Radiology Coding Alert

Question: We started performing venous ablation and one of our radiologists wants to know if there is time limitation on when he can perform greater saphenous and lesser saphenous venous ablation?

Florida Subscriber

Answer: When you report a venous ablation, you check for two things: first the nature of the ablation and second your payer policies.

Note that most payers reimburse venous ablation only when you furnish appropriate documentation to support prior conservative treatment such as exercise, leg elevation, weight loss and compressive therapy. Make sure your radiologist justifies the need for ablation in the clinical note. Also note that Medicare does not reimburse vein ablation when your radiologist treats varicose vein for cosmetic reasons. Most carriers cover saphenous vein ablation only if the patient has symptoms attributable to saphenofemoral or saphenopopliteal reflux, i.e. 454.0 (Varicose veins of lower extremities with ulcer) - 454.8 (Varicose veins of lower extremities with other complications).

Guide to codes: Your radiologist may perform saphenous vein ablation using radiofrequency (RF) or endovenous laser treatment (EVLT). For RF ablation, you report 36475 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated) or +36476 (... second and subsequent veins treated in a single extremity, each through separate access sites [list separately in addition to code for primary procedure]). For EVLT, you select from 36478 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated) or +36479 (... second and subsequent veins treated in a single extremity, each through separate access sites [list separately in addition to code for primary procedure]).

Tip: Do not report the RF codes 36475 and +36476 with the EVLT codes 36478 and +36479, or vice versa.

Important: Pay attention to the mention of "all imaging guidance and monitoring" in the descriptors for 36475-36479. This implies that these codes are inclusive of imaging guidance. This is because endovenous ablation therapy requires imaging, including ultrasound for access, guidance, and monitoring. Therefore, you can not report any of the following codes with codes 36475-36479:

• Needle and catheter introduction and venipuncture codes 36000-36005, 36410, and 36425
• Percutaneous transcatheter occlusion code 37204

Reporting bilateral procedures? If your radiologist performs RF endovenous ablation on one vein in each leg during the same procedure, you do not report +36476 with 36475. Code 36475 specifically tells you to report it for ablation performed on multiple veins in the same leg. Same rules apply to the EVLT procedures. In this case, you may report 36475-50 (Bilateral procedure) or two units of 36475. Before you do this, do not forget to check with your payer policies.