Contact Payer First to Determine Medical-Necessity Guidelines for Vein Ligation
Published on Thu Aug 01, 2002
Medicare and third-party payers will not pay for vein ligation and stripping procedures for cosmetic purposes. If you demonstrate a reasonable level of medical necessity and apply careful and accurate diagnosis coding, however, you can increase your chances for reimbursement. What's Involved?
CPT contains two primary codes to describe surgical ligation and stripping of veins: 37720 Ligation and division and complete stripping of long or short saphenous veins
37730 of long and short saphenous veins. In addition, the surgeon may also remove varicose vein clusters, as described by 37785 (Ligation, division, and/or excision of recurrent or secondary varicose veins [clusters], one leg), during the same operative session.
Note: See CPT for a complete list of surgical ligation and vein stripping codes. A surgeon performs procedures 37720 and 37730 on the main trunk of the superficial saphenous vein, either by making an incision at the groin (long saphenous vein) or behind the knee (short saphenous vein), depending on which vein is to be removed. In both cases, the targeted vein is located and excised through a separate incision below the point of entry.
Code 37720 is used if either the long or short saphenous veins are targeted, while 37730 is appropriate if both the long and short saphenous veins are removed.
The surgeon removes vein clusters (37785) by making a small incision over localized areas of superficial varicose veins along the leg. The veins are then isolated and dissected free of neighboring tissue and, finally, either tied with sutures or stripped out bluntly. Beware of Bundling Issues Note that although a surgeon may remove saphenous veins and varicose vein clusters during the same operative session, due to national Correct Coding Initiative (CCI) bundling edits he or she may not always report the procedures separately. CCI considers 37785 mutually exclusive of both 37730 and 37720. The edits include a CCI indicator of "1," however, meaning that modifier -59 (Distinct procedural service) may be attached to 37785 under certain circumstances (e.g., the procedures are performed at distinct anatomical sites) to override the edit.
For example, if a surgeon removes both the long and short saphenous vein and also removes varicose vein clusters at a different location on the same leg, both procedures may be billed if modifier -59 is appended to 37785 to indicate a separate anatomic location.
In a second example, the surgeon removes the short saphenous veins in the right leg, along with varicose vein clusters at the same location. In this case, only the more extensive procedure (37720) may be reported because the criteria for appending modifier -59 (and therefore for separate reporting) have not been met. Note: Code 37780 (Ligation and division of short saphenous vein at saphenopopliteal junction) is similarly bundled [...]
