Radiology Coding Alert

Verify laser, RF or chemical saphenous vein ablation before you code Payers set up lots of reimbursement hurdles for saphenous vein ablation, but we’ve got four expert tips to coach you to coding success. 1. Separate RF and Laser Ablation Coding Interventional radiologists often perform saphenous vein ablation using radiofrequency (RF) or endovenous laser treatment (EVLT).

RF ablation: Report RF endovenous ablation with codes 36475-36476, says Roseanne R. Wholey, president of Roseanne R. Wholey and Associates in Oakmont, Pa.:

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

• +36476--... second and subsequent veins treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure). You shouldn’t report these RF codes with EVLT codes 36478 or 36479, per CPT guidelines , says Dianne Nakvosas, head coder at Compubill Inc. in Orland Park, Ill.

Laser ablation: The codes for laser endovenous ablation are 36478 and 36479, Wholey says:

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

• +36479--... second and subsequent veins treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure). CPT guidelines tell you not to report these laser codes with the RF ablation codes, Nakvosas says.

Don’t miss: Physicians may also perform a phlebectomy (37765-37766, Stab phlebectomy of varicose veins, one extremity ...) at the same encounter as EVLT.   NCCI Edits do not forbid you from reporting both of these services, but reimbursement will depend on your individual payer, Nakvosas says. Cover your bases--be sure your physician’s documentation supports medical necessity for both the phlebectomy and EVLT and shows that the physician performed them as separate procedures.

2. Include Imaging Services in 36475-36479 CPT guidelines instruct you not to report 36475-36479 in addition to a number of other codes, Nakvosas says. These include:

• needle and catheter introduction and venipuncture codes 36000-36005, 36410, and 36425
• percutaneous transcatheter occlusion code 37204. Important: The descriptors for 36475-36479 specify that they include “all imaging guidance and monitoring.” Rationale: Endovenous ablation therapy requires imaging, including ultrasound for access, guidance, and monitoring and sometimes fluoroscopy (75894, 76000-76003, 76937, 76942), according to CPT Changes: 2005, says Dave Williford, RCC, senior coder for Desert Radiologists in Las Vegas.

Notes following 36475-36479 also tell you not to report these codes in conjunction with 93970 (Duplex scan of extremity veins including responses to compression [...]