Varicose veins and saphenous vein reflux procedures are quickly becoming one of the highest volume elective surgeries in the US with 40 Million people being diagnosed with this condition. With awareness growing each year the Vascular industry must invest in continuously improving treatment options for patients. With advances in technology comes new treatment options which creates new CPT codes, reimbursement regulations and ultimately the need for professionals that stay up to date to ensure you maximize your revenue.
Whether your practice solely focuses on the treatment of veins or you have a vein clinic within your vascular/ cardiovascular clinic; you will need to employ a professional that is focused on precertification, payer medical policies, annual updates and patient coverage and benefits. This professional should have a clear understanding of vascular medical terminology, payer requirements and general anatomy knowledge. Your reimbursement success begins at the patients first consultation. Proper documentation of symptoms effecting daily living, types of conservative therapies that have been attempted and required compression stocking trial are all needed for approval. Following the consultation the ultrasound technician must have general knowledge of the anatomical location payers are evaluating for approval ( junctional reflux vs generalized reflux within the saphenous vein itself ) and what measurements need to be documented. A valuable precertification specialist will be able to compile and interpret all necessary information and provide their determination based on the medical policy of the patients payer regarding coverage for services. Emphasis on selecting the appropriate candidate with the ability to effectively communicate, stay knowledgeable with reimbursement updates and implement proper procedures in your vein clinic will determine your level of success.
Vein Procedure Code Set
Coding Instructions
Per CPT code set guidelines use code 37799 for less than 10 stab phlebectomies. We suggest using a custom code with a compare to code of 37766 in the description. Coding for stab phlebectomies is depended on the number of incisions the physician makes. Proper documentation is critical for correct coding.
Ultrasound guidance, catheter placement, ongoing imaging during the procedure, and completion imaging after therapy is included in the following codes; 36465-36471, 36473-36479, 36482 & 36483 and therefor should not be separately reported.
76942 ultrasound guidance for needle placement can be reported with codes 36468, 36471, and 36471 when performed.
36468 should only be reported once per extremity and considered cosmetic in most cases.
36470 and 36471 describe the use of a compounded or non-compounded sclerosant to treat non-truncal veins and other than telangiectasia. While 36465 and 36466 describe the use of a compounded or non-compounded foam sclerosant to treat truncal veins. Truncal veins include the great saphenous vein, small or lesser saphenous vein and the accessory saphenous vein. 36465 and 36466 included imaging guidance and therefor it is not separately reportable.
Use add-on code 36474, 36476, 36479 or 36483 for additional veins ablated through separate access sites of other truncal veins in the same leg. Only report add on code once regardless of the number of additional separate access sites and treatments performed on a single leg.
37241 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural road mapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles), should not be reported for endovenous ablation therapy of incompetent or varicose veins of lower extremities. Use 37241 to report treatment of true vascular malformations.
36473 and 36474 should be used to report mechanochemical ablation of truncal lower extremity varicose veins.
36465/36466- Common sclerosant brand name is Varithena.
36482/36483- Common chemical adhesive brand name is VenaSeal.
36473/36474 - Common MOCA brand name is ClariVein
For additional questions and inquiries contact Sloan Medical LLC @ 855-204-0275 or email Alex @ alex.nedzelskiy@sloanmed.com
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