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!