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Upgrade Your Coding for Incompetent-Vein Therapy With These 2018 Highlights

Sclerosant injections and endovascular ablation therapy have had a place in CPT® code search for years, but treatment advances have led to new additions, effective Jan. 1, 2018. Check out the new codes and some helpful Medicare coding hints below.

Factor In These 2 New Codes for Foam Sclerosant Injections

In 2018, watch for these two new codes for foam sclerosant injection when you perform a CPT® procedure code lookup:

  • 36465 (Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein))
  • 36466 (… multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg).

Note these areas in particular:

  • The codes are specific to use of non-compounded foam sclerosant (meaning the provider doesn’t compound or mix the sclerosant)
  • The codes include ultrasound compression maneuvers and all imaging guidance/monitoring
  • Code choice varies based on injection in a single truncal vein (36465) or multiple truncal veins (36466).

The product name you may see related to this code is BTG Varithena®.

Dive Deeper Into 36465 and 36466

RVUs/fees: The 2018 Medicare Physician Fee Schedule (MPFS) Relative Value Units (RVUs) for CPT® codes 36465 and 36466 vary greatly depending on setting. Multiplying the total RVUs by the 2018 conversion factor (CF) 35.9996 gives you the national payment rate. (Your final payment will vary based on factors like geographic adjustment.)

Code

Non-Facility Total RVUs

xCF

Facility Total RVUs

xCF

36465

45.12

$1,624.30

3.46

$124.56

36466

47.14

$1,697.02

4.40

$158.40

MUEs: CMS assigns a Medically Unlikely Edit (MUE) of 1 to both 36465 and 36466. The MUE Adjudication Indicator (MAI) for both is 2, Date of Service Edit: Policy.

In other words, the MUE of 1 is an absolute date of service (DOS) edit. Medicare checks all your claims for the beneficiary on a single DOS to be sure you didn’t report more than 1 unit of the code.

Global days: Both 36465 and 36466 have a 000 global period. For codes with that global period, the usual preoperative and postoperative services are included in the medical procedure codes’ payment. That means same-day E/M services often are not separately payable.

Bilateral indicator: The 2018 MPFS assigns a bilateral indicator of 1 to both codes. This is an important piece of the reimbursement puzzle because bilateral indicator 1 means that a 150 percent payment adjustment applies when you append modifier 50 (Bilateral procedure).

CCI: Codes 36465 and 36466 are in the column 1 position for 474 new Correct Coding Initiative (CCI) edits, effective Jan. 1, 2018. Don’t miss that single vein code 36465 is bundled into multiple veins code 36466. CCI assigns a modifier indicator of 1 to that edit, so you may override the edit with a modifier on the column 2 code (36465) when documentation supports reporting both codes as distinct services.

2018 CPT® Code Search Results Will Look a Little Different for 364xx Codes

CPT® 2018 revises descriptors for the three codes below, but the language changes will be easy to adjust to because they bring the descriptors more in line with the language in new codes 36465 and 36466.

36468

  • 2017: Single or multiple injections of sclerosing solutions, spider veins (telangiectasia), limb or trunk
  • 2018: Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk

36470

  • 2017: Injection of sclerosing solution; single vein
  • 2018: Injection of sclerosant; single incompetent vein (other than telangiectasia)

36471

  • 2017: Injection of sclerosing solution; multiple veins, same leg
  • 2018: Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg

 

Add These Chemical Adhesive EVAT Codes

The code changes for treatment of incompetent veins don’t end there. Be sure your 2018 CPT® code lookup includes these two new codes for endovenous ablation therapy (EVAT), too:

  • 36482 (Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated)
  • +36483 (… subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure))

The codes describe EVAT by chemical adhesive. A name you may see with these cases is Medtronic VenaSealTM.    

Increase Your Knowledge of New EVAT Codes

 

RVUs/fees: The MPFS RVUs for 36482 and 36483 vary based on the setting, as shown below.

 

Code

Non-Facility Total RVUs

xCF

Facility Total RVUs

xCF

36482

60.06

$2,162.14

5.13

$184.68

36483

4.08

$146.88

2.56

$92.16

 

MUEs: Code 36482 has an MUE of 1, while subsequent-vein code +36483 has an MUE of 2. Both have MAI 3, Date of Service Edit: Clinical. Like MAI 2, MAI 3 means the payer checks all units reported for the code for the beneficiary on the same DOS to be sure you didn’t go over the MUE. But with MAI 3, the payer may pay for additional units based on appeal or documentation of medical necessity.

Global days: Code 36482 has a 000 global period. As an add-on code, 36483 has a ZZZ global designation, which means it’s related to another service and its global period.

Bilateral indicator: The 2018 MPFS assigns a bilateral indicator of 1 to both codes, so be sure to append modifier 50 when appropriate to get full reimbursement.

CCI: Codes 36482 and 36483 are in the column 1 position for 520 new edits. The edits will remind you to think twice before reporting the codes with E/M, imaging, or injection codes.

Final tip: Check LCDs for coverage rules. Payers tend to have detailed requirements for covering incompetent-vein treatments. For instance, your documentation may have to show that the patient is experiencing certain symptoms and conservative treatment has failed.

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