Vein Ablation Best Practices

Vein Ablation Best Practices
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Vein Ablation Best Practices

Veins are the blood vessels that carry deoxygenated blood from the tissues back to the heart.

Varicose veins are enlarged, swollen and twisting veins that often appear blue or dark purple when faulty valves in the veins allow blood to flow in the wrong direction or to pool. This increases the pressure in the vein, often causing swelling, pain, itching and discoloration to the affected area. Endovenous ablation is a procedure to close off varicose veins. Endovenous means that the procedure is performed inside the vein. Ablation heat is used to close off the vein.

Some patients may want varicose vein treatment for cosmetic reasons. Medicare does not cover cosmetic surgery or expenses incurred in connection with such surgery. Cosmetic surgery includes any surgical procedure directed at improving appearance, except when required for the prompt (i.e., as soon as medically feasible) repair of accidental injury or for the improvement of the functioning of a malformed body member. If the patient has no symptoms, discomfort, functional impairments or activity limitations treatment may not be appropriate.

Code	Vein Ablation and Related Services
36473	Mechanochemical destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance
36474	Mechanochemical destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance
36475	Destruction of insufficient vein of arm or leg, accessed through the skin
36476	Radiofrequency destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance
36478	Laser destruction of incompetent vein of arm or leg using imaging guidance, accessed through the skin
36479	Laser destruction of insufficient vein of arm or leg, accessed through the skin using imaging guidance
36482	Chemical destruction of incompetent vein of arm or leg, accessed through the skin using imaging guidance
36483	Chemical destruction of incompetent vein of arm or leg, accessed through the skin using imaging guidance

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Documentation requirements:

Doppler ultrasound;

Documentation stating the presence or absence of DVT, aneurysm, and/or tortuosity (when applicable);

Documented incompetence of the valves of the saphenous, perforator or deep venous systems consistent with the patient's symptoms and findings (when applicable);

Photographs if the clinical documentation received is inconclusive;

The patient's medical record must contain a history and physical examination supporting the diagnosis of symptomatic varicose veins (evaluation and complaints), and the failure of an adequate (at least three months) trial of conservative management (before the initial procedure).

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Best Practice/Documentation Feedback/Tips and Help

Documentation must indicate prior treatments.

Documentation must support signs and/or symptoms that interfere with activities of daily living and/or quality of life.

Documentation much include tests validating the location and level of varicosities.

Prior authorization requests for vein ablations should clearly identify for which extremity and vein(s) the request is made.

Prior authorization should include clear indication of laterality of the procedure being requested.

If a provider’s plan of care is to perform serial ablations, treating one leg and different veins over several sessions, a prior authorization request is required for each session. Each claim billed to Medicare will require its own Unique Tracking Number.

Prior authorization requests must meet FDA guidance for vein ablation.

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Billing/Coding Alerts

Prior authorization requests should ensure that second vein HCPCS are not being chosen without first vein HCPCS being indicated.

Code Order	Code	Description
1^st	36475	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imagining guidance and monitoring, percutaneous, radiofrequency: first vein treated.
2^nd	36476	Subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure).

Code Order	Code	Description
1^st	36478	Endogenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated.
2^nd	36479	Subsequent vein(s) treated in a single extremity, each through separated access sites (List separately in addition to code for primary procedure).

Code Order	Code	Description
1^st	36482	Endogenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive remote from the access site. Inclusive of all imagine guidance and monitoring, percutaneous, first vein treated.
2^nd	36483	Add on code: subsequent veins treated through a single extremity, each through separate access sites.

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Vein Ablation Best Practices

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