|by AJ Riviezzo
United Healthcare (UHC) came out with a new policy dated September 1, 2019, Policy Number 2019T0447Y. The policy still allows the treatment of GSV that are at least 5.5mm and SSV that are 5.0mm along with perforators underlying an ulcer and 3.5mm in size. Other criteria must also be met.
Of rather profound change is UHC’s misinterpretation of the American Medical Association’s (AMA) coding guidance. UHC has chosen to believe that the coding guidance allows for the treatment of the primary vein and one subsequent vein to be treated on the same day only. They are not allowing for proper staging of the GSV on one day and the SSV on another. This despite ample evidence that lidocaine toxicity can be an issue as, unlike during lipo, the lidocaine remains in the patient. Other concerns include breaking the sterile field when having to ‘flip’ the patient as well as the time spent doing the two procedures on one limb.
We recommend that physicians and their societies push back on this misinterpretation of the AMA’s coding guidance. While a second vein being treated by RF or Laser on the same day is indeed a 36476 or 36479, the guidelines do not REQUIRE that a second vein be treated the same day. You also cannot bill the add on codes of 36476 or 36479 on a separate day.
You may find the policy at: UHC Link