General Surgery Coding Alert

Question: Our surgeon performed “vein stripping” in the patient’s right calf due to inflamed varicose veins that were causing itching, swelling and discomfort. What are the correct diagnosis and procedure codes?

Ohio Subscriber

Answer: The appropriate diagnosis code is I83.11 (Varicose veins of right lower extremity with inflammation).

You don’t describe the technique that the surgeon used for the “vein stripping,” but the most likely method is ligation and excision. You also don’t specify which vein(s) of the lower leg the surgeon treats, but you can rule out codes that reference the saphenous vein above the knee.

You’ll need to get documentation from the surgeon regarding the method and which vein(s) to select an appropriate code such as one of the following:

• 37718 (Ligation, division, and stripping, short saphenous vein)
• 37785 (Ligation, division, and/or excision of varicose vein cluster(s), 1 leg)

If the op report mentions radiofrequency vein ablation or laser vein ablation, you should instead consider the following codes:

• 36475 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated)
• 36478 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated)

Medical necessity: Medicare and other payers may require a six-week trial of conservative therapy before covering varicose vein stripping. If that’s the case for your payer, you’ll need to document the appropriate actions, which often include the following:

• Weight reduction
• A daily exercise plan
• Periodic leg elevation
• The use of graduated compression stockings.