General Surgery Coding Alert

Question: What is the correct way to code the treatment of multiple varicose veins by endovenous ablation therapy when the patient has bilateral venous incompetence in the greater saphenous veins as well as incompetent perforators bilateral and deep system incompetence? Our office codes as follows: 36475-LT, 36476-LT, 36475-RT,36476-RT using one unit on each code listed. Is this correct coding?

Minnesota Subscriber

Answer:. Essentially you have the right codes but you may be missing some revenue. You may also be better off using modifier 50 (Bilateral procedure) rather than LT (Left side) and RT (Right side) in some cases, depending on the payer.

In this case: You can apply modifier 50 to both 36475 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated) and +36476 (... second and subsequent veins treated in a single extremity, each through separate access sites [List separately in addition to code for primary procedure]) and many payers prefer that modifier over LT and RT. You should consider your payers' preferences when coding bilateral procedures. Check with the payer you're billing to, and use LT/RT or 50 based on the payer preference.

Capture each vein: Note that code +36476 is for each subsequent vein in the same extremity. With the information provided the exact coding is not clear. However, you would report +36476 with additional units for each vein treated after the first one.

So if the physician uses this treatment for five veins in the right leg you would report 36475, +36476 x 4.

The coding mentioned in the question would only be for two veins in each leg. If the physician in fact treated additional veins you'll need to report additional instances of +36476, based on the number of veins your surgeon documents.

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPCOBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program.