CPT CODE - 93971 -Treatment of varicose veins - covered ICD code and revenue code

Indications of Coverage and/or Medical Necessity

Varicose veins are a manifestation of chronic venous disease (CVD) caused by ambulatory venous hypertension. Varicose veins are superficially located, dilated, tortuous, veins of the lower extremities. They are usually caused by insufficiency, or valvular reflux, of the valvular apparatus (primary disease), or as a result of previous thrombosis or trauma (secondary disease). These dilated superficial veins of the lower limbs are considered pathologic when they are 5 mm or greater in diameter or sometimes 3 mm or greater in diameter (depending on the indication as outlined further in the LCD) when measured in the upright position and have greater than 500 milliseconds of reflux by duplex scan. CVD can cause clinically significant pain and result in a decrease in quality of life and even disability which may necessitate treatment which would be considered reasonable and necessary. CVD is progressive, and over time may progress to secondary skin changes (edema, lipodermatosclerosis, and ulceration), which is referred to as chronic venous insufficiency (CVI). CVD and CVI can be further complicated by superficial thrombophlebitis and variceal hemorrhage.

The superficial venous system has one-way valves that prevent backflow of blood (reflux) when normal and allow movement of blood toward the heart. The axial superficial veins communicate with the deep venous system at different locations. The point where the great saphenous vein (GSV) joins the common femoral vein, saphenofemoral junction (SFJ), is located proximally at the groin. The point where the small saphenous vein (SSV) joins the popliteal vein, saphenopopliteal junction (SPJ), is typically located behind the knee. Reflux involves the main axial superficial veins: GSV and SSV saphenous veins and their tributaries. Clinically significant reflux can also be found in accessory great saphenous veins (i.e., anterior or posterior) which parallel the GSV in the saphenous compartment, the SSV, circumflex veins which course oblique to the GSV, or perforating veins (veins that connect the superficial to the deep veins). There are numerous perforator veins found throughout the leg from the thigh to the ankle that traverse the muscular fascia of the lower extremity and, under normal circumstances, drain from the superficial veins toward the deep (intramuscular) veins. Variations in the anatomy of the deep and superficial venous systems are common.

The evaluation of a patient with lower extremity venous incompetence and its advanced consequences—edema and skin changes—should include the assessment of history and physical examination including the CEAP classification and revised Venous Clinical Severity Score (VCSS). A duplex ultrasound scan of the deep and superficial venous systems must support the examination findings.

The treatment of C1 disease (spider telangiectasia and their feeding reticular veins) is considered cosmetic, and therefore, not reasonable and necessary for the purposes of Medicare coverage.

For patients with C2 disease and VCSS score < 6, the plan of care must include at least a 90 day course of compression therapy further defined below. (C2 patients with VCSS < 6, who failed at least a 90 day course of compression therapy, would start a new 90 day episode of care, and proposed interventions should be addressed in the plan of care.)

For patients with C2 disease and VCSS score > 6, or patients with C3-C6 disease, proposed interventions for a 90 day episode of care should be addressed in the treatment plan.


Limitations of Coverage and/or Medical Necessity

CPT code 37241 Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (e.g., congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles)] is not applicable (incorrect coding) for saphenous ablation and is not covered.

CPT code 76942 has limited coverage by qualified physicians for image-guided foam sclerotherapy, as outlined in this policy.

Thermal ablation includes the necessary ultrasound imaging for any additional procedures done with the thermal ablation.

CPT add-on code 76937 (ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting) is not a covered service for outpatient varicose vein procedures.

Local anesthesia and minimal to no sedation is the standard of care. Monitored Anesthesia Care (MAC) or moderate (conscious) sedation needs clear support in the medical record based on patient clinical presentation/characteristics and may be subject to prepayment review.

Photothermal sclerosis (also referred to as an intense pulsed light source, e.g., the PhotoDerm VascuLight, VeinLase), transdermal laser treatment, and mechanicochemical ablation (MOCA) (Clarivein) do not meet the Medicare reasonable and necessary threshold for coverage. Providers are required to code to specificity. If no such procedure of service exists, then report the service using the appropriate unlisted procedure code. Unlisted procedure, vascular surgery code 37799 should be reported until the specific CPT codes are established. Claims billed for these procedures will be denied.

If it is determined on review that the varicose veins were asymptomatic, the claim will be denied as a non-covered (cosmetic) procedure. Isolated injections for the treatment of telangiectasias and reticular veins less than 3mm in diameter are considered cosmetic and do not meet the Medicare reasonable and necessary threshold for coverage. Claims billed for these procedures will be denied.

Device/sclerosant combination procedures without a unique CPT code are described by CPT code 37799. The sclerosant is included in the procedure. Coverage is limited to the ‘sclerotherapy’ indications.


Revenue Codes
Code Description
0360 Operating Room Services - General Classification
0361 Operating Room Services - Minor Surgery
0362 Operating Room Services - Organ Transplant - Other than Kidney
0367 Operating Room Services - Kidney Transplant
0369 Operating Room Services - Other OR Services
0490 Ambulatory Surgical Care - General Classification
0499 Ambulatory Surgical Care - Other Ambulatory Surgical Care
0510 Clinic - General Classification
0511 Clinic - Chronic Pain Center
0512 Clinic - Dental Clinic
0513 Clinic - Psychiatric Clinic
0514 Clinic - OB-GYN Clinic
0515 Clinic - Pediatric Clinic
0516 Clinic - Urgent Care Clinic
0517 Clinic - Family Practice Clinic
0519 Clinic - Other Clinic
0761 Specialty Services - Treatment Room
0920 Other Diagnostic Services - General Classification
0921 Other Diagnostic Services - Peripheral Vascular Lab
0929 Other Diagnostic Services - Other Diagnostic Service


ICD-10 Codes that Support Medical Necessity
Group 1 Paragraph
N/A
Group 1 Codes
I80.11 Phlebitis and thrombophlebitis of right femoral vein
I80.12 Phlebitis and thrombophlebitis of left femoral vein
I80.13 Phlebitis and thrombophlebitis of femoral vein, bilateral
I80.221 Phlebitis and thrombophlebitis of right popliteal vein
I80.222 Phlebitis and thrombophlebitis of left popliteal vein
I80.223 Phlebitis and thrombophlebitis of popliteal vein, bilateral
I80.231 Phlebitis and thrombophlebitis of right tibial vein
I80.232 Phlebitis and thrombophlebitis of left tibial vein
I80.233 Phlebitis and thrombophlebitis of tibial vein, bilateral
I80.291 Phlebitis and thrombophlebitis of other deep vessels of right lower extremity
I80.292 Phlebitis and thrombophlebitis of other deep vessels of left lower extremity
I80.293 Phlebitis and thrombophlebitis of other deep vessels of lower extremity, bilateral
I80.3 Phlebitis and thrombophlebitis of lower extremities, unspecified
I83.001 Varicose veins of unspecified lower extremity with ulcer of thigh
I83.002 Varicose veins of unspecified lower extremity with ulcer of calf
I83.003 Varicose veins of unspecified lower extremity with ulcer of ankle
I83.004 Varicose veins of unspecified lower extremity with ulcer of heel and midfoot
I83.005 Varicose veins of unspecified lower extremity with ulcer other part of foot
I83.008 Varicose veins of unspecified lower extremity with ulcer other part of lower leg
I83.009 Varicose veins of unspecified lower extremity with ulcer of unspecified site
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
I83.019 Varicose veins of right lower extremity with ulcer of unspecified site
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
I83.029 Varicose veins of left lower extremity with ulcer of unspecified site
I83.10 Varicose veins of unspecified lower extremity with inflammation
I83.11 Varicose veins of right lower extremity with inflammation
I83.12 Varicose veins of left lower extremity with inflammation
I83.201 Varicose veins of unspecified lower extremity with both ulcer of thigh and inflammation
I83.202 Varicose veins of unspecified lower extremity with both ulcer of calf and inflammation
I83.203 Varicose veins of unspecified lower extremity with both ulcer of ankle and inflammation
I83.204 Varicose veins of unspecified lower extremity with both ulcer of heel and midfoot and inflammation
I83.205 Varicose veins of unspecified lower extremity with both ulcer other part of foot and inflammation
I83.208 Varicose veins of unspecified lower extremity with both ulcer of other part of lower extremity and inflammation
I83.209 Varicose veins of unspecified lower extremity with both ulcer of unspecified site and 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
I83.219 Varicose veins of right lower extremity with both ulcer of unspecified site 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
I83.229 Varicose veins of left lower extremity with both ulcer of unspecified site and inflammation
I83.811 Varicose veins of right lower extremities with pain
I83.812 Varicose veins of left lower extremities with pain
I83.813 Varicose veins of bilateral lower extremities with pain
I83.891 Varicose veins of right lower extremities with other complications
I83.892 Varicose veins of left lower extremities with other complications
I83.893 Varicose veins of bilateral lower extremities with other complications
I87.2 Venous insufficiency (chronic) (peripheral)
R60.0 Localized edema
ICD-10 Codes that DO NOT Support Medical Necessity
I78.0 Hereditary hemorrhagic telangiectasia
I78.1 Nevus, non-neoplastic
I78.8 Other diseases of capillaries
I78.9 Disease of capillaries, unspecified
I80.11 Phlebitis and thrombophlebitis of right femoral vein
I80.12 Phlebitis and thrombophlebitis of left femoral vein
I80.13 Phlebitis and thrombophlebitis of femoral vein, bilateral
I80.221 Phlebitis and thrombophlebitis of right popliteal vein
I80.222 Phlebitis and thrombophlebitis of left popliteal vein
I80.223 Phlebitis and thrombophlebitis of popliteal vein, bilateral
I80.231 Phlebitis and thrombophlebitis of right tibial vein
I80.232 Phlebitis and thrombophlebitis of left tibial vein
I80.233 Phlebitis and thrombophlebitis of tibial vein, bilateral
I80.291 Phlebitis and thrombophlebitis of other deep vessels of right lower extremity
I80.292 Phlebitis and thrombophlebitis of other deep vessels of left lower extremity
I80.293 Phlebitis and thrombophlebitis of other deep vessels of lower extremity, bilateral
I80.3 Phlebitis and thrombophlebitis of lower extremities, unspecified
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
I83.229 Varicose veins of left lower extremity with both ulcer of unspecified site and inflammation
I83.811 Varicose veins of right lower extremities with pain
I83.812 Varicose veins of left lower extremities with pain
I83.813 Varicose veins of bilateral lower extremities with pain
I83.891 Varicose veins of right lower extremities with other complications
I83.892 Varicose veins of left lower extremities with other complications
I83.893 Varicose veins of bilateral lower extremities with other complications
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
I87.099 Postthrombotic syndrome with other complications of unspecified lower extremity
I87.2 Venous insufficiency (chronic) (peripheral)
R60.0 Localized edema

No comments:

Top Medicare billing tips