Sclero… One More Time
by AJ Riviezzo
My apologies to our regular readers but I received quite a number of questions regarding Medically Necessary Ultrasound Guided Sclerotherapy. Below is our answers to two very frequent questions posed at the this year’s ACP Annual Congress:
Is Medically Necessary Sclerotherapy Paid for by Insurance Plans?
Medicare and almost all commercial insurance plans do pay for medically necessary sclerotherapy (MNS). There are a few keys to being reimbursed. First, you need to ensure the service is medically necessary based upon that payers medical criteria. Second, you typically need to authorize the service with the commercial plan in the same way you would authorize the ablation. Third, you need to ensure you have an operative note for the procedure as well as some notes showing why the patient requires this service.
How do You Bill for Medically Necessary Sclerotherapy?
Each payer is a bit different and there is even some difference in Medicare administrators. That being noted, our typical set of codes for MNS is a 93971 – single leg doppler US as you are usually re-scanning the leg before doing any injection, 76942 for the US guidance, and a 36471 if multiple veins are injected or a 36470 if only one vein is being injected. Even if the 76942 US guidance is rejected or excluded per the policy, we recommend still billing it as you are performing the service.
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