyanoacrylate superglue, n-butyl-cyanoacrylate e. Aetna considers polymorphism genotyping of matrix metalloproteinases genes e.
Aetna considers synthetic matrix metalloproteinases inhibitors for the treatment of varicose veins experimental and investigational because its effectiveness has not been established.
For endoluminal cryoablation also referred to as cryofreezing, cryostripping, cryosurgery, cryotherapy for varicose veins, see CPB - Cryoablation. Background Varicose veins are a common condition. In most persons, varicose veins do not cause symptoms other than poor cosmesis.
Varicose vein surgery is one of the most commonly performed cosmetic procedures in the United States. Most varicose veins do not require medical treatment Tapley et al, In some cases, however, the circulation may be hindered enough to cause swelling of the foot and ankle, discomfort, a tingling sensation, or a feeling of heaviness.
For most people with varicose veins, wearing specially fitted elastic stockings is all that is needed. The stockings should be carefully fitted to the individual, providing the most pressure in the lowest part of the leg.
The stockings should be put on when first arising in the morning, preferably before getting out of bed.
Exercise such as walking or cycling also helps promote better circulation from the lower part of the body. Resting with the legs elevated will help promote circulation; in contrast, sitting with the legs crossed can aggravate the condition.
A substantial proportion of varicose vein symptoms respond to conservative management. Conservative management consisted of lifestyle advice relating to exercise, leg elevation, management of weight and diet, and the use of compression hosiery.
In the surgical arm of the trial patients received the same lifestyle advice but also underwent surgical treatment, consisting of flush ligation of sites of reflux, stripping of the long saphenous vein and multiple phlebectomies, as appropriate.
Although a greater proportion of patients assigned to surgery plus lifestyle advice at relieving symptoms at 1 year, approximately one-third of subjects assigned to conservative management reported some relief from conservative management with compression hosiery.
At 2 years, there was no significant difference in symptom improvement between groups assigned to conservative management versus surgery.Human Rights Watch would like to thank all of the survivors of sexual violence, former offenders and their families, social workers, advocates, law enforcement officials, and attorneys who shared.
Number: Policy. Aetna considers the following procedures medically necessary for treatment of varicose veins when the following criteria are met: great saphenous vein or small saphenous vein ligation / division / stripping, radiofrequency endovenous occlusion (VNUS procedure), and endovenous laser ablation of the saphenous vein (ELAS) (also known as endovenous laser treatment (EVLT)).
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The Style Manual used by the New York State Law Reporting Bureau in preparing court decisions for publication in the New York Official Reports.
Human Rights Watch would like to thank all of the survivors of sexual violence, former offenders and their families, social workers, advocates, law enforcement officials, and attorneys who shared. Discover the best resource for University of Phoenix homework help: University Of Phoenix study guides, notes, practice tests, and more.