NEW YEAR AND NEW CODES

Everyone is excited for the 2018 coding changes.  Some of the hottest new technologies have been assigned codes by the AMA and these will be effective on 01/01/18.  Just in time for the New Year, APFS is providing coding clarification on these new service codes.

36465 – Non compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein.

36466 – Multiple incompetent extremity truncal veins.

These codes are used to describe the chemical ablation procedure performed with Varithena™.  There had been some confusion on the proper use of these codes and what veins in particular would be excluded from this description.

Clarification provided by the AMA does state that only truncal veins are included, and perforating veins or saphenous tributaries are not included and should not be reported with these codes.

Additionally, the codes are defined in the same way as the original sclerosing codes 36470 and 36471 in that 36465 is used when one vein is injected, and 36466 is used when more than one vein is injected in the same extremity. These 2 codes should not be billed on the same claim for the same extremity as 36466 is not an add-on code.

Unlike 36470/1, all imaging is inclusive and would not be reported separately, and these codes cannot be reported when using a compounded foam.

36482 – Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive remote from the access site. Inclusive of all imaging guidance and monitoring, percutaneous, first vein treated.

36483 – add on code; subsequent veins treated through a single extremity, each through separate access sites.

These codes would be used for the VenaSeal™ procedure, and unlike the 2 codes listed for Varithena™, these follow the same coding guidelines as the other traditional ablative procedures RF and Laser.  Use 36482 to report treatment of the first vein in a single extremity, and for additional veins treated in the same extremity with a separate access during the same session, report the add-on code of 36483. CPT also states that regardless of how many additional veins are treated in the same session, you will report code 36483 one time with one unit only.  This is in line with the other ablative add-on codes of 36476 and 36479.

It is important to note that just because there are assigned codes with Medicare RVU’s it does not guarantee that there is coverage by any individual payer for these services.  Payers may still exclude them from coverage.  Reviewing the pertinent medical policies prior to treatment, following standard authorization protocols, and verifying plan benefits are still necessary to achieve success with these codes.

One extra related change is to the existing codes of 36470 and 36471.  The valuation of these codes will change on 01/01/18 with the RVU’s for 36470 being reduced, and 36471 being increased relative to the amount of time and supplies used for these services.  A review of the other commonly utilized phlebology codes show a fairly static fee schedule for the New Year.