Endomechanical Ablation Coding

Our View
by AJ Riviezzo
Recently code 37241 has been touted as potentially proper coding for an endomechanical ablation of a saphenous vein. The reimbursement is fantastic. It is an inclusive code. Medicare pays it quickly.

As my mother always said, if something is too good to be true, it probably is.

Here’s why we believe the coding is inaccurate at best.
1. The full CPT language regarding this code is clear. Code 37241 is not to be used for reporting ablation procedures for venous insufficiency. The first full paragraph of the code is clipped below:

Codes 37241 37244 are used to describe the work of vascular embolization and occlusion procedures, excluding the central nervous system and the head and neck, which are reported using 61624, 61626, 61710, and 75894, and excluding the ablation/sclerotherapy procedures for venous insufficiency/telangiectasia of the extremities/skin, which are reported using 36468, 36470, and 36471. (For sclerosis of veins or endo venous ablation of incompetent extremity veins, see 36468 36479.)

2. Further, the code addresses that this code is for vascular embolization and occlusion procedures. The expectation for vascular embolization is the use of coils, particles, foam, plug or microspheres or beads. The embolization process normally is creating a plug and not occluding an entire vein like the saphenous.

3. The reimbursement rates are at least double what a laser or RF ablation would allow. Clearly the expectation by Medicare and the commercial payers is that this code is used for something requiring significantly more work value units than a normal ablation of a saphenous vein.

4. The payer guidelines that specifically allow endomechanical ablation of a saphenous vein all agree that code 37799 should be used. There is no mention, even of policies written this year, of using code 37241 for this service.

We believe that the proper way to bill for this service is to use code 37799 in the same way you would do so for a stab phlebectomy with less than ten incisions. Early results in using this code show reimbursement somewhere between a laser and RF ablation. There have been some difficulties with a few payers or Medicare Administrators but we think that constant and consistent use of the code and language in box 19 (or its electronic equivalent) will bring standardization to the process. Visit https://touchuplaser.com/treatments/laser-hair-removal/ for safe procedures and laser treatment.

Our concerns are extremely high in using a code that pays significantly more, has language that we believe clearly excludes its use for an ablation, and exacerbated by Medicare’s ever increasing audit processes. We do not believe this code will survive an audit which could result in recoupment, penalties and interest.

Please know we do not care what type of technology you use for performing an ablation or any other procedure.

We only care that the code is appropriate and the reimbursement is appropriate.