# Clari-vein mechanicochemical ablation



## Daingerous (Mar 13, 2013)

Has anybody ever heard of this mechanochemical venous ablation procedure? I see it referred to as Clari-vein and some websites say it is FDA approved and paid by insurance. I cannot find a CPT code or any truth to insurance reimbursement. Any info would be appreciated. Thanks


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## airart (Mar 14, 2013)

*Clarivein CPT*

I found this on a website:

Endomechanical ablation (CPT code 37799) (eg, ClariveinTM [Vascular Insights, Madision, CT]) is a minimally invasive treatment for varicose veins, combining mechanical and chemical modalities. The procedure involves the use of a special percutaneous infusion catheter, which contains a rotating wire, providing endovenous mechanical destruction. Simultaneously, an FDA-approved sclerosing agent (eg, sodium tetradecyl sulfate) is administered in order to enhance occlusion of the vein.

Most plans I have looked at using Endomechanical ablation as my search words do cover this type of treatment when criteria is met.  The commercial payers I have searched so far are referring to the CPT 37799 for this product.

Taken from Highmark Commercial Medical Policy in West Virginia:
When conservative treatments fail to provide relief from symptomatic varicosities and the above general criteria requirements (1-6) are met, the following surgical options are eligible for reimbursement when reported for symptomatic varicose veins. However, in addition to the general criteria (1-6), specific requirements for each procedure must also be met and documented in the patient's medical record.

-Ligation/stripping and phlebectomy (i.e., stab, hook, transilluminated powered)(37700-37761, 37780-37785, 37765, 37766, 37799) 
-Endovenous ablation (36475, 36476, 36478, 36479) 
*-Endomechanical Ablation (37799)* 
-Sclerotherapy (36470 and 36471) 
-Subfascial Endoscopic Perforator Surgery(SEPS)(37500) 

When reported for conditions other than symptomatic varicose veins, these surgical options are considered cosmetic, and therefore, non-covered. This includes the diagnosis of non-symptomatic varicose veins. A participating, preferred or network provider can bill the member for the non-covered service.

Surgical treatment of varicose veins on the contralateral extremity is eligible only if that leg is also symptomatic.
https://www.highmarkbcbswv.com/medpolicy/printerfriendly/S-55-022.html

Good Luck!


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## suemt (Aug 20, 2014)

I came across some updated information on this code and wanted to share it here:

CPT Asst - August 2014 page 14

Frequently Asked Questions:Surgery: Cardiovascular

Question: Is CPT code 37241 appropriate to report for endomechanical ablation of a varicose vein?

Answer:No. Endomechanical ablation of a varicose vein is a venous ablation therapy technique that combines the mechanical induction of vasospasm and endothelial injury with injection of a sclerosant solution into the injured vein. This procedure description does not conform to any of the current Category I CPT venous ablation code descriptions (36468-36479). In addition, it is also not a venous embolization procedure, and therefore, does not qualify to be reported with the venous embolization CPT code 37241, Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles). Based on the procedural description of endo-mechanical ablation, code 37799, Unlisted procedure, vascular surgery, is currently the most appropriate CPT code to report endomechanical ablation of a varicose vein. 

And also this: 
Endomechanical Ablation Coding
By Rick Nielson on March 13, 2014 
http://apfsbilling.com/2014/03/endomechanical-ablation-coding/
Our View
by AJ Riviezzo
Recently code 37241 has been touted as potentially proper coding for an endomechanical ablation of a saphenous vein. The reimbursement is fantastic. It is an inclusive code. Medicare pays it quickly. 

As my mother always said, if something is too good to be true, it probably is.
Here?s why we believe the coding is inaccurate at best.

1. The full CPT language regarding this code is clear. Code 37241 is not to be used for reporting ablation procedures for venous insufficiency. The first full paragraph of the code is clipped below:

Codes 37241 37244 are used to describe the work of vascular embolization and occlusion procedures, excluding the central nervous system and the head and neck, which are reported using 61624, 61626, 61710, and 75894, and excluding the ablation/sclerotherapy procedures for venous insufficiency/telangiectasia of the extremities/skin, which are reported using 36468, 36470, and 36471. (For sclerosis of veins or endo venous ablation of incompetent extremity veins, see 36468 36479.)

2. Further, the code addresses that this code is for vascular embolization and occlusion procedures. The expectation for vascular embolization is the use of coils, particles, foam, plug or microspheres or beads. The embolization process normally is creating a plug and not occluding an entire vein like the saphenous.

3. The reimbursement rates are at least double what a laser or RF ablation would allow. Clearly the expectation by Medicare and the commercial payers is that this code is used for something requiring significantly more work value units than a normal ablation of a saphenous vein.

4. The payer guidelines that specifically allow endomechanical ablation of a saphenous vein all agree that code 37799 should be used. There is no mention, even of policies written this year, of using code 37241 for this service.

We believe that the proper way to bill for this service is to use code 37799 in the same way you would do so for a stab phlebectomy with less than ten incisions. Early results in using this code show reimbursement somewhere between a laser and RF ablation. There have been some difficulties with a few payers or Medicare Administrators but we think that constant and consistent use of the code and language in box 19 (or its electronic equivalent) will bring standardization to the process.

Our concerns are extremely high in using a code that pays significantly more, has language that we believe clearly excludes its use for an ablation, and exacerbated by Medicare?s ever increasing audit processes. We do not believe this code will survive an audit which could result in recoupment, penalties and interest.

Please know we do not care what type of technology you use for performing an ablation or any other procedure.

We only care that the code is appropriate and the reimbursement is appropriate.


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