Medicare may cover sclerotherapy under specific circumstances.
Best bet: Check your local Medicare carrier's local coverage determinations (LCD) to decide whether it covers 36470 (Injection of sclerosing solution; single vein) and 36471 (- multiple veins, same leg).
For instance, the Medicare carriers for Florida and Texas will pay for sclerotherapy when the patient has an ulcer, inflammation or other complications of the lower extremities. To indicate medical necessity for sclerotherapy, Florida and Texas Medicare claims must contain an ICD-9 code of:
- 454.0 -- Varicose veins of lower extremities with ulcer
- 454.1 -- Varicose veins of lower extremities with inflammation
- 454.2 -- Varicose veins of lower extremities with ulcer and inflammation
- 454.8 -- Varicose veins of lower extremities with other complications.
Florida's Medicare carrier, First Coast Health Options, also allows an edema diagnosis (782.3) to support medical necessity for the procedure. The carrier's LCD indicates Florida Medicare -will cover the injection of sclerosing solution in the following circumstances:
- signs and symptoms of significantly diseased vessels of the lower extremities, such as stasis ulcer of the leg, significant pain, or significant edema, that interfere with activities of daily living; and/or
- in conjunction with surgical stripping or ligation.-
Florida Medicare, however, does not allow payment for duplex scanning or any ultrasound procedure for guidance during the injection of sclerosing solution for varicose vein treatment. If a surgeon performs ultrasound-guided sclerotherapy, Medicare will not cover the procedure.
The diagnosis code for an acquired cyst is 593.2 (Cyst of kidney, acquired).
For renal cyst aspiration, you should report 50390 (Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous). A note with 50390 instructs you to look to the following codes for radiological supervision and guidance:
• 74425 -- Urography, antegrade (pyelostogram, nephrostogram, loopogram), radiological supervision and interpretation
• 74470 -- Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and interpretation
• 76942 -- Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation
• 77002 -- Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device)
• 77012 -- Computed tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), radiological supervision and interpretation
• 77021 -- Magnetic resonance guidance for needle placement (e.g., for biopsy, needle aspiration, injection, or placement of localization device), radiological supervision and interpretation.
Your physician documented that he used Ultrasound guidance, so you should report 76942.
Because you also indicated cyst cavity sclerotherapy, use 53899 (Unlisted procedure, urinary system). As always with an unlisted-procedure code, provide adequate documentation to tell the insurer what the doctor did, why you should get paid, and what fair reimbursement would be.