Radiology Coding Alert

Question: Our IR physician performed a new sclerotherapy procedure. A drainage catheter was placed into the lymphatic cavity (i.e., axillary or thigh lymphocele) under ultrasound guidance, sclerosant agent was infused and drainage was secured. The patient returned in a few days. In the next visit, the contrast was injected in the drainage catheter for evaluation. Lymphocele had become infected in setting of obstructed catheter. Drainage catheter was exchanged for a new one. Sclerosant therapy was infused into the collection and drained. How would this case scenario be coded?

Florida Subscriber

Answer: You will report code 36470 (Injection of sclerosing solution; single vein) and 36471 (Injection of sclerosing solution; multiple veins, same leg) depending upon whether your radiologist performs the sclerotherapy in a single or multiple veins. You will however need to check with your local Medicare carrier’s local coverage determinations (LCD) to decide whether these codes are covered or not.

Your payer may reimburse for sclerotherapy when the patient has an ulcer, inflammation or other complications of the lower extremities. You can also report the appropriate diagnosis code 454.0 (Varicose veins of lower extremities with ulcer), 454.1 (Varicose veins of lower extremities with inflammation), 454.2 (Varicose veins of lower extremities with ulcer and inflammation), 454.8 (Varicose veins of lower extremities with other complications), or 782.3 (Edema).

Your payer may cover sclerosing procedures for signs and symptoms of significantly diseased vessels of the lower extremities, such as stasis ulcer of the leg, significant pain, or significant edema, that interfere with activities of daily living. Your payer may also consider reimbursement of sclerosing therapy in conjunction with surgical stripping or ligation.

Check if your payer allows payment for duplex scanning or any ultrasound procedure for guidance during the injection of sclerosing solution for varicose vein treatment. If your physician performs ultrasound-guided sclerotherapy, Medicare will not cover the procedure.

If your payer covers the ultrasound guidance, you report code 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation).