Quick Information Regarding Ablation of Other Elements
by AJ Riviezo, MBA
We are frequently asked if one can perform an RF or laser ablation for a tributary, anterior accessory or perforator – and receive payment for the work.
The answer is, like most everything regarding insurance, perhaps.
First, the vein to be ablated must meet the minimum guidelines that are in place by the payer for the saphenous veins. For example, they may require the vein to be at least 3mm in diameter, showing evidence of reflux, and the patient has to have met conservative treatment guidelines.
Second, please note that many payers believe this procedure should be performed concurrently with an ablation of the saphenous vein. The codes for a second insertion/ablation are 36476 and 36479 for RF or laser. You should have a progress note stating why the patient needs this ablation versus alternative treatment, and why you are recommending this to be a staged procedure.
Next, should you determine that there is a need to stage the procedure and not perform it during the ablation of the saphenous vein, we recommend reviewing the patient insurance carrier’s guidelines regarding ablations. Some, like Anthem Blue Cross/Blue Shield, are very clear that they will not authorize the service. Their guidelines note usage of sclerotherapy to resolve these issues after an ablation of the saphenous vein. You will not have to review these guidelines every time but we do recommend reviewing them at least quarterly to check for any changes. Some payers, like Blues of Illinois, changes their guidelines at least once per year.
If you have an authorization (if required), the CPT code used for these ablations is the same as for a saphenous ablation – 36475 for RF ablation and 36478 for laser ablation. Documentation of the procedure is essentially the same save for noting as to why this is a staged procedure.
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