The new changes to the LCD for applying wound grafts for DFUs and LVU's (PCTs/CAMPS) state that a vascular assessment of the foot and lower extremity is required before applying said graft (ABI is no longer sufficient testing, but rather Near Infrared Spectroscopy (NIRS)is).
However, a recent webinar I attended noted that a DPM/MD may not be qualified to perform NIVT unless duly trained and certified to do so. According to the NIVT LCD revised in 2023:
Services will be considered medically reasonable and necessary only if performed by appropriately trained providers:
All non-invasive vascular diagnostic studies must be performed meeting at least one of the following:
performed by a licensed qualified physician, or
performed by a technician who is certified in vascular technology, or
performed in facilities with laboratories accredited in vascular technology
A licensed qualified physician for these services is defined as:
Having trained and acquired expertise within the framework of an accredited residency or fellowship program in the applicable specialty/subspecialty in ultrasound (US) or must reflect equivalent education, training, and expertise endorsed by an academic institution in ultrasound or by applicable specialty/subspecialty society in ultrasound, or
Has the Registered Vascular Technologist (RVT), Registered Physician Vascular Interpretation (RPVI), or American Society of Neuroimaging (ASN): Neuroimaging Subspecialty Certification; and
Is able to provide evidence of proficiency in the performance and interpretation of each type of diagnostic procedure performed
So, based on the above verbiage, can a non-properly trained/certified DPM perform a NIVT in the office?
Another point, please note no changes have been made as of today and who knows if they will in April. As of now doctors/providers should only rely on the active policy and billing articles not future!
Medicare would never have provided legitamacy to only one way to perform vascular assessment. So I am not sure where you received the idea that Near Infrared Spectroscopy (NIRS)is required. If you are one of a select number of physicians performing such service great. But there are other ways to assess the microvascularity of the area around the wound. PVR and PPG are far more effective than U.S and rationale for US education makes little sense, since the policy seems to be significantly downplaying the role of US.
ABI as the policy states is really non reliable and while you may perform it, hopefully it will go the way of the horse and buggy.
Most DPM's including myself would qualify under C: Is able to provide evidence of proficiency in the performance and interpretation of each type of diagnostic procedure performed. I have performed thousands of tests over 40 years and written articles and lectures on this topic.
Many of the techniques such as digital PVR, PPG and laser doppler were not available during my training.
The bottom line is that any podiatrist performing these tests must meet the same standards as those others providers outlined in the policy. The same is true for the reports.
Not only do I stipulate that mine are as good as those others, but likely my reports are superior. Having seen vascular surgeons report, I know this to be true!
So don't shy away, get trained and perform these test correctly and don't look back