July 21, 2021
Vein Ablation and Related Services
Veins are the blood vessels that carry deoxygenated blood from the tissues back to the heart.
Varicose veins are enlarged, swollen and twisting 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.
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.
| Code | (v) Vein Ablation, and related services |
|---|---|
| 36473 | Mechanochemical destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance |
| 36474 | Mechanochemical destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance |
| 36475 | Destruction of insufficient vein of arm or leg, accessed through the skin |
| 36476 | Radiofrequency destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance |
| 36478 | Laser destruction of incompetent vein of arm or leg using imaging guidance, accessed through the skin |
| 36479 | Laser destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance |
| 36482 | Chemical destruction of incompetent vein of arm or leg, accessed through the skin using imaging guidance |
| 36483 | Chemical destruction of incompetent vein of arm or leg, accessed through the skin using imaging guidance |
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;
- The patient's medical record must contain a history and physical examination supporting the diagnosis of symptomatic varicose veins (evaluation and complaints), and the failure of an adequate (at least 3 months) trial of conservative management (before the initial procedure).
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
- Refer to 42 Code of Federal Regulations (CFR) 411.15(k)(1)
- Social Security Act (SSA) Title XVIII, Section 1862(a)(1)(A)
- Internet Only Manual (IOM) Publication (Pub.) 100 02, Chapter 16, Section 120
- IOM Pub. 100-08, Chapter 3, Section 3.6.2.2.
- NCCI Policy Manual for Medicare
- Refer to the Medicare Administrative Contractor (MAC) Local Coverage Determination (LCD) and/or Local Coverage Article (LCA) if applicable.
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