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Venous Ablation

Eunice Posted Thu 01st of August, 2013 14:49:10 PM

We started performing venous ablation and one of our radiologists wants to know if there is time limitation on when he can perform greater saphenous and lesser saphenous venous ablation?


After the procedure, if patient comes back within 7 days and we perform duplex ultrasound, is that separately billable?

Thank you!

SuperCoder Answered Mon 05th of August, 2013 03:03:42 AM

The correct code depends on the nature of the endovenous abalation procedure and the specific payer policy. Many payers advise that you report the unlisted code (37799, Unlisted procedure, vascular surgery) unless your insurer sends you written authorization to report 37204 (Transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method, non-central nervous system, non-head or neck) instead. Empire Medicare, a Part B carrier in New York, requires that you report 37799 for this service. In addition to this unlisted procedure code you should also report the unlisted imaging code appropriate to the form of imaging used, usually ultrasound.

Empire and most other carriers cover saphenous vein ablation only if the patient has symptoms attributable to saphenofemoral or saphenopopliteal reflux (454.0-454.8). Medicare will not reimburse vein ablation for cosmetic varicose vein treatments. In addition, most payers require that the patient has already tried conservative treatment such as exercise, leg elevation, weight loss and compressive therapy, before they will reimburse ablation.

Here is the coding alert article to work with :

Payers set up lots of reimbursement hurdles for saphenous vein ablation, but we’ve got four expert tips to coach you to coding success.

1. Separate RF and Laser Ablation Coding

Interventional radiologists often perform saphenous vein ablation using radiofrequency (RF) or endovenous laser treatment (EVLT).

RF ablation: Report RF endovenous ablation with codes 36475-36476, says Roseanne R. Wholey, president of Roseanne R. Wholey and Associates in Oakmont, Pa.:

• 36475--Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated

• +36476--... second and subsequent veins treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure).

You shouldn’t report these RF codes with EVLT codes 36478 or 36479, per CPT guidelines , says Dianne Nakvosas, head coder at Compubill Inc. in Orland Park, Ill.

Laser ablation: The codes for laser endovenous ablation are 36478 and 36479, Wholey says:

• 36478--Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated

• +36479--... second and subsequent veins treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure).

CPT guidelines tell you not to report these laser codes with the RF ablation codes, Nakvosas says.

Don’t miss: Physicians may also perform a phlebectomy (37765-37766, Stab phlebectomy of varicose veins, one extremity ...) at the same encounter as EVLT. NCCI Edits do not forbid you from reporting both of these services, but reimbursement will depend on your individual payer, Nakvosas says. Cover your bases--be sure your physician’s documentation supports medical necessity for both the phlebectomy and EVLT and shows that the physician performed them as separate procedures.

2. Include Imaging Services in 36475-36479

CPT guidelines instruct you not to report 36475-36479 in addition to a number of other codes, Nakvosas says. These include:

• needle and catheter introduction and venipuncture codes 36000-36005, 36410, and 36425
• percutaneous transcatheter occlusion code 37204.

Important: The descriptors for 36475-36479 specify that they include “all imaging guidance and monitoring.” Rationale: Endovenous ablation therapy requires imaging, including ultrasound for access, guidance, and monitoring and sometimes fluoroscopy (75894, 76000-76003, 76937, 76942), according to CPT Changes: 2005, says Dave Williford, RCC, senior coder for Desert Radiologists in Las Vegas.

Notes following 36475-36479 also tell you not to report these codes in conjunction with 93970 (Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study) and 93971 (… unilateral or limited study), Nakvosas says.

Exception: You may report the duplex scan codes if the physician performs a scan as an independent diagnostic study on the same day as the ablation therapy, according to CPT Changes: 2005.

Note: The descriptors for 36475-36479 also specify percutaneous access. But if the physician accesses the vein by a small cutdown, don’t code this separately. Include this procedure in the ablation therapy codes, says CPT Changes: 2005.

3. Avoid Add-on Codes for Bilateral Procedures

If your physician performs RF endovenous ablation on one vein in each leg during the same procedure, don’t report 36476 with 36475. Why? Code 36475 specifically tells you to report it for ablation performed on multiple veins in the same leg.

Instead: Report the bilateral procedure according to your payer’s guidelines. You may need to report 36475-50 (Bilateral procedure) or two units of 36475.

The same rule applies to laser ablation coding. Instead of reporting 36478 and 36479 for ablation performed on one vein in each leg, report 36478-50, or two units of 36478, or whatever method your payer prefers.

4. Clue in to Chemical Ablation

Codes 36468-36471 all describe sclerotherapy (chemical ablation) procedures, Wholey says.

But the codes you’re likely to use for saphenous vein ablation are 36470-36471:

• 36470--Injection of sclerosing solution; single vein
• 36471--... multiple veins, same leg.

Payers may or may not include payment for imaging guidance and monitoring for chemical ablation in the sclerotherapy codes. Tip: Dispute the inclusion of imaging in 36470-36471 because the codes aren’t defined or valued to include imaging, which is rare for these services.

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