This has to be one of the most utilized codes on phlebology claims. We see this code appended to all claims, from office visits, to diagnostic ultrasounds, and even appended to procedures. While this code is perfectly appropriate to report venous reflux, and is also an approved code for diagnostic ultrasound, it is not usually an approved diagnosis for providing treatment such as ERFA or EVLT, Sclerotherapy, or Phlebectomy.
The reason it is not normally on the list of approved codes is because you can have venous insufficiency without having any complications. Complications such as pain, swelling, stasis dermatitis, and the like are the golden rule for insurance coverage of interventional treatment of varicose veins. ICD10 has required diagnosis reporting to be more specific and support the treatment being rendered. The code, therefore, must substantiate the need for the care you are providing.
So while the patient may indeed have venous insufficiency and the code is absolutely correct, it is not sufficiently informative to append to surgical claims. A more specific condition with a complication is the only code that will suffice.
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