Radiology Coding Alert

Question: Our radiologist performed a direct puncture ablation of the saphenous vein. Should we report CPT 36470 ? New York Subscriber Answer: No. The correct code depends on the nature of the endovenous abalation procedure and the specific payer policy. Many payers advise that you report the unlisted code (37799, Unlisted procedure, vascular surgery) unless your insurer sends you written authorization to report 37204 (Transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method, non-central nervous system, non-head or neck) instead. Empire Medicare, a Part B carrier in New York, requires that you report 37799 for this service. In addition to this unlisted procedure code you should also report the unlisted imaging code appropriate to the form of imaging used, usually ultrasound. HCPCS introduced a new code that became effective on April 1, 2004 that describes radiofrequency ablation (S2131, Endovascular laser ablation of long or short saphenous vein, with or without proximal ligation or division). Some payers, including most Blue Cross-Blue Shield plans, suggest using this code. Empire and most other carriers cover saphenous vein ablation only if the patient has symptoms attributable to saphenofemoral or saphenopopliteal reflux (454.0-454.8). Medicare will not reimburse vein ablation for cosmetic varicose vein treatments. In addition, most payers require that the patient has already tried conservative treatment such as exercise, leg elevation, weight loss and compressive therapy, before they will reimburse ablation.