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Left knee Venous Malformation - Sclerotherapy

Kelly Posted Thu 08th of March, 2018 09:45:53 AM
What are the appropriate CPT codes for the procedure described below? "...Ultrasound shows characteristic venous malformation within the left semimembranosus muscle. Ultrasound image obtained. Using ultrasound guidance, 5 separate 21-gauge needles were used to puncture the venous malformation in different locations. Blood was spontaneously obtained from all needles. Venograms were performed followed by injection of Sotradecol foam and alcohol under fluoroscopic observation. A total of 12 MLS of Sotradecol foam was injected and 3 MLS of absolute alcohol. Sotradecol foam was generated by taking 7 mL's of 3% Sotradecol mixed with 1 mL of lipiodol agitated with 8 MLS of air containing a quarter block of Gelfoam confetti..." Thank you!
SuperCoder Answered Fri 09th of March, 2018 06:01:59 AM


CPT code 49185 is found to be appropriate for the above procedure.

Have a good day!

Kelly Posted Wed 14th of March, 2018 11:25:53 AM
Hi! When I check the CPT code book for 49185, there is a note in the book that states (For sclerotherapy for a lymphatic/vascular malformation, use 37241). What is the most appropriate and why based on the documentation shared above? Thanks for your help!
SuperCoder Answered Thu 15th of March, 2018 02:52:57 AM

Hi Kelly, 

We apologize, when we hade a deeper research of the codes and considering venous malformation, CPT code 36470 (Injection of sclerosant; single incompetent vein (other than telangiectasia)) seems appropriate with the ultrasound guidace to be reported by CPT code 76942 based on the provided documentation.

Hope this helps!

Further query is welcome. 


Kelly Posted Thu 15th of March, 2018 12:24:23 PM
You recommend CPt code 36470, which is described clinically as follows, "When the patient is appropriately prepped, the provider inserts a syringe filled with a sclerosing solution directly into the affected vein. The solution causes the vein’s walls to collapse. After injecting the solution, the provider removes the needle and applies pressure to stop bleeding. The Op note that I provided describes "Blood was spontaneously obtained from all needles..." before the sclerosant was injected... does that change things or do you still stand by 36470?
SuperCoder Answered Fri 16th of March, 2018 02:30:44 AM

Hi Kelly,

The purpose of obtaining blood from needles is to disperse sclerosing solution effectively. Hence, code remains the same.

Have a good day!


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