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A57706
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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
A57706
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Treatment of Varicose Veins of the Lower Extremities
Article Type
Billing and Coding
Original Effective Date
12/01/2019
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 notrecommending 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. Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission.No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may becopied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes anddescriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative workwithout the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. 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 onlyauthorized 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 oraccuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in thepreparation of this material, or the analysis of information provided in the material. The views and/or positionspresented in the material do not necessarily represent the views of the AHA. CMS and its products and services arenot endorsed by the AHA or any of its affiliates.
CMS National Coverage Policy
Language quoted from CMS National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review a NCD. See §1869(f)(1)(A)(i) of the Social Security Act. Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources: Title XVIII of the Social Security Act, §1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. CMS Manual System, Pub 100-08, Medicare Program Integrity Manual, Chapter 13, §13.5.1 indicates services will be considered medically reasonable and necessary only if ordered and furnished by appropriately trained personnel. This training and expertise must have been acquired within the framework of an accredited residency and/or fellowship program in the applicable specialty/subspecialty or must reflect extensive continued medical education activities. If these skills have been acquired by way of continued medical education, the courses must be comprehensive, offered or sponsored or endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States, and designated by the American Medical Association (AMA) as Category 1 Credit.
Article Guidance
Article Text The following coding and billing guidance is to be used with its associated Local coverage determination. 1. Each claim must be submitted with an ICD-10-CM code(s) that reflects the condition of the patient and indicates the reason(s) for which the service was performed. 2. The patient's medical record must contain a history and physical examination supporting the diagnosis of symptomatic varicose veins, and the failure of an adequate (at least 3 months) trial of conservative management. 3. The medical record must document the performance of appropriate tests, if medically necessary, to confirm the pathology of the vascular anatomy. 4. This documentation must be made available to Medicare upon request. 5. The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare. 6. When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary under Section 1862(a)(1) of the Social Security Act.
Response To Comments
| Number | Comment | Response |
|---|---|---|
| 1 |
N/A
Coding Information
Bill Type Codes
| Code | Description |
|---|---|
| 011x | Hospital Inpatient (Including Medicare Part A) |
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 071x | Clinic - Rural Health |
| 077x | Clinic - Federally Qualified Health Center (FQHC) |
| 085x | Critical Access Hospital |
| 999x | Not Applicable |
N/A
Revenue Codes
| Code | Description |
|---|---|
| 0330 | Radiology - Therapeutic and/or Chemotherapy Administration - General Classification |
| 0360 | Operating Room Services - General Classification |
| 0490 | Ambulatory Surgical Care - General Classification |
| 0510 | Clinic - General Classification |
| 0520 | Freestanding Clinic - General Classification |
N/A
CPT/HCPCS Codes
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Group 1
(26 Codes)
Group 1 Paragraph 36299* is used for sclerotherapy with mechanical agitation (e.g. Clarivein® device) prior to January 1, 2017. On and after this date use the AMA assigned codes 36473 and 36474 to report this procedure. These codes are inclusive of the sclerosing agent. 37799* should be used to report "Trivex Procedure"
| Code | Description |
|---|---|
| 36299 | UNLISTED PROCEDURE, VASCULAR INJECTION |
| 36465 | INJECTION OF NON-COMPOUNDED FOAM SCLEROSANT WITH ULTRASOUND COMPRESSION MANEUVERS TO GUIDE DISPERSION OF THE INJECTATE, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING; SINGLE INCOMPETENT EXTREMITY TRUNCAL VEIN (EG, GREAT SAPHENOUS VEIN, ACCESSORY SAPHENOUS VEIN) |
| 36466 | INJECTION OF NON-COMPOUNDED FOAM SCLEROSANT WITH ULTRASOUND COMPRESSION MANEUVERS TO GUIDE DISPERSION OF THE INJECTATE, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING; MULTIPLE INCOMPETENT TRUNCAL VEINS (EG, GREAT SAPHENOUS VEIN, ACCESSORY SAPHENOUS VEIN), SAME LEG |
| 36470 | INJECTION OF SCLEROSANT; SINGLE INCOMPETENT VEIN (OTHER THAN TELANGIECTASIA) |
| 36471 | INJECTION OF SCLEROSANT; MULTIPLE INCOMPETENT VEINS (OTHER THAN TELANGIECTASIA), SAME LEG |
| 36473 | ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, MECHANOCHEMICAL; FIRST VEIN TREATED |
| 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) |
| 36475 | ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED |
| 36476 | ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; SUBSEQUENT VEIN(S) TREATED IN A SINGLE EXTREMITY, EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 36478 | ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, LASER; FIRST VEIN TREATED |
| 36479 | ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, LASER; SUBSEQUENT VEIN(S) TREATED IN A SINGLE EXTREMITY, EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 36482 | ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, BY TRANSCATHETER DELIVERY OF A CHEMICAL ADHESIVE (EG, CYANOACRYLATE) REMOTE FROM THE ACCESS SITE, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS; FIRST VEIN TREATED |
| 36483 | ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, BY TRANSCATHETER DELIVERY OF A CHEMICAL ADHESIVE (EG, CYANOACRYLATE) REMOTE FROM THE ACCESS SITE, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS; SUBSEQUENT VEIN(S) TREATED IN A SINGLE EXTREMITY, EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 37700 | LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS |
| 37718 | LIGATION, DIVISION, AND STRIPPING, SHORT SAPHENOUS VEIN |
| 37722 | LIGATION, DIVISION, AND STRIPPING, LONG (GREATER) SAPHENOUS VEINS FROM SAPHENOFEMORAL JUNCTION TO KNEE OR BELOW |
| 37735 | LIGATION AND DIVISION AND COMPLETE STRIPPING OF LONG OR SHORT SAPHENOUS VEINS WITH RADICAL EXCISION OF ULCER AND SKIN GRAFT AND/OR INTERRUPTION OF COMMUNICATING VEINS OF LOWER LEG, WITH EXCISION OF DEEP FASCIA |
| 37760 | LIGATION OF PERFORATOR VEINS, SUBFASCIAL, RADICAL (LINTON TYPE), INCLUDING SKIN GRAFT, WHEN PERFORMED, OPEN,1 LEG |
| 37761 | LIGATION OF PERFORATOR VEIN(S), SUBFASCIAL, OPEN, INCLUDING ULTRASOUND GUIDANCE, WHEN PERFORMED, 1 LEG |
| 37765 | STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; 10-20 STAB INCISIONS |
| 37766 | STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE THAN 20 INCISIONS |
| 37780 | LIGATION AND DIVISION OF SHORT SAPHENOUS VEIN AT SAPHENOPOPLITEAL JUNCTION (SEPARATE PROCEDURE) |
| 37785 | LIGATION, DIVISION, AND/OR EXCISION OF VARICOSE VEIN CLUSTER(S), 1 LEG |
| 37799 | UNLISTED PROCEDURE, VASCULAR SURGERY |
| 93970 | DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMPLETE BILATERAL STUDY |
| 93971 | DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; UNILATERAL OR LIMITED STUDY |
N/A
CPT/HCPCS Modifiers
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Group 1
Group 1 Paragraph N/A
N/A
N/A
ICD-10-CM Codes that Support Medical Necessity
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Group 1
(66 Codes)
Group 1 Paragraph Note: Diagnosis codes are based on the current ICD-10-CM codes that are effective at the time of LCD publication. Any updates to ICD-10-CM codes will be reviewed by Noridian, and coverage should not be presumed until the results of such review have been published/posted. These are the only ICD-10-CM codes that support medical necessity for the following CPT codes: 36465, 36466, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780 and 37785.
| Code | Description |
|---|---|
| I80.01 | Phlebitis and thrombophlebitis of superficial vessels of right lower extremity |
| I80.02 | Phlebitis and thrombophlebitis of superficial vessels of left lower extremity |
| I80.03 | Phlebitis and thrombophlebitis of superficial vessels of lower extremities, bilateral |
| I83.011 | Varicose veins of right lower extremity with ulcer of thigh |
| I83.012 | Varicose veins of right lower extremity with ulcer of calf |
| I83.013 | Varicose veins of right lower extremity with ulcer of ankle |
| I83.014 | Varicose veins of right lower extremity with ulcer of heel and midfoot |
| I83.015 | Varicose veins of right lower extremity with ulcer other part of foot |
| I83.018 | Varicose veins of right lower extremity with ulcer other part of lower leg |
| I83.021 | Varicose veins of left lower extremity with ulcer of thigh |
| I83.022 | Varicose veins of left lower extremity with ulcer of calf |
| I83.023 | Varicose veins of left lower extremity with ulcer of ankle |
| I83.024 | Varicose veins of left lower extremity with ulcer of heel and midfoot |
| I83.025 | Varicose veins of left lower extremity with ulcer other part of foot |
| I83.028 | Varicose veins of left lower extremity with ulcer other part of lower leg |
| I83.11 | Varicose veins of right lower extremity with inflammation |
| I83.12 | Varicose veins of left lower extremity with inflammation |
| I83.211 | Varicose veins of right lower extremity with both ulcer of thigh and inflammation |
| I83.212 | Varicose veins of right lower extremity with both ulcer of calf and inflammation |
| I83.213 | Varicose veins of right lower extremity with both ulcer of ankle and inflammation |
| I83.214 | Varicose veins of right lower extremity with both ulcer of heel and midfoot and inflammation |
| I83.215 | Varicose veins of right lower extremity with both ulcer other part of foot and inflammation |
| I83.218 | Varicose veins of right lower extremity with both ulcer of other part of lower extremity and inflammation |
| I83.221 | Varicose veins of left lower extremity with both ulcer of thigh and inflammation |
| I83.222 | Varicose veins of left lower extremity with both ulcer of calf and inflammation |
| I83.223 | Varicose veins of left lower extremity with both ulcer of ankle and inflammation |
| I83.224 | Varicose veins of left lower extremity with both ulcer of heel and midfoot and inflammation |
| I83.225 | Varicose veins of left lower extremity with both ulcer other part of foot and inflammation |
| I83.228 | Varicose veins of left lower extremity with both ulcer of other part of lower extremity and inflammation |
| I83.811 | Varicose veins of right lower extremity with pain |
| I83.812 | Varicose veins of left lower extremity with pain |
| I83.813 | Varicose veins of bilateral lower extremities with pain |
| I83.891 | Varicose veins of right lower extremity with other complications |
| I83.892 | Varicose veins of left lower extremity with other complications |
| I83.893 | Varicose veins of bilateral lower extremities with other complications |
| I87.001 | Postthrombotic syndrome without complications of right lower extremity |
| I87.002 | Postthrombotic syndrome without complications of left lower extremity |
| I87.003 | Postthrombotic syndrome without complications of bilateral lower extremity |
| 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 |
| I87.301 | Chronic venous hypertension (idiopathic) without complications of right lower extremity |
| I87.302 | Chronic venous hypertension (idiopathic) without complications of left lower extremity |
| I87.303 | Chronic venous hypertension (idiopathic) without complications of bilateral lower extremity |
| I87.311 | Chronic venous hypertension (idiopathic) with ulcer of right lower extremity |
| I87.312 | Chronic venous hypertension (idiopathic) with ulcer of left lower extremity |
| I87.313 | Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity |
| I87.321 | Chronic venous hypertension (idiopathic) with inflammation of right lower extremity |
| I87.322 | Chronic venous hypertension (idiopathic) with inflammation of left lower extremity |
| I87.323 | Chronic venous hypertension (idiopathic) with inflammation of bilateral lower extremity |
| I87.331 | Chronic venous hypertension (idiopathic) with ulcer and inflammation of right lower extremity |
| I87.332 | Chronic venous hypertension (idiopathic) with ulcer and inflammation of left lower extremity |
| I87.333 | Chronic venous hypertension (idiopathic) with ulcer and inflammation of bilateral lower extremity |
| I87.391 | Chronic venous hypertension (idiopathic) with other complications of right lower extremity |
| I87.392 | Chronic venous hypertension (idiopathic) with other complications of left lower extremity |
| I87.393 | Chronic venous hypertension (idiopathic) with other complications of bilateral lower extremity |
| I87.8 | Other specified disorders of veins |
N/A
ICD-10-CM Codes that DO NOT Support Medical Necessity
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Group 1
(3 Codes)
Group 1 Paragraph Use of any ICD-10-CM code not listed in the "ICD-10-CM Codes That Support Medical Necessity" section of this LCD will be denied. In addition, the following ICD-10 CM codes are specifically listed as not supporting medical necessity for emphasis, and to avoid any provider errors. Claims listing the following ICD-10-CM code will be considered as cosmetic and denied for lack of medical necessity: I78.1 Nevus, non-neoplastic CPT codes 36465, 36466, 36470, 36471, 36473, 36474,36475, 36476, 36478, 36479, 36482, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37799 (when used to report "Trivex Procedure") submitted for any of the following ICD-10-CM codes will be denied for lack of medical necessity:
| Code | Description |
|---|---|
| I78.0 | Hereditary hemorrhagic telangiectasia |
| I78.1 | Nevus, non-neoplastic |
| I78.8 | Other diseases of capillaries |
N/A
ICD-10-PCS Codes
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Group 1
Group 1 Paragraph N/A
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 typicallyused to report this service. Absence of a Bill Type does not guarantee that thearticle does not apply to that Bill Type. Complete absence of all Bill Types indicatesthat coverage is not influenced by Bill Type and the article should be assumed toapply equally to all claims.
| Code | Description |
|---|---|
| 011x | Hospital Inpatient (Including Medicare Part A) |
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 071x | Clinic - Rural Health |
| 077x | Clinic - Federally Qualified Health Center (FQHC) |
| 085x | Critical Access Hospital |
| 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 otherRevenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicatesthat coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.
Revenue codes only apply to providers who bill these services to Part A.
| Code | Description |
|---|---|
| 0330 | Radiology - Therapeutic and/or Chemotherapy Administration - General Classification |
| 0360 | Operating Room Services - General Classification |
| 0490 | Ambulatory Surgical Care - General Classification |
| 0510 | Clinic - General Classification |
| 0520 | Freestanding Clinic - General Classification |
N/A
Other Coding Information
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Group 1
Group 1 Paragraph N/A
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 | R2 | Updated to indicate this article is an LCD reference Article. |
| 01/01/2023 | R1 | Per 2023 CPT/HCPCS updates, either the long or short descriptions of CPT codes 36299 and 37799 have been updated. |
N/A
Associated Documents
Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
Articles
A53084 - Billing and Coding: Sclerosing of Varicose Veins
A54713 - Response to Comments: Treatment of Varicose Veins of Lower Extremities
LCDs
L34209 - Treatment of Varicose Veins of the Lower Extremities
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 | |
|---|---|---|---|
| 11/14/2023 | 01/01/2023 - N/A | Currently in Effect | You are here |
| 12/16/2022 | 01/01/2023 - N/A | Superseded | View |
| Some older versions have been archived. Please visit theMCD Archive Site to retrieve them. | |||
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LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE (NUBC)
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