Basics about CPT code 36473, 36474, 36475 and 36476

As we know there have been many changes in Procedures codes in 2017. I have already discussed about the removal of moderate sedation from more than 400 CPT codes in 2017. Also, we have new cpt codes for coding moderate conscious sedation in 2017. Today, again we are here to learn more about new CPT codes of 2017. We have two new CPT code 36473 and 36475 for coding endovenous ablation therapy. Varicose veins are caused by venous insufficiency as a result of valve reflux (incompetence). The venous insufficiency results in dilated, tortuous, superficial vessels that protrude from the skin of the lower extremities. Spider veins (telangiectasias) are dilated capillary veins that are most often treated for cosmetic purposes. Treatment of telangiectasias (36468) is not covered by Medicare.

Percutaneous mechanochemical endovenous ablation (MOCA) therapy is done to treat venous incompetence or venous insufficiency in an extremity. Mechanochemical endovenous ablation utilizes a rotating wire in a catheter to disrupt the endothelial lining, causing mechanical damage without the use of heat while a sclerosant is injected at the same time, causing chemical damage to the disrupted vein wall without using tumescent anesthesia. 

These codes have been added to report the use of mechanical and chemical destruction of an incompetent vein. We already have CPT code 36475, 36476, 36478 and 36478 for coding radiofrequency and laser ablation. All these codes are mainly used for ablation procedure with different techniques.

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When to code CPT code 36473 and 36474

As I have already told that the mechanical and chemical destruction of an incompetent vein should be assigned with CPT code 36473 for initial vein and 36474 for each additional vein. In this procedure, the physician uses a rotating wire in conjunction with an infused sclerosing agent to damage the wall of the vein. The common site for these procedure is greater saphenous vein. Below is the detail code description for CPT code 36473 and 36474.

36473 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated

+36474 subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

The patient is symptomatic and has the following indications for a surgical approach for vericose veins : 

a. Pain or burning in the extremity severe enough to impair mobility 
b. Recurrent episodes of superficial phlebitis 
c. Non-healing skin ulceration 
d. Bleeding from a varicosity 
e. Stasis dermatitis 
f. Refractory dependent edema

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When to use CPT code 36475 and 36476

These codes are used when a radiofrequency is used to heat and seal the vein closed. In this procedure radiofrequency energy in the form of electricity is used to heat, collapse and seal the targeted blood vessels. Electricity is delivered to a heating element in 20-second pulses, heating and contracting the collagen within the walls of the vein until they shrink and shut down. This whole process is called ablation. Below is the code description for CPT code 36475 and 36476.

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

+36476 subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

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When to code CPT code 36478 and 36479

When the ablation of veins is done using laser technique, these codes should be used. In this procedure, the physician inserts a small laser fiber into the damaged vein around the knee level. Under ultrasound guidance, the physician guides the fiber to the upper thigh and then pulses of laser light are given as the fiber is pulled through the vein causing it to collapse and seal shut. Below is the detail code description for CPT code 36478 and 36479.

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)

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Do and Don’t with CPT code 36473, 36474, 36475, 36476, 36478, 36479

Do not report 36474, 36476 and 36479 for more than once per extremity, regardless of the number of additional vein(s) treated.

Do not report any imaging guidance like 76942, 77001 etc. with cpt code 36473, 36474, 36475, 36476, 36478 and 36479, as all the imaging guidance are included in these codes.

 Limitations for ERFA(endoluminal radiofrequency ablation) and laser ablation:

1. ERFA and laser ablation are covered only for the treatment of symptomatic varicosities of the lesser or greater saphenous veins and their tributaries which have failed 3 months of conservative therapy.
2. Intra-operative ultrasound guidance is not separately payable with ERFA, laser ablation, and sclerotherapy. 3. The treatment of asymptomatic varicose veins, or symptomatic varicose veins without a 3-month trial of conservative measures, by any technique will be considered cosmetic and therefore not covered.
4. The treatment of spider veins or superficial telangiectasis by any technique is considered cosmetic, and therefore not covered.
5. Coverage is only for devices specifically FDA-approved for these procedures.
6. One pre-operative Doppler ultrasound study or duplex scan will be covered.
7. Codes added effective January 1, 2018 indicate new procedures and new definitions of the first vein then the combining of the second and all other veins being included in the second code with the second code billable only once per day.