# 37241 and Clarivein



## healing13 (Feb 25, 2014)

Help!
This has become a huge debate and I am reaching out for some other opinions.

The code in question is 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)

CPT notes state: For sclerosis of veins or endo venous ablation of incompetent extremity veins, see 36468 36479; 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. Embolization and occlusion procedures are performed for a wide variety of clinical indications and in a range of vascular territories. Arteries, veins, and lymphatics may all be the target of embolization.

Code 37241 is used to report vascular embolization or occlusion procedures performed for venous conditions other than hemorrhage. Examples include embolization of venous malformations, capillary hemangiomas, varicocele's, and visceral varices. Embolization of side branches of an outflow vein from hemodialysis access would be reported using 37241.

The question is; is the above code appropriate for the Clarivein procedure?

The Clarivein procedure is also known as endomechanical ablation for varicose veins. The full description is: Endomechanical ablation  (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. (typically billed as 37799).

The company says to use 37241, but according to all the notes this looks wrong. Ablation for venous insufficiency is excluded from this code per CPT.

Comments? Opinions? Anyone?


----------



## Matthew Douglass (Mar 10, 2014)

I have had bad luck with vendors saying how to code things, information given is not always correct.

I have not experience with this procedure but I agree with you, 37241 is not the correct code.    

I would say 36468, 36470 or 36471 (not 37799) for the injection.  Notice in the notes that 37241 is not billable with these.

I don't know of a code that fits the mechanical ablation part of your procedure.

Matthew


----------



## dianakayf (Mar 25, 2014)

*Clarivein*

I think this is a big push by the vendors who may or may not have a good product but they are definitely pushing the wrong code out there in order to sell their product!!!  Which is what most vendors do.  They are not the ones that will be there when the auditors come around.  I am attaching a link where the AMA has expressed it's opinion on this.

http://www.veinexperts.org/blog/201...-cpt-37241-discussion-from-linkedin-group.asp

I am not comfortable billing this code at all for vein ablations.

Diana Franklin, CMRS, CPC
dianaf@twlakes.net


----------



## Matthew Douglass (Apr 17, 2014)

That was a good link. Diana.


----------



## sballard (May 23, 2014)

*clarivein varicose vein closure new code 37241*

The RF closure for varicose veins is 36475.   The *Clarivein code in 2013 was 37204, 36011 and 75894.  Medicare accepted these codes.  (commercial insurances did not accept the clarivein code)  This year the code 37204 is a deleted code.  This is why we have all the confusion.  After looking extensively into the code.  I do not believe 37241 is a code that can be used for Clarivein.  After speaking with the doctor, we have concluded the correct coding would be 37799, 36011, 75894.  This is to describe "closing down a varicose vein" that is diagnosed as 459.81, venous insufficiency, with pain 729.5   (We are not discussing sclerotherapy for spider (Telangiectasia) veins.  That code IS 36470, 36471.  This is not the procedure being discussed.


----------



## suemt (Feb 17, 2015)

*Sclerotherapy and Anesthesia*

I'm posting this question here because it looks like there are some experts on this specialty here.  

Do your providers use anesthesia for sclerotherapy procedures?  What type?  If so, is it always or just on a case by case basis?

Thanks in advance for your responses!


----------



## icd9rn (Mar 9, 2016)

*Insurance Nurse*

I work in a Blue Cross, we do varicose vein cases all day long. The CPT rules we have gone by for Clarivein procedures is that the proper billing is with 37799, because there is no official code assigned to it yet. I think the post about the vendors pushing their product is valid, but what it comes down to is how much the provider is payed based on what they are contracted to receive from their local payor. Fee scale in geographic areas will pay whatever the allowable is. Because we are a Blue Cross I talk to providers all over the country, and only once have I had a provider (from California) indicate that they regularly use 37241 to report this. So it seems the vast majority are coding it properly. If the local Blue wants to pay for that code for a Clarivein, then I don't really worry about it as long as I know the exact procedure (in English) they are reporting with it.


----------

