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December 13, 2019

Documentation Reminder for TAVR

Transcatheter Aortic Valve Replacement (TAVR): This procedure is used for the treatment of aortic stenosis when furnished according to the Food and Drug Administration (FDA)-approved indications.

The Comprehensive Error Rate Testing (CERT) contractor has issued errors resulting in a denial of inpatient claims due to missing documentation to support the need for the TAVR procedure. CERT Reviewer Comments include: The submitted medical records were missing evidence that two cardiac surgeons had independently examined the patient face-to-face and evaluated the patient's suitability for open aortic valve replacement (AVR) surgery. Both surgeons must document the rationale for their clinical judgment and that the rationale was available to the heart team.

Please review the NCD 20.32, Transcatheter Aortic Valve Replacement (TAVR) which includes all the covered indications and limitations of coverage for this procedure. The above error discussed in the previous paragraph is just one of the requirements that must be met in order to determine medical necessity for this procedure.

Providers should ensure that all documentation to support the medical necessity for this procedure is submitted when requested (this includes documentation from BOTH SURGEONS) by CERT and other Medicare contractors.


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