by Cheryl Nash
After extensive research into CPT code 37241, along with the conflicting information being provided by various sources, I submitted a query to the AMA in regards the appropriate use of this code specifically in relation to Endo-Mechanical/ Endo-Chemical ablation (MOCA) (ClariVein©) for the treatment of varicose veins.
The AMA provided a comprehensive reply back. It essentially noted that the endomechanical ablation procedure should be billed using code 37799 and not code 37241. Code 37241 is for an embolization procedure most commonly used when treating a congenital or acquired venous malformation, venous hemagiomas, or a varices.
As such, we still believe that the proper code to report this procedure is 37799. This is reported successfully to the various insurance payers when it includes a detailed description of the procedure performed in BOX 19 of the paper CMS 1500 form, or in Loop 2300 or 2400 in the NTE segment of the 5010 electronic filing form.
After submission, it is standard for the insurance company to request a copy of the medical records detailing the procedure in the report. Any additional information providing a clinical description and procedural comparisons along with a letter of Medical Necessity would also be appropriate to send. Pricing should be consistent with the RVU’s for RFA. With correct submission and persistence, a practice should be successful in receiving reimbursement so long as the payer allows this service.
Do be aware that there are many commercial payers who specifically exclude this service from their payment policies as experimental and investigational, so it will be imperative to check the guidelines prior to authorization and treatment.
Hi Cheryl
I appreciate your diligence and recommendations regarding use of the 37241 code. Would you please share a copy of the query you submitted to the AMA. It would help in better understanding their response.
Thanks
Steve Kaufman
Yes, please show me what was submitted to the AMA, as I am having a hard time understanding why the 37241 code does not fit.
On your article on veinexperts.org you state:
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.
That seems contradictory as the first sentence states for embolization and occlusion procedures, yet in the next sentence it states not occluding an entire vein. Please elaborate and show what was submitted to AMA to get that response.
We all wish to bill properly but we need the full information.
Thank you for your time!
Rebecca