# endovenous laser ablation with venography



## Shirleybala (Jan 15, 2009)

Hi,
How to code this report myy codes are
36478	
36005	59
75820	26

Please confirm 
      The patient was brought into the procedure suite.  Ultrasound
       examination of the left lower extremity veins was performed
       demonstrating occlusion of the greater saphenous vein below the
       sapheno femoral junction.  An incompetent perforator within the
       upper thigh reconstitutes several superficial varicosities along
       the medial fine.  Communication with segments of the saphenous
       vein are noted. Several large incompetent perforators are
       identified within the calf, primarily arising from the posterior
       tibial veins.  The greater saphenous vein within the mid and lower
       calf is patent an incompetent.  A large conglomeration of
       superficial varicosities is identified within the medial,
       posterior aspect of the mid to upper calf.

        The patient was then placed supine on the procedure table and the
        leg prepped and draped in the usual sterile fashion.  The
       saphenous vein was accessed at the ankle under ultrasound guidance
       using a 21 gauge micropuncture needle.  The needle was exchanged
       over a 0.018 inch guide wire for a 4 French tapered dilator. After
       exchanging for a 0.035 inch guide wire, a five French 45 cm long
       sheath was advanced to the mid calf.  Venography was performed
       demonstrating communication of the saphenous vein with large
       incompetent perforators within the lower calf. An Angioynamics
       laser fiber was then advanced through the sheath.  Tumescent
       anesthesia using .25% lidocaine solution was administered along
       the entire course of the vein under ultrasound guidance.
       Compression of the vein was noted throughout its course.  After
       redetermining that the tip of the fiber was below the
       saphenofemoral junction, the laser was activated to the 10 Watts
       energy and slowly withdrawn with the sheath.  Total pullback time
       was approximately 94 seconds.  Total energy delivered was 1395 J.
       Total vein length treated was 19 cm. The laser was deactivated
       approximately 2 cm proximal to the puncture site.  The sheath and
       fiber were then removed.  Repeat ultrasound exam demonstrates no
       flow within the  saphenous vein. The common femoral vein remains
       patent. A grade 2 thigh high compression stocking was then
       applied.  The patient tolerated the procedure without incident.

       Impression: Successful endovenous laser ablation of the left
       greater saphenous vein within the calf as described above.

       The patient is to return in one month for follow-up examination.
       Sclerotherapy of incompetent perforators and superficial
       varicosities, particularly adjacent to the medial malleolus will
       be considered at that time.


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## dpumford (Jan 16, 2009)

Hello

You can only bill for the 36478.  If you look at the green writing underneath the procedure code in the CPT you will see what you "Do Not Report" in conjuction with the 36478.  36005 is listed so you should not report it.  I don't believe I would bill the 75820 for it looks like it is more for guidance and not medically necessary.  

Hope this help!


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