by Cheryl Nash


The question of how to bill for Non-Compounded Foam, commonly known as Varithena, has caused some confusion in phlebology circles, so we thought we would clarify some of the most commonly asked questions presented to APFS.


Q. We have been told we can use Varithena to treat tributaries, is this true?


A. Yes, the FDA approval allows the use of Varithena for the treatment of the greater saphenous vein and its tributaries.


Q. If treating tributaries how should we report this on our claims?


A. Billing for injection of any sclerosing solution into a tributary is reported with CPT codes 36470 for a single vein and 36471 for multiple veins.


Q. I thought the new codes 36465 and 36466 should be used for all Varithena claims, is this wrong?


A. CPT codes 36465 and 36466 are limited to reporting treatment with non-compounded foam in truncal veins only. The AMA has further defined truncal veins as the GSV, SSV, AASV, VOG, and PAV. Tributary and perforator veins are excluded from this description and would be reported with 36470 and 36471.


Q. What if we treat the GSV and associated tributaries in the same session, can we use 36466?


A. No, 36466 also has the descriptor of truncal veins only, and reporting for injection into a tributary would be considered a false claim.


Q. Can we perform a repeat injection into the same vessel during separate treatment sessions?


A. Yes, as long as all payer guidelines for reasonable and necessary treatment are met.


Q. Can we bill for Varithena at the same time as a thermal ablation?


A. Yes, there are no edits prohibiting billing both modalities on the same claim. Both codes must be approved on the authorization and it cannot be the same vein.


Q. Can we bill for 36465/6 on the same claim as 36470/1?


A. Yes, however there are edits prohibiting billing on the same claim unless an allowable modifier is used. The codes are considered mutually exclusive, and care must be taken to determine if separate billing is appropriate.


Q. Will the payers authorize Varithena at the same time as a thermal ablation?


A. This is variable depending on the payer. Some will allow both on the same auth and some payers will require a waiting period after thermal ablation before considering an auth for Varithena.


In conclusion, there are some distinct differences between how a product can be utilized and what codes are used for reporting the procedure. The CPT code provides very detailed instructions on how to select correct codes and reporting otherwise constitutes false claims. On the subject of non-compounded foam the CPT is very clear, codes 36465 and 36466 can only be used to report injection of a truncal vein. If any other veins are injected you must report with 36470 and 36471 regardless of the sclerosing product used.

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