Peripheral vascular intervention (PVI) cases often need multiple billing codes (CPT codes). Sometimes, changes to these codes are identified before the procedure, while other times they are discovered during the procedure and require review afterward. EviCore’s Billing Group system makes it easier to update these codes when needed. Recent improvements to the case entry system ensure a faster and smoother process for both providers and patients.
Benefits of These Updates:
For Open or Approved Cases:
- If you need to add CPT codes to a case, you must withdraw the original request to avoid duplicates. Starting April 10, 2025, you can withdraw cases using the web portal www.evicore.com/provider or by calling EviCore for help.
- When creating a new request, include both original and additional CPT codes.
- Add important details, like requests for the opposite extremity, new symptoms, planned follow-ups, or changes in provider or location, to avoid delays. This makes it clear that your second request is not a duplicate.
For Denied Cases:
- EviCore cannot accept resubmitted requests for identical CPT codes for certain patients within a specific timeframe due to regulatory rules.
- If a CPT code is denied because it is too similar to a previous case, providers can follow the reconsideration, peer-to-peer review, or appeal processes to request another review of the case.
- Including new clinical details, such as opposite extremity requests or signs of new or worsening symptoms can speed up the review process.
For Retroactive Requests (case review requests after the procedure has been completed):
- Follow the health plan’s policy regarding submission of retroactive requests.
These updates aim to make things easier for providers and improve care for patients. Providers are encouraged to use EviCore’s web portal for submitting PVI cases, with phone support available if needed.