by AJ Riviezzo
CPT coding for a new product is always an interesting process with opportunities to create real difficulties for the rendering physician. It is important to be careful with new product coding. Many may recall the difficulties and recoupments that occurred when some practices billed an embolization code for what is now the MOCA codes of 36473 and 36474. Medicare recouped thousands of dollars from practices for using the wrong code.
The American Venous Forum recently published a venousnews article dated September 3, 2024. It is attached here. After their review of the relatively new ScleroSafe™ percutaneous endovenous ablation procedure, they are recommending the aforementioned MOCA codes of 36473 and 36474.
We have concerns with that recommendation. The M in MOCA is for mechanical. The ScleroSafe™ product, while quite interesting, does not really have a mechanical element. The AVF noted that the ScleroSafe™ device utilizes mechanical disruption and abrasion of the venous intima. We do not see such an element in the video or information provided on their website attached here. ClariVein® has a small rotating wire tip to score the lumen.
Please note, we are neither advocating for or against the use of ScleroSafe™. We want to ensure proper coding and reimbursement so our physician community is not subject to any Medicare or other payer audits.
The CPT guide is very specific when it comes to new products and technologies. They state: “Do not select a CPT code that merely approximates the service provided. If no such specific code exists, then report the service using the appropriate unlisted procedure or service code.”
To that end, the code for an unlisted vascular procedure is 37799. That is what we believe should be used for this product as it seems to combine injection of a sclerosant with the elements of a drainage of a hematoma concurrently. We do recommend that the practice reaches out to each of the commercial payers to not only obtain an authorization, but to try and obtain a pre-determination on their first few ScleroSafe™ procedures with that payer.
When the payer receives a code like 37799 they are supposed to review the product, service, cost, and physician time (along with other factors) to determine a fair reimbursement amount. The information we have used is attached. We strongly recommend if you are or are considering using this product, that you research the coding elements yourself. It is, ultimately, the rendering physician that chooses the CPT code that should be used.