Vein ablation and related services
Veins are blood vessels that carry deoxygenated blood from tissues back to the heart.
- Varicose veins are enlarged, swollen and twisted veins that often appear blue or dark purple when faulty valves in the veins allow blood to flow in the wrong direction or to pool. This increases the pressure in the vein, often causing swelling, pain, itching and discoloration to the affected area.
- Endovenous ablation is a procedure to close off varicose veins. Endovenous means that the procedure is performed inside the vein. Ablation heat is used to close off the vein.
- Chronic venous insufficiency (CVI) is a cause of abnormalities of the venous system producing edema, skin changes, or venous ulcers that are associated with varicose veins.
Some patients may want varicose vein treatment for cosmetic reasons. Medicare does not cover cosmetic surgery or expenses incurred in connection with such surgery. Cosmetic surgery includes any surgical procedure directed at improving appearance, except when required for the prompt (i.e., as soon as medically feasible) repair of accidental injury, or for the improvement of the functioning of a malformed body member. If the patient has no symptoms, discomfort, functional impairments, or activity limitations, treatment may not be appropriate.
Codes
| Code | Description |
|---|---|
| 36473 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated |
| 36474 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites |
| 36475 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated |
| 36476 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites |
| 36478 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated |
| 36479 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites |
| 36482 | Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (e.g., cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated |
| 36483 | Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (e.g., cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access sites |
Documentation requirements
- Doppler ultrasound.
- Documentation stating the presence or absence of DVT (deep vein thrombosis), aneurysm, and/or tortuosity (when applicable).
- Documented incompetence of the valves of the saphenous, perforator or deep venous systems consistent with the patient's symptoms and findings (when applicable).
- Photographs if the clinical documentation received is inconclusive.
- Documentation supporting the diagnosis of symptomatic varicose veins (evaluation and complaints), and the failure of an adequate trial of conservative management (before the initial procedure) (refer to your MAC’s LCD/LCA).
Best practice/documentation feedback/tips and help
- Documentation must indicate prior treatments.
- Documentation must support signs and/or symptoms that interfere with activities of daily living and/or quality of life.
- Documentation much include tests validating the location and level of varicosities.
- Prior authorization requests for vein ablations should clearly identify for which extremity and vein(s) the request is made.
- Prior authorization should include clear indication of laterality of the procedure being requested.
- If a provider’s plan of care is to perform serial ablations, treating one leg and different veins over several sessions, a prior authorization request is required for each session. Each claim billed to Medicare will require its own unique tracking number.
- Prior authorization requests must meet FDA guidance for vein ablation.
Billing/coding alerts
Prior authorization requests should ensure that second vein HCPCS are not being chosen without first vein HCPCS being indicated.
36475 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imagining guidance and monitoring, percutaneous, radiofrequency: first vein treated.
36476 Subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure).
36478 Endogenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated.
36479 Subsequent vein(s) treated in a single extremity, each through separated access sites (List separately in addition to code for primary procedure).
36482 Endogenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive remote from the access site. Inclusive of all imagine guidance and monitoring, percutaneous, first vein treated.
36483 Add on code: subsequent veins treated through a single extremity, each through separate access sites.
References
- CMS IOM Pub. 100-02 Medicare Benefit Policy Manual, Chapter 16 - General Exclusions From Coverage, section 120 "Cosmetic Surgery"
- CMS IOM Pub. 100-08 Medicare Program Integrity Manual, Chapter 3 - Verifying Potential Errors and Taking Corrective Actions, section 3.6.2.2 "Reasonable and Necessary Criteria"
- LCA, Billing and coding: Treatment of chronic venous insufficiency of the lower extremities (A58250)
- LCD, Treatment of chronic venous insufficiency of the lower extremities (L38720)
- NCCI Policy Manual for Medicare
- Social Security Act (SSA) Title XVIII, Section 1862(a)(1)(A)
- 42 Code of Federal Regulations (CFR) 411.15(k)(1)
The A/B Medicare Administrative Contractor Prior Authorization Collaboration Workgroup developed this document. This joint effort ensures consistent communication and education throughout the nation on a variety of topics and assists the provider and physician community with information necessary to submit claims appropriately and receive proper payment in a timely manner.