Varithena Microfoam Ablation 2019 Coding and Reimbursement Guide - BTG plc
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Varithena® Microfoam Ablation 2019 Coding and Reimbursement Guide
Varithena Microfoam Ablation
2019 Coding and Reimbursement Guide
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 system above and below the knee. Varithena improves the symptoms of superficial venous incompetence and the appearance of visible
varicosities.
Per Site of Care (non‐facility/facility)
As of January 1st, 2018, Varithena may be billed with one of the following CPT1 codes listed below. Per CPT instructions, the code selected should accurately describe
the service performed.
Physician (Non‐ Physician (Non‐ Physician (Facility)
CPT Code Description Physician (Facility)
facility) facility)2 Total
Injection of non‐compounded foam sclerosant with ultrasound
compression maneuvers to guide dispersion of the injectate, inclusive of
36465 43.64 $1,572.75 3.45 $124.33
all imaging guidance and monitoring; single incompetent extremity
truncal vein (e.g., great saphenous vein, accessory saphenous vein)
Injection of non‐compounded foam sclerosant with ultrasound
compression maneuvers to guide dispersion of the injectate,
36466 inclusive of all imaging guidance and monitoring; multiple 45.87 $1,653.11 4.39 $158.21
incompetent truncal veins (e.g., great saphenous vein, accessory
saphenous vein), same leg
Injection of sclerosant; single incompetent vein (other than
36470* 3.02 $108.84 1.11 $40.00
telangiectasia)
Injection of sclerosant; multiple incompetent veins (other than
36471* 5.47 $197.13 2.21 $79.65
telangiectasia), same leg
*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® Microfoam Ablation 2019 Coding and Reimbursement Guide
Possible Hospital Outpatient CPT Codes for Use of Varithena and 2019 Medicare National Average Payment (Site of Service 22)
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.
Code Description Hospital APC3 Status4
Injection of non‐compounded foam sclerosant with ultrasound
compression maneuvers to guide dispersion of the injectate, inclusive
36465 $1,548.96 5054 T
of all imaging guidance and monitoring; single incompetent extremity
truncal vein (e.g., great saphenous vein, accessory saphenous vein)
Injection of non‐compounded foam sclerosant with ultrasound
compression maneuvers to guide dispersion of the injectate, inclusive of
36466 $1,548.96 5054 T
all imaging guidance and monitoring; multiple incompetent truncal veins
(e.g., great saphenous vein, accessory saphenous vein), same leg
Not paid by
36468 Injection(s) of sclerosant for spider veins (telangiectasia),limb or trunk
Medicare
Injection of sclerosant; single incompetent vein (other than
36470* $314.18 5052 T
telangiectasia)
Injection of sclerosant; multiple incompetent veins (other than
36471* $314.18 5052 T
telangiectasia), same leg
*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‐CM 5 Description ICD 10‐CM Description
I83.011‐
Varicose Veins Lower Extremities (Right) I83.211‐ I83.218 Varicose Veins Lower Extremities right w/ Ulcer & inflammation
I83.009
I83.021‐ I83.221‐ I83.228 Varicose Veins Lower Extremities left w/ Ulcer & inflammation
Varicose Veins Lower Extremities (Right)
I83.028
I83.11‐ I83.12 Varicose Veins Lower Extremities (Right) I83.811‐ I83.212 Varicose Veins Lower Extremities right, with painCMS‐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, 36466, 36470 or 36471 is a clinical decision dependent on the coder’s interpretation of the physician’s
notes.
Sources
1 Current Procedural Terminology (CPT®) Professional Edition 2018. Copyright 2017 American Medical Association. All rights reserved.
2 Medicare Physician Fee Schedule Final Rule CY2019. Federal Register Document 2018‐24170, published 23 Nov 2018 https://www.federalregister.gov/d/2018‐24170. Effective through December 31,
2019. Conversion factor $36.0391
3 Medicare Outpatient Prospective Payment System Final Rule CY2019. Federal Register Document 2018‐24243, published 21 Nov 2018, https://www.federalregister.gov/d/2018‐24243. Effective
through December 31, 2019.
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
All information supplied is for informational purposes only. BTG does not provide advice or guidance with respect to reimbursement for specific charges in particular medical
circumstances. The information provided is only intended to summarize a possible reading of certain payer policies. However, interpretation of the policies to inform reimbursement
decisions is the obligation of the entity seeking reimbursement (e.g., physician, qualified healthcare professional, hospital or other facility).
The information represents no statement of guarantee by BTG or its group companies. The decisions related to reimbursement must be made by the provider after considering the medical
necessity of the services and supplies provided as well as considering any regulations and local, state, or federal laws that may apply.
All reimbursement information is subject to change without notice, and specific payers may have their own reimbursement requirements and policies. Payers should be consulted for
interpretation of local coverage reimbursement policies.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. ©2019 Biocompatibles Inc., a BTG International group company All rights reserved. US‐VAR‐1800627 Varithena is a registered 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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