Learn CPT-4 Codes for Varicose Vein Procedures involved in Treatment Therapy, Supplies, Evaluation.

Varicose veins are abnormally large veins that bulge through the skin, usually in the legs. They can be painful for many people, whether they're walking or staying still.

Many treatment recommendations exist on how to reduce the swelling of varicose veins, including surgical options. For medical billing purposes, these procedures need to be coded, as do the supplies that may be used.

For clarification purposes, procedures codes are called CPT-4 codes, although many people use that term and HCPCS interchangeably. HCPCS codes actually refer to what's known as Level II codes, which cover extended procedures and supply codes. Code descriptions can be very long; they are truncated here, so it's recommended you read through the manuals for complete descriptions.

Varicose Vein Procedures CPT-4 Codes: Therapy, Supplies and Evaluation

CPT Codes for Varicose Vein Evaluation

Before any treatment can begin, evaluations must be given to determine the type of treatment that needs to take place. The CPT-4 codes used for those determinations include the following codes. The initial one is a radiology code, while the other codes are categorized as Extremity Venous Studies. These codes are:
  1. CPT Code 76942 Ultrasonic Guidance for Needle Placement.
  2. CPT Code 93965 Noninvasive Physiologic Studies of Extremity Veins.
  3. CPT Code 93970 Duplex Scan of Extremity Veins.
  4. CPT Code 93971 Duplex Scan of Extremity Veins.

Varicose Vein Procedures Types

There are three main treatment categories for varicose veins. Though all of the codes are listed within the surgical category of CPT-4 codes, not all of the procedures are actually surgical procedures. Also, none of these codes are exclusive during a day of treatment.

It means if a physician wishes to perform multiple procedures in one day, it can be done as long as the medical documentation supports it. However, some codes can't be billed together on the same day, so it's best to verify those codes through the coding manual.

The least invasive of the three varicose vein surgical treatments introduces solutions into the veins, usually via a drip process to try to reduce the hardening that's taken place.
  • CPT Code 36468 Single or Multiple Injections of Sclerosing Solutions.
  • CPT Code 36470 Injection of Sclerosing Solution; Single Vein.
  • CPT Code 36471 Injection of Sclerosing Solution; Multiple Veins, Same Leg.

Endovenous Ablation Therapy CPT Codes

Ablation therapy means varicose veins will be treated by inserting a solution and then heating it up with an outside source. The source is indicated within the codes below:
  • CPT Code 36475
    Ablation therapy of incompetent vein, percutaneous, radiofrequency; first vein treated
  • CPT Code 36476
    Ablation therapy of incompetent vein, percutaneous, radiofrequency; second and subsequent veins
  • CPT Code 36478
    Ablation therapy of incompetent vein, percutaneous, laser; first vein treated
  • CPT Code 36479
    Ablation therapy of incompetent vein, percutaneous, laser; second and subsequent veins

Vein Ligation Surgery CPT Codes

These codes indicate actual surgical procedures. Hospitals might not use these codes for billing purposes, deciding instead to use surgical ICD-9, or diagnosis codes, but physicians will need to use at least one of these codes:
  • CPT Code 37700
    Ligation and division of long saphenous vein at saphenofemoral junction.
  • CPT Code 37718
    Ligation, division, and stripping, short saphenous vein.
  • CPT Code 37722
    Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below.
  • CPT Code 37735
    Ligation and division and complete stripping of long or short saphenous veins.
  • CPT Code 37760
    Ligation of perforator veins, subfascial, radical.
  • CPT Code 37765
    Stab phlebectomy of varicose veins, one extremity; 10-20 stab incisions.
  • CPT Code 37766
    Stab phlebectomy of varicose veins, one extremity; more than 20 incisions.
  • CPT Code 37780
    Ligation and division of short saphenous vein at saphenopopliteal junction.
  • CPT Code 37799
    Unlisted procedure, vascular surgery.

HCPCS Procedure

There is one last procedure that, unfortunately, isn't covered by most insurance companies because, as of mid-2009, they see it as an experimental procedure. That code is:

CPT Code S2202 Echosclerotherapy Supplies

Compression stockings are the most used supply item in the treatment of varicose veins. Not all insurance companies will pay for this item, as it's considered take-home equipment, which usually isn't covered. The range of HCPCS codes for this item is from A6533 through A6549, with the only difference being the size and length of the stocking.

Post a Comment

  1. What is the reimbursement for CPT code 76942 for ultrasound guidance for needle placement? And can you always bill this code for endovenous laser ablations?

    1. Medical billing codingJune 7, 2015 at 8:20 PM

      The reimbursement for CPT code 76942 depend upon your locality, medicare carrier name and percentage of the fee schedule you are contracted..
      suppose if your fee schedule is 100% of Medicare ny then Medicare reimbursement will be as
      $94.24 for Global
      $41.03 for profession component(26)
      $51.21 for Technical component

    2. Do not bill CPT code 76942 for ultrasound guidance with CPT code 36475-36479 for endovenous lasion ablation because all imaging guidance already included in CPT 36475 so if you bill these two codes together then insurance will pay only one code or just for endovenous laser ablation procedure which has higher reimbursement amount. Some local commercial carrier may be pay both CPT codes but Medicare do not pay for both codes when bill together.

  2. Can one bill 36476 with a modifier more than once when treatment is being billed in conjunction with the 36475? Example 36475x1 36476x1 (Cx#1) then 36476x1(cx#2)

    1. For billing CPT code 36475 Modifier LT,RT or Modifier-50 can be used if bilateral services are performed. If procedure is performed as unilateral then coding should be as only one unit without modifier or code LT or RT, Bill CPT 36475 if first vein is treated and for additional or second vein treatment on same day you have to bill CPT 36476 also.

  3. Can you bill a code for the actual numbing of the veins prior to the RF procedure?

    1. First confirm that whether you are looking for CPT code for Anesthesia performed for RF procedure or another procedure to block nerve which is other than RF procedure?
      Please describe in detail to answer your question regarding "CPT code for the actual numbing of the veins

  4. should 93971 be billed at the same time as 36475 and 37766?

    1. No! You cannot bill at the same time the Duplex scan CPT code 93971 with CPT 36475 endovenous ablation because the ultrasound scanning, imaging guidance and monitoring are alreay included in CPT code 36475. CPT 93971 will be denied always by insurance if you bill it with CPT 36475 on same day.

      However you can CPT 36475 and 37765 together on same day for varicose veins and Medicare/Commercial Insurances both will pay the claim.

  5. Can you use a 79 modifier if a pt comes in for a 36475 on day 1 and then a 36471 on day 2?

    1. Since there is no global period for procedure 36475 defined in CPT book so in that case you do not need to append modifier 79 with 36471 on day 2.

  6. I believe Farhan's previous question relates to coding 36476 more than once per session. I also have this same question.
    Ex: Pt has RFA of right GSV, ASV, and SSV in the same session.
    Would it be appropriate to code 36475-RT, 36476-RT x2?
    Some carriers pay this and some deny. We are trying to get confirmation of correct billing for this procedure.

    1. Thanks Lisa, You can bill CPT 36475x1 for initial vein treated and in conjunction bill also CPT 36476x1 when second or subsequent vein treated through a new incision site. Please note 36475 is primary code for first vein and CPT 36476 is add-on code used to bill when additional veins are treated by surgeon. For multiple veins treatment on same day you should report 36476 only once with conjunction to primary add-on code 36475. It is not correct to report 36476 twice on same day.

  7. Hello, I just joined this practice and I have noticed the previous biller would use 93970 and 93971 same day and both were actually paid . Can some one please tell me when is okay to bill these two together as 93970 is bilateral and 93971 is unilateral.
    Thank you

    1. Yes both codes are payable on same day if two different Scan/exam were performed but it must be supported by documentation otherwise you should not report both services together on same day.

  8. how would i bill icd9 93971, 29580 , 99213 and the modifiers they need

    1. Medical billing codingJune 7, 2015 at 9:29 PM

      You should bill Modifier 25 with Evaluation and management code and LT/RT with CPT 29580 (use modifier 50 with 29580 if services were performed bilaterally otherwise not)
      99213-25, 29580-LT/RT or 29580-50 for bilateral, 993971 (ICD code you use, should be appropriate or support medical necessity for CPT 29580)

  9. Can we bill 36476 Multiple time if the Primary Vein is 36475 -gsv and then 36476 cx and 36476 perf? I really am trying to see if we can bill the 36476 more than once on same day

    1. This Question has been answered. see above

  10. Is there a code for the "medication" (chemical) used for sclerotherapy (chemical ablation)...ie Sotradecol ?

  11. Is there a CPT code for the Tumescent anesthesia that can be billed with codes 36478 and 37766?

  12. 37766 and 37765 billed with LT & RT Modifier also 37700 billed with LT & RT on same DOS. Medicare denied as medically necessity...Help

  13. If we do a 36475-RT on Monday and then a 37766-RT on Wednesday, and then the patient comes in complaining of pain from the 36475 and we do an ultrasound, what modifier do I use with 93971?

  14. For example, I billed 36475 and 37765 for the RT leg on 9/4. On 9/25 I bill 36475 for the LT leg and they are denying the 9/25, do I need to use Modifier -59?


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