ED Coding and Reimbursement Alert

Question: A patient with varicose veins in her left lower leg reports to the ED complaining of leg pain. One of the veins is bleeding, so the doctor uses suture ligation to stem the bleeding and remove one of the veins. How can I report this scenario? I-ve pored over CPT 2006 and cannot find any mention of suture ligation treatment for varicose veins.


Minnesota Subscriber

Answer: You did not find a CPT code for suture ligation of varicose veins because one does not exist. There are a few different ways you can report this encounter, but you-d be best served to contact your carrier before filing the claim.

Option 1: the varicose vein ligation code. To use this code, you should:

- review CPT code 37785 (Ligation, division and/or excision of varicose vein cluster[s], one leg) for the ligation.

- attach ICD-9 code 454.8 (Varicose veins of lower extremities; with other complications) to 37785 to prove medical necessity for the procedure.

Potential problems: Code 37785 has high relative value units and is a much more formal procedure than your doctor likely performed.

Option 2: Consider reporting the encounter with a simple repair code. So if the physician made a 3.1-cm repair to the patient's leg, you would:

- report 12002 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.6 cm to 7.5 cm) for the repair.

- attach ICD-9 code 454.8 to 12002 to prove medical necessity for the procedure.

One more option: If all the physician did was ligate the bleeding vein with a single stitch, you might best recognize the work by rolling it into the overall evaluation and management service.