Billing and Coding: Treatment of Varicose Veins of the Lower Extremities

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
associated Local Coverage Determination (LCD) L34536 Treatment of Varicose
Veins of the Lower Extremities.

Historically, varicose veins have been treated by conservative measures such
as exercise, periodic leg elevation, weight loss, compressive therapy, and
avoidance of prolonged immobility. When conservative measures are
unsuccessful, and symptoms persist, the next step has been sclerotherapy or
surgical ligation with or without stripping.

**General**

  1. It is not enough to link the procedure code to a correct, payable diagnosis code. The diagnosis or clinical suspicion must be present for the procedure to be paid.
  2. When performing ligation/ablation on the opposite leg during the postoperative (90 day global) period, bill the appropriate CPT code with the 79 modifier.
  3. Use unlisted CPT code 37799 when less than 10 **stab phlebectomies** are done. Provide a description of what was done and the number of stab phlebectomies in Item 19 on the CMS-1500 claim form, or in the equivalent field for electronic submissions.
  4. When reporting **surgical ligation** procedures (37700, 37718, 37722, 37780, 37785) performed bilaterally, report the appropriate code with the 50 modifier. When reporting any combination of surgical ligation procedures performed on opposite legs, report the appropriate CPT codes with a RT or LT modifier on separate lines.
  5. When reporting **sclerotherapy** procedures (36465, 36466, 36470, and 36471) performed on opposite legs, report CPT code 36465, 36470 (one vein) and 36466, 36471(multiple veins) on separate lines using the RT and LT modifiers. For bilateral services, use the 50 modifier. Only one service should be reported for each leg regardless of how many veins are treated. When the procedure is performed for cosmetic purposes, use code Z41.1.  
  
When reporting procedures (36482 and 36483) performed on opposite legs, report
CPT code 36482 (one vein) and 36483 (multiple veins) on separate lines using
the RT and LT modifiers. For bilateral services, use the 50 modifier. Only one
service should be reported for each leg regardless of how many veins are
treated. When the procedure is performed for cosmetic purposes, use code
Z41.1.  
  
Please be advised that the practice expense for CPT codes 36465, 36466, 36470,
36471, 36473, and 36474 already contain the reimbursement for the sclerosant.
Providers should not bill separately for the sclerosant.  
  
Please be advised that the practice expense for CPT codes 36482 and 36483
already contain the reimbursement for the chemical adhesive. Providers should
not bill separately for the chemical adhesive. Use CPT code 36483 to report
the second and subsequent veins treated in a single extremity _**only when
treated through separate access sites**_.

  6. When reporting **endoluminal radiofrequency ablation (ERFA)** , use CPT code 36475 for **the** first vein on each extremity. Use CPT code 36476 to report the second and subsequent veins treated in a single extremity _**only when treated through separate access sites**_.