LCD Reference Article Billing and Coding Article

Billing and Coding: Endovenous Stenting

A56414

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56414
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Endovenous Stenting
Article Type
Billing and Coding
Original Effective Date
05/20/2019
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Social Security Act (Title XVIII) Standard Reference:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L37893 Endovenous Stenting. Please refer to the LCD for reasonable and necessary requirements.

Medicare reimbursement for endovenous stenting is limited to the treatment of severely symptomatic venous obstructions as outlined in the related LCD.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Claims must be submitted with an ICD-10-CM code that represents the reason the procedure was done. The ICD-10-CM code must be billed to the highest level of specificity for that code set. The ICD-10-CM code must be linked to the appropriate procedure code.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. Medical record documentation should list type and length of conservative treatment as applicable per the LCD.
  5. Pre- and post-deployment intervention images should be obtained and made available upon request. Intermediate stages pertinent to the endovascular procedure may also be documented with images. Details should include the position of the device, and when appropriate, the nature of the obstruction (if a determination can be made regarding the etiology), and effect of the device on target or nontarget vessels.
  6. Medical record documentation should list guide catheter used, as well as stent type, diameter and length.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

(4 Codes)
Group 1 Paragraph

 

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

The following CPT codes will not have diagnosis to procedure code limitations applied at this time: 36903, 36906 and 36908.

Group 1 Codes
Code Description
37182 Insert hepatic shunt (tips)
37183 Revision tips
37238 Open/perq place stent same
37239 Open/perq place stent ea add
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(66 Codes)
Group 1 Paragraph

 

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 37182, 37183, 37238, and 37239.

Group 1 Codes
Code Description
I28.8 Other diseases of pulmonary vessels
I82.0 Budd-Chiari syndrome
I82.210 Acute embolism and thrombosis of superior vena cava
I82.211 Chronic embolism and thrombosis of superior vena cava
I82.220 Acute embolism and thrombosis of inferior vena cava
I82.221 Chronic embolism and thrombosis of inferior vena cava
I82.290 Acute embolism and thrombosis of other thoracic veins
I82.411 Acute embolism and thrombosis of right femoral vein
I82.412 Acute embolism and thrombosis of left femoral vein
I82.413 Acute embolism and thrombosis of femoral vein, bilateral
I82.421 Acute embolism and thrombosis of right iliac vein
I82.422 Acute embolism and thrombosis of left iliac vein
I82.423 Acute embolism and thrombosis of iliac vein, bilateral
I82.511 Chronic embolism and thrombosis of right femoral vein
I82.512 Chronic embolism and thrombosis of left femoral vein
I82.513 Chronic embolism and thrombosis of femoral vein, bilateral
I82.521 Chronic embolism and thrombosis of right iliac vein
I82.522 Chronic embolism and thrombosis of left iliac vein
I82.523 Chronic embolism and thrombosis of iliac vein, bilateral
I82.721 Chronic embolism and thrombosis of deep veins of right upper extremity
I82.722 Chronic embolism and thrombosis of deep veins of left upper extremity
I82.723 Chronic embolism and thrombosis of deep veins of upper extremity, bilateral
I82.A11 Acute embolism and thrombosis of right axillary vein
I82.A12 Acute embolism and thrombosis of left axillary vein
I82.A13 Acute embolism and thrombosis of axillary vein, bilateral
I82.A21 Chronic embolism and thrombosis of right axillary vein
I82.A22 Chronic embolism and thrombosis of left axillary vein
I82.A23 Chronic embolism and thrombosis of axillary vein, bilateral
I82.B11 Acute embolism and thrombosis of right subclavian vein
I82.B12 Acute embolism and thrombosis of left subclavian vein
I82.B13 Acute embolism and thrombosis of subclavian vein, bilateral
I82.B21 Chronic embolism and thrombosis of right subclavian vein
I82.B22 Chronic embolism and thrombosis of left subclavian vein
I82.B23 Chronic embolism and thrombosis of subclavian vein, bilateral
I87.011 Postthrombotic syndrome with ulcer of right lower extremity
I87.012 Postthrombotic syndrome with ulcer of left lower extremity
I87.013 Postthrombotic syndrome with ulcer of bilateral lower extremity
I87.021 Postthrombotic syndrome with inflammation of right lower extremity
I87.022 Postthrombotic syndrome with inflammation of left lower extremity
I87.023 Postthrombotic syndrome with inflammation of bilateral lower extremity
I87.031 Postthrombotic syndrome with ulcer and inflammation of right lower extremity
I87.032 Postthrombotic syndrome with ulcer and inflammation of left lower extremity
I87.033 Postthrombotic syndrome with ulcer and inflammation of bilateral lower extremity
I87.091 Postthrombotic syndrome with other complications of right lower extremity
I87.092 Postthrombotic syndrome with other complications of left lower extremity
I87.093 Postthrombotic syndrome with other complications of bilateral lower extremity
I87.1 Compression of vein
K76.6 Portal hypertension
Q26.0 Congenital stenosis of vena cava
Q26.1 Persistent left superior vena cava
Q26.8 Other congenital malformations of great veins
Q89.8 Other specified congenital malformations
Q89.9 Congenital malformation, unspecified
T82.818A Embolism due to vascular prosthetic devices, implants and grafts, initial encounter
T82.818D Embolism due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.818S Embolism due to vascular prosthetic devices, implants and grafts, sequela
T82.828A Fibrosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.828D Fibrosis due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.828S Fibrosis due to vascular prosthetic devices, implants and grafts, sequela
T82.858A Stenosis of other vascular prosthetic devices, implants and grafts, initial encounter
T82.858D Stenosis of other vascular prosthetic devices, implants and grafts, subsequent encounter
T82.858S Stenosis of other vascular prosthetic devices, implants and grafts, sequela
T82.868A Thrombosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.868D Thrombosis due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.868S Thrombosis due to vascular prosthetic devices, implants and grafts, sequela
T86.818 Other complications of lung transplant
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
999x Not Applicable
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2023 R4

Article revised and published on 01/26/2023 effective for dates of service on and after 01/01/2023 to reflect the Annual HCPCS/CPT Code Updates. For the following CPT code either the short description and/or the long description was changed. Depending on which description is used in this article, there may not be any change in how the code displays: 37183 in Group 1 Codes.

01/01/2022 R3

Article revised and published on 01/20/2022 effective for dates of service on and after 01/01/2022 to reflect the annual CPT/HCPCS Code Updates. For the following CPT code the long description was changed. Depending on which description is used in this article, there may not be any change in how the code displays: 37183 in the CPT/HCPCS Codes/Group 1 Codes.

06/25/2020 R2

LCD revised and published on 6/25/2020 to create a collaborative article with First Coast Service Options..

11/21/2019 R1

Article revised and published on 11/21/2019. Consistent with CMS Change Request 10901, all coding information from the related LCD has been placed into this article. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
01/20/2023 01/01/2023 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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