Radiology Coding Alert

Help your practice determine when patients are responsible for payment

Payers are picky about covering saphenous vein ablation, and choosing a diagnosis code based on what will get you paid could mean paybacks and fines. Protect your practice by following veteran coders’ advice on reporting only the diagnosis codes your physician documents and knowing when to require the patient to pay.  

Red flag: Many payers, including Medicare, cover saphenous vein ablation only for a short list of specific varicose-vein diagnoses, says Dianne Nakvosas, head coder at Compubill Inc. in Orland Park, Ill., such as:

• 454.0--Varicose veins of lower extremities; with ulcer
• 454.1--... with inflammation
• 454.2--... with ulcer and inflammation
• 454.8--... with other complications.
 
Even these diagnosis codes won’t always guarantee coverage, however. Most payers have very detailed requirements, such as documentation of symptomatic varicose veins, failure of non-surgical management,
exclusion of other causes of the symptoms, and confirmation of incompetent perforating veins, using
appropriate tests.

Helpful: Many payers have policies with coding rules for endovenous laser treatment (EVLT), which is a common method of saphenous vein ablation. “Most commercial carriers closely follow Medicare guidelines,” says Dave Williford, RCC, senior coder for Desert Radiologists in Las Vegas.

Check your carrier’s Web site or customer-service representative for specific coding and billing instructions, such as prior-authorization requirements, Williford says.

Your manufacturer may offer reimbursement guides with form letters and medical documentation supporting EVLT use, Williford says. You can also find suggestions on manufacturer Web sites, such as www.evlt.com, which offers reimbursement information under “Physician” and insurance information under “Patients.”

Remember: Your payer will have the final word about coding and reimbursement. Your manufacturer’s suggestions may or may not fly with your payer.

Bottom line: Only report ICD-9 Codes for the diagnoses your physician documents. Obtain a coverage policy in writing from the major payers you send these claims to and make payment arrangements with patients whose cases payers aren’t likely to cover.