by AJ Riviezzo
For whatever reason, the Varithena codes and use of same seem to have a never-ending bit of creativity. The latest interesting twist is a practice using Physician Compounded Foam (PCF) and billing the Varithena codes. The reason they are selecting that code, per the practice, is that they are not ‘compounding’ anything. However, you are indeed changing the properties when you take the liquid and make it into a foam or self-compounding. This now makes it a PCF.
The AMA makes it very clear in their March 2018 CPT Assistant Article that you cannot use codes 36465 and 36466 to report the injection of self-prepared (self-compounded) sclerosant into a truncal vein. They also make it very clear that self-compounded foam used to treat a truncal vein or a non-truncal vein should be reported using code 36470 or 36471.
Here is a LINK to the Premera Blue Cross Varicose Vein policy that also specifically calls out using Varithena when using code 36465. The literature and the AMA along with the CPT code itself are pretty clear that using the 36465 and 36466 CPT codes are for Varithena and not anything else or a mixture of Varithena and PCF. It is not, in my estimation, worth the potential downside to do anything else.