ACC Deep venous thrombosis - DVT (POAC)

All Pinnacle practices in Waikato region can claim for this service. 

• Patients with suspected ACC related DVT with a Wells Score of >= 2 or a positive D-dimer.
• Superficial venous thrombosis.
• Management of a pregnant women with a clinical suspicion of DVT must be discussed immediately with relevant hospital specialist and documented in consult notes.
• Detailed clinical notes to clearly support POAC claim including a Wells Score as detailed below and/or D-dimer (except in superficial venous thrombosis).
• Repeat scans funded in following circumstances: 
  - Wells score >= 2, D-Dimer positive and 1st scan negative 
  - below knee DVT on first scan with no initial anticoagulation given 
  - persisting superficial venous thrombosis at 7-10 days with no risk factors in an ambulatory.  

• Patients with DVT and co-existing PE. Not eligible for POAC funding due to acuity of PE. Refer to Respiratory Medicine acutely.
• DVT in pregnancy.
• Leg swelling secondary to other causes (ruptured Baker’s cyst, calf sprain, muscle tear). Consider  alternative ACC funding if injury related. 

Exclusion criteria to access POAC funding should not preclude emergency treatment of any medical conditions. 

Wells score >=2 

• POAC funds a Doppler venous ultrasound. D-dimer via usual lab testing (2 negative tests required to rule out DVT as per Health Pathways) 
• If the D-dimer is positive and the first ultrasound is negative repeat Doppler venous ultrasound in 5-8 days is funded by POAC.  

Wells score <2

Arrange D-dimer as per HealthPathways. 

• If negative: DVT excluded – POAC will not fund ultrasound. 
• If positive: POAC will fund a Doppler venous ultrasound – if this is negative no further follow up scans will be funded.  

If superficial vein thrombosis (HealthPathways)

• No D-Dimer needed for POAC funding of ultrasound.
• POAC will fund Doppler venous ultrasound if:
  • there is an involved segment of vein 5cm or more
  • either the great or small saphenous vein is involved, or
  • there is asymmetrical leg swelling. 

If below knee DVT (HealthPathways)

• POAC will fund Doppler venous ultrasound follow up scan in 5 to 8 days if no initial anticoagulation given. 
• Seek haematology advice if uncertain re treatment.  

If superficial venous thrombosis with no risk factors (presence of DVT/superficial venous thrombosis within 3cm of sapheno-femoral junction) and the patient is ambulatory

• POAC will fund Doppler venous ultrasound follow up scan in 7 to 10 days if there is no resolution at the time.

Active cancer (treatment in past 6/12 or palliative) +1 
Paralysis, paresis or recent plaster immobilisation of lower leg +1 
Recent immobilisation > 3 days, or major surgery < 12 weeks +1 
Localised tenderness along the distribution of the deep veins +1 
Calf swelling > 3cm difference from asymptomatic side (Measure at 10cm below the tibial tuberosity) +1 
Pitting oedema confined to symptomatic leg +1 
Distended non-varicose superficial veins on symptomatic side +1 
Previously documented DVT +1 
Entire leg is swollen +1 
Is alternative diagnosis as likely or more likely than DVT -2 

Total score: 
  
If score is 1 or less, order D-dimer (low risk); If score is 2 or more, refer for ultrasound (high risk). 

Once the episode of care is completed and the patient is no longer acutely unwell, they exit the POAC programme.  

Once the patient exits the POAC programme, the case requires a clinical outcome to be lodged. No payment can be made for any claims unless the outcome is completed.  

Where treatment in the community is no longer clinically appropriate, the patient may be admitted to hospital during a POAC plan of care. Please indicate this in the clinical outcome.  

The initial 15-minute GP/NP consultation incurs the usual consultation fee/ACC surcharge paid by the patient. All POAC services thereafter are provided at no cost to the patient. If the claim is unable to be funded by POAC, the patient may be liable to the practice for the fees incurred. 

Please make your claim via Primary Options, select ACC Deep Vein Thrombosis and then attach the appropriate invoice(s).

Prices listed below are GST inclusive.  

ACC DVT enoxaparin: $39 
Administration of enoxaparin where oral treatment is unsuitable.

ACC DVT GP/NP/CP follow up consult: $49 
Follow up consultation following ultrasound.
 
Funded via third party providers 
An ultrasound is funded under this service. Patients who are not acutely unwell and do not require a same day scan are not funded under POAC and should be referred to primary referred radiology. The scan can be the next day with Clexane coverage. 

GP/NP provided point of care ultrasound is excluded from POAC services – it is expected that patients will be charged for this service.  

Practices are required to provide sufficiently detailed consultation notes to determine appropriate use of POAC funding otherwise the referral may be declined.   

It has been recommended that in addition to a good assessment and history, the full range of appropriate observations should be documented, especially where the diagnosis is undetermined. It is important to state the time of consultations and interactions with the patient.  

Please include a Wells Score as detailed below and/or D-dimer (except in superficial venous thrombosis). 

The initial 15-minute GP/NP consultation/ACC surcharge incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient. 

The service is funded by Te Whatu Ora.