When conservative treatments fail to provide relief from symptomatic varicosities, the following surgical options are eligible for reimbursement when reported for symptomatic varicose veins (454.0-454.8):
Ligation and Stripping (procedure codes 37700-37785)
Ligation and stripping procedures are beneficial in the treatment of symptomatic varicose veins and, as such, are covered surgical services.
In some cases, limited sclerotherapy may be necessary during the routine surgical postoperative period to achieve a better and more complete surgical result. As such, sclerotherapy performed by the surgeon, his associate or, the assistant surgeon during the postoperative period following vein ligation and stripping procedures is part of the global surgical allowance. A participating, preferred, or network provider cannot bill the member separately for these services.
Sclerotherapy (procedure codes 36470 and 36471)
This service is eligible for payment for those patients who meet all of the following criteria:
- The patient should be symptomatic (e.g., the varicosities are resulting in pain, burning, etc.).
- There is no sapheno-femeral insufficiency or disease/occlusion of the deep venous system.
- The veins are demonstrable (bulging) above the surface of the skin.
- The varicosities are at least 5 millimeters in size.
- Medical management (e.g., compression therapy) has failed.
This procedure should be reported under codes 36470 and 36471 as appropriate. Sclerotherapy treatment for reasons other than those listed above is considered cosmetic, and therefore, not covered.
Claims for multiple injections should be processed in accordance with the multiple surgery guidelines on Medical Policy Bulletin S-100. All secondary injections should be priced at 50% of the allowance.
Endovenous Radiofrequency Obliteration of the Greater Saphenous Vein (procedure code S2130)
Endovenous radiofrequency obliteration is a covered service.
Laser Obliteration of the Greater Saphenous Vein (procedure code 37799, 76986)
Laser obliteration with ultrasonic guidance is a covered service.
- NOTE:
- Procedure codes 17106-17108 should not be used to report laser destruction of varicose veins.
Ambulatory Phlebectomy (procedure code 37785)
Ambulatory phlebectomy is an eligible service.
Transilluminated Powered Phlebectomy (procedure code 37785)
Transilluminated powered phlebectomy (TPPS) is considered an eligible alternative treatment of varicose veins.
- NOTE:
- None of the above procedures are eligible when reported for non-symptomatic varicose veins (454.9). Such services are considered cosmetic. Participating, preferred, or network providers can bill the patient for these denied services.
The following services are not eligible for reimbursement:
Echosclerotherapy (procedure code S2202)
Echosclerotherapy is beyond the experimental/investigational stage but it is not generally accepted by the medical community as clinically useful as treatment for varicose veins. Therefore, it is not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service.
Treatment of Spider Veins
Any method of treatment for reticular veins and/or superficial telangiectases, including laser, is not covered. Treatment of these superficial veins is primarily cosmetic in nature.
- The injection of sclerosing solution into telangiectases such as spider veins, hemangiomata and angiomata should be reported with codes 36468 and 36469).
- Laser destruction of reticular veins and/or telangiectasis (e.g., VascuLite) should be reported with code 37799 (Unlisted procedure, vascular surgery).
Procedure codes 17106-17108 should not be used to report the treatment of reticular veins and/or spider veins.
Participating, preferred, or network providers can bill the member for services denied as cosmetic.
See Medical Policy Bulletin S-28 for information regarding Cosmetic Surgery.
Description
Varicose veins, which usually occur in the lower extremities, are dilated superficial veins whose valves have become incompetent, permitting reversed blood flow when the extremities are in the dependent position. The vascular dilatation results from increased pressure within the veins, as often occurs if the individual stands for long periods of time. Genetics, pregnancy and obesity contribute to the development of varicose veins.
Symptoms, which are not necessarily related to the size of the varicosity, include swelling, generalized leg aching, heaviness and restlessness, itching around the veins, leg cramps, leg muscles that tire easily and sores on the skin near the ankle. The veins may also appear stretched, bulging and discolored.
Varicose veins should be treated conservatively with the use of elastic stockings to provide support during daily activities. Since prolonged standing exacerbates the condition, regular walking and elevating the feet as often as possible should be encouraged.
Sclerotherapy
The injection of sclerosing solution into varicose leg veins irritates the lining of the vein causing it to close. The blood flow is then diverted through healthier veins.
Endovenous Radiofrequency Obliteration of the Greater Saphenous Vein
Endovenous radiofrequency (e.g., the VNUS Closure procedure) is a minimally invasive treatment used as an alternative to saphenous vein ligation and stripping in patients with symptomatic venous insufficiency of the lower extremities (e.g., varicose veins). It involves the use of a catheter temporarily inserted into the patient’s saphenous vein. This procedure utilizes radiofrequency energy at the catheter tip to heat the vein to approximately 85 degrees, which results in contraction of the vein. As the catheter is slowly withdrawn from the vein, the heat causes the vein to collapse and occlude thus terminating the reflux that causes the patient’s symptoms.
Laser Obliteration of the Greater Saphenous Vein
Laser obliteration of the greater saphenous vein is also a minimally invasive procedure that is performed in a fashion similar to endovenous radiofrequency obliteration. A bare tipped laser fiber is introduced into the greater saphenous vein under ultrasonic guidance (76986). The laser is activated and slowly removed along the course of the saphenous vein.
Ambulatory Phlebectomy
Ambulatory phlebectomy is a minimally invasive procedure performed as an alternative to ligation and stripping of veins that are too large for successful sclerotherapy. Prior to the procedure, the veins are located using a Doppler ultrasound. After the vein is marked, it is removed through pinhole incisions made along the length of the vein.
Transilluminated Powered Phlebectomy
Transilluminated powered phlebectomy (e.g., TriVex System) is a minimally invasive procedure in which an endoscopic illuminator is inserted into the vein to allow visualization of the varicose vein clusters. The veins are then ablated using a vein resector. During destruction of the veins, the debris is removed from the wound using suction.
Echosclerotherapy
During echosclerotherapy (S2202),duplex ultrasound is used to guide the injections and enhance the precision of saphenous vein sclerotherapy. However, there are no proven indications that echosclerotherapy provides any advantage over and above conventional methods of treatment such as sclerotherapy or ligation and stripping. |