Diagnosis
This question will always be asked. Its important to decide which diagnosis you want to go for.
Cardiovascular Disease
If the patient has preexisting cardiovascular disease, we need to document at least one example. See the right hand list for example of cardiovascular disease.
What to Send
- What type of cardiovascular disease the patient has.
Examples
- Acute Coronary Syndromes
- Angina
- Coronary Artery Disease
- Myocardial Infarction
- Peripheral Vascular Disease
- Revascularization procedure (e.g. coronary bypass graft)
- Stroke
- Transient Ischemic Attack
Familial Hypercholesterolemia
For FH patient use the MEDPED criteria to qualify the patient's diagnosis. (This is based on total cholesterol, not LDL)
What to Send
- Starting Total Cholesterol (not LDL)
- Closest relative who also has FH (e.g. first degree, second degree, etc.)
MEDPED Criteria
Primary Hyperlipidemia
If the patient also has cardiovascular disease or FH, it is better to go that route as it is easier to get covered.
What to Send
- Statement the patient has primary hyperlipidemia.
LDL Lab
Documentation of the patients starting and post treatment LDL (if applicable).
What to Send
- Most recent LDL lab.
- Starting LDL lab or approximation of what the starting LDL was (if for continuation).
Tips
- For new patients insurance generally will want the lab taken within 30-90 days of the request.
- For renewals generally with 6-12 months is acceptable.
Statin History
On Statin
We need to know what statin they are currently taking and if it is the maximum dose they can tolerate.
What to Send
- Statin currently being taken
- If not on a "high intensity statin" is this the maximum dose they can take?
Not On Statin
If not on a statin, we need a specific reason why they are not taking one.
What to Send
- Statin currently being taken
- If not on a "high intensity statin" is this the maximum dose they can take?