Medicare Compliance & Reimbursement

Question: My physician performed an excision due to a painful clotted vein in the lower extremity. I cannot find a code specific to this type of surgery. Is there a code that would be appropriate than 28899? My surgeon thought maybe 27632 might work.

Answer: This is a difficult coding challenge without having more information. Depending on the clinical situation, there are a few codes that might be appropriate, as follows:

Code 27632 (Excision, tumor, soft tissue of leg orankle area subcutaneous; 3 cm or greater) would be appropriate if the physician thought it was a tumor but found out subsequently it was just a clot.

If the physician had previously performed a procedure on the patient, which ended up with a painful clot, he might consider billing 35860 (Exploration for postoperative hemorrhage, thrombosis or infection; extremity).

If it was a varicose vein, you might want to look at some of those procedures such as 37765 (Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions). In this case, however, you would want to use the unlisted code 37799 (Unlisted procedure, vascular surgery) because only one vein was involved. Compare the procedure to a stab phlebectomy if that sounds reasonable when the note is actually reviewed.

Best bet: Go back to your surgeon and find out what the clinical circumstances were for this procedure so that you can choose the appropriate code.