HCPCS Codes for Varicose Vein Procedures

Varicose veins are abnormally large veins that bulge through the skin, usually in the legs. They can be painful for many people, whether they're walking or staying still. Many treatment recommendations exist on how to reduce the swelling of varicose veins, including surgical options. For medical billing purposes, these procedures need to be coded, as do the supplies that may be used.

For clarification purposes, procedures codes are called CPT-4 codes, although many people use that term and HCPCS interchangeably. HCPCS codes actually refer to what's known as Level II codes, which cover extended procedures and supply codes. Code descriptions can be very long; they are truncated here, so it's recommended you read through the manuals for more complete descriptions.

Evaluation

Before any treatment can begin, evaluations must be given to determine the type of treatment that needs to take place. The CPT-4 codes used for those determinations include one radiology code:

76942 - Ultrasonic Guidance for Needle Placement

The other codes are categorized as Extremity Venous Studies. These codes are:

93965 - Noninvasive physiologic studies of extremity veins

93970 - Duplex scan of extremity veins

93971 - Duplex scan of extremity veins

Types of Procedures

There are three main treatment categories for varicose veins. Though all of the codes are listed within the surgical category of CPT-4 codes, not all of the procedures are actually surgical procedures. Also, none of these codes are exclusive during a day of treatment. This means if a physician wishes to perform multiple procedures in one day, it can be done as long as the medical documentation supports it. However, some codes can't be billed together on the same day, so it's best to verify those codes through the coding manual.

Sclerosing Solutions Injections

The least invasive of the three varicose vein surgical treatments introduces solutions into the veins, usually via a drip process to try to reduce the hardening that's taken place.

36468 - Single or Multiple Injections of sclerosing solutions

36470 - Injection of sclerosing solution; single vein

36471 - Injection of sclerosing solution; multiple veins, same leg

Endovenous Ablation Therapy

Ablation therapy means varicose veins will be treated by inserting a solution and then heating it up with an outside source. The source is indicated within the codes below:

36475 - Ablation therapy of incompetent vein, percutaneous, radiofrequency; first vein treated

36476 - Ablation therapy of incompetent vein, percutaneous, radiofrequency; second and subsequent veins

36478 - Ablation therapy of incompetent vein, percutaneous, laser; first vein treated

36479 - Ablation therapy of incompetent vein, percutaneous, laser; second and subsequent veins

Vein Ligation (surgery)

These codes indicate actual surgical procedures. Hospitals might not use these codes for billing purposes, deciding instead to use surgical ICD-9, or diagnosis codes, but physicians will need to use at least one of these codes:

37700 - Ligation and division of long saphenous vein at saphenofemoral junction

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

37760 - Ligation of perforator veins, subfascial, radical

37765 - Stab phlebectomy of varicose veins, one extremity; 10-20 stab incisions

37766 - Stab phlebectomy of varicose veins, one extremity; more than 20 incisions

37780 - Ligation and division of short saphenous vein at saphenopopliteal junction

37799 - Unlisted procedure, vascular surgery

HCPCS Procedure

There is one last procedure that, unfortunately, isn't covered by most insurance companies because, as of mid-2009, they see it as an experimental procedure. That code is:

S2202 Echosclerotherapy

Supplies

Compression stockings are the most used supply item in the treatment of varicose veins. Not all insurance companies will pay for this item, as it's considered take-home equipment, which usually isn't covered. The range of HCPCS codes for this item is from A6533 through A6549, with the only difference being the size and length of the stocking.

References

• CPT 20099 Professional Edition, American Medical Association, 2009
• Medical Policies, Blue Cross Blue Shield of Florida
• HCPCS Level II, Ingenix 2009

Resources

• Procedures for Ablation of Varicose Veins, United Healthcare
• Varicose Veins of the Lower Extremity, Treatment of, National Government Services