When to use CPT 36478 and 36479

The physician uses percutaneous, laser, endovenous ablation therapy to treat venous incompetence in an extremity vein. Laser energy is used to heat the vein and seal the vein closed. The most common site of treatment is the greater saphenous vein. The procedure includes any imaging guidance and monitoring. The leg is prepared and draped and a local anesthetic is applied to the puncture site. A needle is inserted into the access site. A guidewire is placed into the vessel using ultrasound guidance. An introducer sheath is placed over the guidewire and the guidewire is removed. The laser ablation catheter system is introduced and the tip is advanced to the site of the venous incompetence under ultrasound guidance.

A local anesthetic agent is injected into the tissues surrounding the vein within its fascial sheath. The anesthetic is injected along the course of the vein. Ultrasonography is used to position the catheter tip at the level of the terminal valve and laser energy is applied via a laser fiber along the length of the vein as the catheter is slowly withdrawn. When the laser catheter tip reaches the introducer sheath in the distal vein, the laser energy is terminated. The ablation catheter and introducer sheath are removed and pressure is applied at the puncture site. CPT code 36478 is reported  for the first vein treated in a single extremity and CPT 36479 for each additional vein treated through a separate access site in the same extremity.

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

+36479 – subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) 

Do not report 36479 more than once per extremity

(Do not report 36478, 36479 in conjunction with 29581, 29582, 36000, 36002, 36005, 36410, 36425, 36475, 36476, 37241, 75894, 76000, 76001, 76937, 76942, 76998, 77022, 93970, 93971 in the same surgical field) 
 

All imaging guidance, catheterization, contrast injection and monitoring is included in the endovascular ablation therapy codes 36478 & 36479

The add-on codes for subsequent vein(s) treated in the same extremity may only be reported once per extremity, regardless of the number of additional vein(s) treated.

All required supplies and equipment are included when the procedure is performed in the office setting and may not be separately reported.

Sclerosant injection by either needle or catheter followed by a compression technique is not mechanochemical vein ablation.

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Sample Coded report for CPT 36478

Reason for Exam
Dx: Venous insufficiency [I87.2 (ICD-10-CM)]

Interpretation Summary

EVLT right GREATER SAPHENOUS VEIN

PRODEDURE:
After informed consent, patient received oral xanax. The patient was placed supine on the procedure table. The patient’s leg was prepped and draped in standard fashion. Ultrasound guidance was used to mark the vein throughout it’s length along the leg. 1% lidocaine was used to anesthetize the skin overlying the vein at various points proceeding up the leg. A microintroducer needle was used to access the targeted vein below the knee, and then using Seldinger technique, a guidewire and a dilator with sheath were advanced to the level of the saphenofemoral junction within the targeted vein. The laser fiber was then advanced up the sheath and the laser tip was uncovered by backing out the sheath and positioning the tip of the laser fiber 2cm distal to the saphenofemoral junction within the saphenous vein.

Perisaphenous tumescent anesthesia was then performed under ultrasound guidance. Ultrasound images were stored. Once this was complete the laser fiber was activated and withdrawn. The fiber was deactivated just before exiting the skin distally. Digital pressure was applied at the exit site for hemostasis. Compression stocking was applied and the patient was released in stable condition.

Provide patient with post EVLT instruction sheet regarding activity, signs and symptoms to report, importance of compression hose compliance, follow up ultrasounds and office visits as scheduled.

Total laser energy usage: (Joules) 3933.957
Total laser treatment time: (Seconds) 400.93
Total laser treatment length: (cm) 41
Total tumescent anesthesia used: (ml) 200

CPT- 36478

When to use CPT code 36471 and 36470

In this exam, the physician inserts a tiny needle through the skin and injects sclerosant into a single, incompetent vein, other than telangiectasias (spider veins), of the leg. The patient stands while the sclerosant injection is given. The leg is elevated and wrapped in an elastic dressing. The solution causes the walls of the veins to become inflamed, collapse, and stick together so the veins close. CPT code 36471 is reported  for injection of sclerosant into multiple incompetent veins, other than telangiectasias, of the same leg.

36471 – Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg

36470 –  Injection of sclerosant; single incompetent vein (other than telangiectasia)

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Sample coded report for CPT code 36471

Reason for Exam
Dx: Venous insufficiency [I87.2 (ICD-10-CM)]

Interpretation Summary

Sclerotherapy:

Consent: After informed consent, the patient was brought to the procedure room.
Procedure: Vein interrogation was performed with ultrasound to identify incompetent perforator veins. The patient was then prepped with sterile technique over the right leg. Next 2cc’s of 1.5% foamed sotradecol was injected under ultrasound guidance into the perforator vein, after aspiration of venous blood was confirmed, into the lower medial calf and into the lower medial calf.
Ultrasound images stored.

Post procedure ultrasound confirmed sclerosant induced collapse of the target vein. Patient was then placed in the compression stocking and will be observed for 30 minutes prior to discharge from the office.