Varithena Micro-Foam Ablation 2018 Coding and Reimbursement Guide
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Varithena® Micro-Foam Ablation 2018 Coding and Reimbursement Guide
Varithena® Micro-Foam Ablation
2018 Coding and Reimbursement Guide
Varithena® Micro-Foam Ablation is a procedure that generates injectable foam for ultrasound-guided intravenous injection.
Varithena® is indicated for the treatment of incompetent great saphenous veins, accessory saphenous veins and visible varicosities of the great saphenous vein
system above and below the knee. Varithena™ improves the symptoms of superficial venous incompetence and the appearance of visible varicosities.
Potential CPT Codes for Use of Varithena with 2018 Medicare National Average Physician Payment
Per Site of Care (non-facility/facility)
As of January 1st, 2018, Varithena® may be billed with one of the following CPT codes listed below.
Per CPT instructions, the code selected should accurately describe the service performed.
CPT Physician Physician Physician Physician
(Facility) Total
(Non-facility) (Non-facility) (Facility)
Code Description Total RVUs2 Total Payment2 Total RVUs2 Payment2
36465 Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the 45.12 $1,624.30 3.46 $124.56
injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (e.g., great
saphenous vein, accessory saphenous vein)
36466 Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the 47.14 $1,697.02 4.40 $158.40
injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (e.g., great saphenous
vein, accessory saphenous vein), same leg
36468 Injection(s) of sclerosant for spider veins (telangiectasia),limb or trunk Not paid Not paid
by Medicare by Medicare
36470* Injection of sclerosant; single incompetent vein (other than telangiectasia) 3.00 $108.00 1.11 $39.96
36471* Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg 5.39 $194.04 2.21 $79.56
*If the targeted vein is an extremity truncal vein and injection of non-compounded foam sclerosant with ultrasound guided compression maneuvers to guide dispersion
of the injectate is performed, see 36465,36466. Reference: AMA 2018 CPT Professional, Page 248Varithena® Micro-Foam Ablation 2018 Coding and Reimbursement Guide
Possible Hospital Outpatient CPT Codes for Use of Varithena and 2018 Medicare National Average Payment
Hospitals use CPT® codes to report outpatient services. Medicare assigns each CPT® code to an Ambulatory Payment Classification (APC).
Each APC is assigned a payment amount.
CPT
Hospital APC3 Status
Code Description Outpatient3 Indicator4
Endovenous Ablation Therapy
36465 Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive $1,568.43 5054 T
of all imaging guidance and monitoring; single incompetent extremity truncal vein (e.g., great saphenous vein, accessory saphenous vein)
36466 Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all $1,568.43 5054 T
imaging guidance and monitoring; multiple incompetent truncal veins (e.g., great saphenous vein, accessory saphenous vein), same leg
36468 Injection(s) of sclerosant for spider veins (telangiectasia),limb or trunk Not paid
by Medicare
36470* Injection of sclerosant; single incompetent vein (other than telangiectasia) $310.80 5052 T
36471* Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg $310.80 5052 T
*If the targeted vein is an extremity truncal vein and injection of non-compounded foam sclerosant with ultrasound guided compression maneuvers to guide dispersion
of the injectate is performed, see 36465,36466. Reference: AMA 2018 CPT Professional, Page 248
Possible ICD-10-CM Diagnoses Codes for Use of Varithena
Providers are required to report diagnosis codes on claims submitted for payment using the International Classification of Disease, Clinical Modification (ICD-10-CM)
codes that reflect the patient’s medical condition.
ICD 10-CM5 Description ICD 10-CM5 Description
I83.011- Varicose Veins Lower Extremities (Right) I83.211- Varicose Veins Lower Extremities right w/ Ulcer & inflammation
I83.009 I83.218
I83.021- Varicose Veins Lower Extremities (Right) I83.221- Varicose Veins Lower Extremities left w/ Ulcer & inflammation
I83.028 I83.228
I83.11- Varicose Veins Lower Extremities (Right) I83.811- Varicose Veins Lower Extremities right, with pain
I83.12 I83.212CMS-1500 Form
Below is an example of how Varithena could be billed on a CMS-1500 form. Prior Authorization Numbers, ICD-10 CM Codes, NPIs and charged amounts may vary
depending on the provider, payer and contract. Coding 36465 or 36466 is a clinical decision dependent on the coders interpretation of the physician’s notes.
Need assistance? Contact the Varithena Solutions Center™:
Call 1-855-971-VEIN (8346) between 8 AM and 8 PM ET, Monday through Friday
Sources
1
Current Procedural Terminology (CPT®) Professional Edition 2018. Copyright 2017 American Medical Association. All rights reserved.
2
CMS-1676-FC; Medicare Physician Fee Schedule Final Rule CY2018. Effective through December 31, 2018. Conversion factor $35.9996
3
CMS-1678-CN; Medicare Outpatient Prospective Payment System Final Rule CY2018. Effective through December 31, 2018.
4
Status Indicators: T - Procedure or Service, Multiple Procedure Reduction Applies Paid under OPPS; separate APC payment. N - Packaged Items and Services Packaged into APC Rates
Paid under OPPS; payment is packaged into payment for other services. Therefore, there is no separate APC payment.
5
ICD-10-CM Expert for Physicians and Hospitals, 2018. AAPC publication
Disclaimer
This resource is provided for informational purposes only and is not legal advice or official coding or reimbursement guidance from any payer, including both government
and commercial payers. BTG does not warrant, promise, guarantee or make any statement that the CPT® codes included in this document are appropriate, or that the use
of this information will result in coverage or payment for use of Varithena. Providers are responsible for compliance with Medicare and other payer rules and requirements
and for the information submitted with all claims and appeals. Before any claims or appeals are submitted, providers should review official payer instructions and
requirements and should use independent judgment when selecting codes that most appropriately describe the services or supplies provided.INDICATIONS Varithena® (polidocanol injectable foam) is indicated for the treatment of incompetent great saphenous veins, accessory saphenous veins and visible varicosities of the great saphenous vein (GSV) system above and below the knee. Varithena® improves the symptoms of superficial venous incompetence and the appearance of visible varicosities. IMPORTANT SAFETY INFORMATION The use of Varithena® is contraindicated in patients with known allergy to polidocanol and those with acute thromboembolic disease. Severe allergic reactions have been reported following administration of liquid polidocanol, including anaphylactic reactions, some of them fatal. Observe patients for at least 10 minutes following injection and be prepared to treat anaphylaxis appropriately. Intra-arterial injection or extravasation of polidocanol can cause severe necrosis, ischemia or gangrene. Patients with underlying arterial disease may be at increased risk for tissue ischemia. If intra-arterial injection of polidocanol occurs, consult a vascular surgeon immediately. Varithena® can cause venous thrombosis. Follow administration instructions closely and monitor for signs of venous thrombosis after treatment. Patients with reduced mobility, history of deep vein thrombosis or pulmonary embolism, or recent (within 3 months) major surgery, prolonged hospitalization, or pregnancy are at increased risk for developing thrombosis. The most common adverse events observed were pain/discomfort in extremity, retained coagulum, injection site hematoma or pain, common femoral vein thrombus extension, superficial thrombophlebitis, and deep vein thrombosis. Physicians administering Varithena® must be experienced with venous procedures, possess a detailed working knowledge of the use of the duplex ultrasound in venous disease and be trained in the administration of Varithena®. See Full Prescribing Information for Varithena®.
©2018 Biocompatibles, Inc., a BTG International group company All rights reserved. NA-VAR-2018-0000 Varithena is a registered trademark and Varithena Solutions Center is a trademark of Provensis Ltd, a BTG International group company BTG and the BTG roundel logo are registered trademarks of BTG International Ltd
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