Local Coverage Article Billing and Coding

Billing and Coding: Sclerosing of Varicose Veins

A53079

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Contractor Information

Article Information

General Information

Article ID
A53079
Article Title
Billing and Coding: Sclerosing of Varicose Veins
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
01/01/2017
Revision Ending Date
N/A
Retirement Date
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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.

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CMS National Coverage Policy

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Article Guidance

Article Text

Important Coding Alert

Noridian is revising this article to further clarify that CPT® 37241 is not an acceptable choice of procedure codes for treatment of symptoms of varicose veins of the lower extremity regardless of the method used.

Noridian’s Local Coverage Determination, Treatment of Varicose Veins of the Lower Extremities; L34209 (JEA and JEB)/L34010 (JFA and JFB) provides coverage criteria for the treatment of varicose veins and the CPT® codes that are expected to be utilized for billing this service.

As previously noted, a product for the treatment of varicose veins has appeared on the market for which the product’s information states that it utilizes both a sclerosing agent and a rotating wire which allegedly mixes the agent and possibly macerates any clots in the area.

Noridian has been informed that some providers may have been recommended to use CPT® 37241 when using this device for the treatment of varicose veins. This advice is incorrect. CPT®37241 must not be used to bill for the treatment of varicose veins of the lower extremities with this or similar devices.

When using the ClariVein device in the treatment of varicose veins before January 1, 2017, Noridian recommends billing with CPT® code 36299. The sclerosing agent is bundled into the procedure code and is not separately reimbursable. ClariVein must be entered in Item 19 of the CMS-1500 form or the electronic notepad equivalent. For dates of service on and after January 1, 2017 providers should use CPT® 36473 for first vein (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated) and 36474 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) If billing for both extremities it is appropriate to append modifier RT or LT to the respective claim line.

Based on the intensity of service for CPT® code 37241, Noridian no longer allows payment for claims using this CPT® in Place of Service 11 – Office effective June 6, 2016.

Coding Information

CPT/HCPCS Codes

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CPT/HCPCS Modifiers

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ICD-10-CM Codes that Support Medical Necessity

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

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Additional ICD-10 Information

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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.

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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.

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Other Coding Information

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Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2017 R10

Converted to Billing and Coding article type only. No changes to article content.

01/01/2017 R9

Typographical Error in article corrected.

01/01/2017 R8 2017 CPT revised verbiage.
01/01/2017 R7 2017 CPT updates
07/18/2016 R6 Typographical Error in article.
07/18/2016 R5 R5 Revised verbiage for billing 36299 bilaterally.
07/18/2016 R4 Revision of article to further clarify that CPT® 37421 is not an acceptable choice of procedure codes for treatment of symptoms of varicose veins of the lower extremity regardless of the method used.
10/01/2015 R3 Updated related LCD number.
10/01/2015 R2 This article was updated to include billing instructions for ClariVein.
10/01/2015 R1 Article revised with change in title.

Associated Documents

Related National Coverage Documents
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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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Other URLs
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Public Versions
Updated On Effective Dates Status
05/08/2020 01/01/2017 - N/A Currently in Effect You are here
09/05/2018 01/01/2017 - N/A Superseded View
01/05/2017 01/01/2017 - N/A Superseded View
11/30/2016 01/01/2017 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Varicose
  • Vein
  • 37241
  • 37472
  • 37473
  • Sclerosing
  • Ablation
  • ClariVein