VARITHENA REVISITED

by AJ Riviezzo

There has been some ‘noise’ out in the phlebology community regarding the use of Varithena. I would like to present some information for your consideration.

The Varithena codes, 36465 and 36466, are only to be used if you are using the Varithena product. The CPT code description clearly states that the code is for “Injection of a non-compounded foam sclerosant…”. If you are using anything else you cannot use the Varithena codes and must use the sclerotherapy codes of 36471 or 36470. To do otherwise is to set yourself up for a potentially dramatic audit.

The Varithena codes are also only approved for use when treating truncal veins. These are the GSV, SSV, AASV, PASV, and the extension of the SSV termed the intra-saphenous vein (vein of Giacomini). While Varithena itself is approved for more than this list, the code which is set by the AMA can ONLY be used for treating these veins.

We have seen some problematic coding when using the 36466 multiple vein code. Both veins being treated must be truncal veins. For example, you can use the 36466 code when treating the distal portion of the GSV and the AASV on the same leg same day. You cannot use the 36466 code when treating the distal portion of the GSV and a tributary. The tributary is not a truncal vein.

Regarding the treatment of the distal portion of the GSV, we do recommend a bit of a process. The physician is treating the proximal portion of the GSV with thermal. Once the treatment is complete, we recommend waiting for a week or two and then reassessing the patient’s distal portion. If the distal portion still meets medical necessity criteria, that is documented and then treatment moves forward or a new authorization and then treatment. This review of the distal portion helps to ensure you are using due diligence in ensuring treatment is necessary rather than just ordering it due to internal protocols. Of course, payer guidelines and policies hold sway and not our recommendation.