# Sclerotherapy



## dadhich.girish

Hi:

I m new to coding sclerotherapy.  Please advise what codes should I bill for direct-puncture venography of neck veins x3 (name not specified) and direct puncture sclerotherapy of same sites.  He is using roadmapping and fluoroscopy.  Any and all inputs are welcome.

Report:

Using fluoroscopic guidance, the right neck and supraclavicular components of the venous malformation were punctured using a 5-French ring access sheath with a central needle. The needle was removed from the sheath, and backflow of blood was noted in all 3 locations. Contrast injection was then made under digital road-map imaging to confirm the presence of the sheath within the vascular lakes of the venous malformation. Once secure position of the catheter/sheath was noted within the malformation, contrast injection was further made in order to create a road map of the vascular lakes involved with the venous malformation. Non-opacified absolute or dehydrated alcohol was then injected through the sheath in order to rinse the opacified contrast from the malformation. The clearing of the contrast from the malformation would indicate appropriate injection of alcohol into this malformation. A total of 60 mL of absolute, or dehydrated, alcohol was used in all 3 of these locations.

Following the completion of alcohol injection within the 3 punctured components of the venous malformation, a collagen preparation with saline was then injected through the sheath as it was withdrawn from the vascular lake. In addition, direct digital pressure was applied to the puncture sites until hemostasis was achieved. The puncture sites appeared to increase in size and firmness and showed reddish and bluish discoloration of the skin, all indicative of an inflammatory response with marked tissue edema following the injection of the sclerosing agent.

Regards,


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## kwillard

*Sclerotherapy of upper extremity*

I have a similar question, my physcian has done a Sclerotherapy injection of the upper extremity and I was wondering if I could use the 36470, or if that was just for the lower extremity?
Thanks for your help in advance,
Kathryn


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## msncoder

Sclerotherapy for venous malformation (which the report provided by Girish indicates), lymphangioma, hepatic cyst, seroma, abscess obliteration, etc. is billed as a UPC.

Kathryn-why was your procedure performed? Spider veins? Varicose veins? Any type of varicosities? Or one of the reasons listed above?
Jeff Majchrzak (Vice President of Radiology Services with Medlearn) recently wrote a letter to AMA requesting clarification as to whether or not CPT 36470 was limited to the leg and AMA's response was that CPT 36470 was NOT limited to the leg, it can be used for any vein in the body treated by sclerosing agent. The CPT 36471, however, IS limited to just the leg. Hope this info helps!


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## dadhich.girish

*Thanx*

Hi Anita,

Thanx for your informative response, just a little more query, whether to put UPC for both direct-puncture venography and sclerotherapy, or just for sclerotherapy.  If yes, which code should be billed for unlisted venography.

Thanx in advance.


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## msncoder

IMHO, I do not feel that they performed or dictated a true diagnostic venography. The way the dictation reads, the contrast injections were only performed as assurance that the sheaths/caths were in the appropriate vein before they injected the ethanol. In order to consider charging a venogram they should perform (and document) a study that is diagnostic, meaning that they should perform it as though they are diagnosising the patient/condition/medical necessity prior to the decision for treatment and/or intervention.

Kind of wordy today, aren't I??!!! Sorry, it's Monday and I'm on a roll answering emails!


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## dadhich.girish

Hi Anita,

I think this was pretty quick and helpful response.  Thanks and keep giving such wordy responses.

Regards,


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## suec

*sclerotherapy*

Concerning the questions about sclerotherapy.. If 4 separate distinct injections were made to the superficial veins in the left axilla can we use cpt 36470 x4 or should we use 36299. Injections weren't done on spider veins? Any help is appreciated.

Sue


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## stina0602

I am looking for a CPT code for sclerotherapy of subcutaneous lesion/lymphangioma of chest wall


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