EvaluationBefore any treatment can begin, evaluations must be given to determine the type of treatment that needs to take place. The CPT-4 codes used for those determinations include one radiology code:
76942 - Ultrasonic Guidance for Needle Placement
The other codes are categorized as Extremity Venous Studies. These codes are:
93965 - Noninvasive physiologic studies of extremity veins
93970 - Duplex scan of extremity veins
93971 - Duplex scan of extremity veins
Types of ProceduresThere are three main treatment categories for varicose veins. Though all of the codes are listed within the surgical category of CPT-4 codes, not all of the procedures are actually surgical procedures. Also, none of these codes are exclusive during a day of treatment. This means if a physician wishes to perform multiple procedures in one day, it can be done as long as the medical documentation supports it. However, some codes can't be billed together on the same day, so it's best to verify those codes through the coding manual.
Sclerosing Solutions InjectionsThe least invasive of the three varicose vein surgical treatments introduces solutions into the veins, usually via a drip process to try to reduce the hardening that's taken place.
36468 - Single or Multiple Injections of sclerosing solutions
36470 - Injection of sclerosing solution; single vein
36471 - Injection of sclerosing solution; multiple veins, same leg
Endovenous Ablation TherapyAblation therapy means varicose veins will be treated by inserting a solution and then heating it up with an outside source. The source is indicated within the codes below:
36475 - Ablation therapy of incompetent vein, percutaneous, radiofrequency; first vein treated
36476 - Ablation therapy of incompetent vein, percutaneous, radiofrequency; second and subsequent veins
36478 - Ablation therapy of incompetent vein, percutaneous, laser; first vein treated
36479 - Ablation therapy of incompetent vein, percutaneous, laser; second and subsequent veins
Vein Ligation (surgery)These codes indicate actual surgical procedures. Hospitals might not use these codes for billing purposes, deciding instead to use surgical ICD-9, or diagnosis codes, but physicians will need to use at least one of these codes:
37700 - Ligation and division of long saphenous vein at saphenofemoral junction
37718 - Ligation, division, and stripping, short saphenous vein
37722 - Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below
37735 - Ligation and division and complete stripping of long or short saphenous veins
37760 - Ligation of perforator veins, subfascial, radical
37765 - Stab phlebectomy of varicose veins, one extremity; 10-20 stab incisions
37766 - Stab phlebectomy of varicose veins, one extremity; more than 20 incisions
37780 - Ligation and division of short saphenous vein at saphenopopliteal junction
37799 - Unlisted procedure, vascular surgery
HCPCS ProcedureThere is one last procedure that, unfortunately, isn't covered by most insurance companies because, as of mid-2009, they see it as an experimental procedure. That code is:
SuppliesCompression stockings are the most used supply item in the treatment of varicose veins. Not all insurance companies will pay for this item, as it's considered take-home equipment, which usually isn't covered. The range of HCPCS codes for this item is from A6533 through A6549, with the only difference being the size and length of the stocking. Varicose veins are abnormally large veins that bulge through the skin, usually in the legs. They can be painful for many people, whether they're walking or staying still. Many treatment recommendations exist on how to reduce the swelling of varicose veins, including surgical options. For medical billing purposes, these procedures need to be coded, as do the supplies that may be used.
For clarification purposes, procedures codes are called CPT-4 codes, although many people use that term and HCPCS interchangeably. HCPCS codes actually refer to what's known as Level II codes, which cover extended procedures and supply codes. Code descriptions can be very long; they are truncated here, so it's recommended you read through the manuals for more complete descriptions.