LCD Reference Article Billing and Coding Article

Billing and Coding: Varicose Veins of the Lower Extremity, Treatment of

A57305

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57305
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Varicose Veins of the Lower Extremity, Treatment of
Article Type
Billing and Coding
Original Effective Date
09/26/2019
Revision Effective Date
10/03/2024
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See §1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Article Guidance

Article Text

The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (Please see "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

The patient's medical record must document the following:


•history and physical findings supporting a diagnosis of symptomatic varicose veins;

•failure of an adequate trial of conservative treatment as described in the "Indications" section of this LCD;

•exclusion of other causes of edema, ulceration and pain in the limbs;

•performance of appropriate tests to confirm the presence and location of incompetent perforating veins;

•location and number of varicosities, level of incompetence of the vein and the veins involved; and

•necessity of utilizing ultrasound guidance, if used.
The medical record must also include pre-treatment photographs of the varicose veins for which claims for sclerotherapy are submitted to Medicare. These photographs must be made available to the carrier upon request for review.

Not applicable

Coverage for podiatrists is limited by scope of practice specific to the state in which the service is provided.

Medicare recognizes that multiple injections are needed to perform sclerotherapy and that responses differ due to the anatomical site being treated. Medicare would not expect to see the following when performing sclerotherapy:


•More than three sclerotherapy sessions for each leg.

•Only one sclerotherapy service per treatment session should be reported for either leg, regardless of how many veins are treated per session.
Patients are not expected to require ablation of the saphenous vein by radiofrequency or laser more than once for either leg.

A duplex ultrasound examination will be allowed when performed within 1 week (preferably within 72 hours) of EFRA to check for any evidence of thrombus extension from the saphenofemoral junction into the deep system.

Response To Comments

Number Comment Response
1
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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(46 Codes)
Group 1 Paragraph

It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

Coverage of CPT codes 76942, 93970 and 93971 is not limited to the diagnoses listed below.

CPT Codes 36465, 36466, 36470, 36471, 36475, 36476, 36478, 36479, 36482, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780 and 37799

Group 1 Codes
Code Description
I80.01 - I80.03 Phlebitis and thrombophlebitis of superficial vessels of right lower extremity - Phlebitis and thrombophlebitis of superficial vessels of lower extremities, bilateral
I80.3 Phlebitis and thrombophlebitis of lower extremities, unspecified
I83.001 - I83.005 Varicose veins of unspecified lower extremity with ulcer of thigh - Varicose veins of unspecified lower extremity with ulcer other part of foot
I83.011 - I83.015 Varicose veins of right lower extremity with ulcer of thigh - Varicose veins of right lower extremity with ulcer other part of foot
I83.021 - I83.025 Varicose veins of left lower extremity with ulcer of thigh - Varicose veins of left lower extremity with ulcer other part of foot
I83.11 Varicose veins of right lower extremity with inflammation
I83.12 Varicose veins of left lower extremity with inflammation
I83.211 - I83.215 Varicose veins of right lower extremity with both ulcer of thigh and inflammation - Varicose veins of right lower extremity with both ulcer other part of foot and inflammation
I83.221 - I83.225 Varicose veins of left lower extremity with both ulcer of thigh and inflammation - Varicose veins of left lower extremity with both ulcer other part of foot and inflammation
I83.811 - I83.813 Varicose veins of right lower extremity with pain - Varicose veins of bilateral lower extremities with pain
I83.891 - I83.893 Varicose veins of right lower extremity with other complications - Varicose veins of bilateral lower extremities with other complications
I87.311 - I87.313 Chronic venous hypertension (idiopathic) with ulcer of right lower extremity - Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity
I87.321 - I87.323 Chronic venous hypertension (idiopathic) with inflammation of right lower extremity - Chronic venous hypertension (idiopathic) with inflammation of bilateral lower extremity
I87.331 - I87.333 Chronic venous hypertension (idiopathic) with ulcer and inflammation of right lower extremity - Chronic venous hypertension (idiopathic) with ulcer and inflammation of bilateral lower extremity
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(24 Codes)
Group 1 Paragraph

Use of any ICD-10-CM code not listed in the "ICD-10-CM Codes that Support Medical Necessity" section of this LCD will be denied. In addition, the following ICD-10-CM codes are specifically listed as not supporting medical necessity for emphasis, and to avoid any provider errors.

Claims listing the following ICD-10-CM code will be considered as cosmetic and denied for lack of medical necessity:
I78.1 Spider nevus

CPT codes 36465, 36466, 36470, 36471, 36475, 36476, 36478, 36479, 36482, 36483, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780 and 37799 (when used to report "Trivex Procedure"), submitted for any of the following ICD-10-CM codes will be denied as not medically necessary:

Group 1 Codes
Code Description
I78.0 Hereditary hemorrhagic telangiectasia
I78.1 Nevus, non-neoplastic
I78.8 Other diseases of capillaries
I78.9 Disease of capillaries, unspecified
I87.001 - I87.003 Postthrombotic syndrome without complications of right lower extremity - Postthrombotic syndrome without complications of bilateral lower extremity
I87.009 Postthrombotic syndrome without complications of unspecified extremity
I87.011 - I87.013 Postthrombotic syndrome with ulcer of right lower extremity - Postthrombotic syndrome with ulcer of bilateral lower extremity
I87.019 Postthrombotic syndrome with ulcer of unspecified lower extremity
I87.021 - I87.023 Postthrombotic syndrome with inflammation of right lower extremity - Postthrombotic syndrome with inflammation of bilateral lower extremity
I87.029 Postthrombotic syndrome with inflammation of unspecified lower extremity
I87.031 - I87.033 Postthrombotic syndrome with ulcer and inflammation of right lower extremity - Postthrombotic syndrome with ulcer and inflammation of bilateral lower extremity
I87.039 Postthrombotic syndrome with ulcer and inflammation of unspecified lower extremity
I87.091 - I87.093 Postthrombotic syndrome with other complications of right lower extremity - Postthrombotic syndrome with other complications of bilateral lower extremity
I87.099 Postthrombotic syndrome with other complications of unspecified lower extremity
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ICD-10-PCS Codes

Group 1

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Revenue codes only apply to providers who bill these services to the Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.


Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/03/2024 R6

Revision Effective: 10/03/2024

Revision Explanation: Annual review, no changes.

11/16/2023 R5

Revision Effective: 11/16/2023

Revisin Explanation: Updated LCD Reference Article section.

10/05/2023 R4

Revision Effective: 10/05/2023

Revision Explanation: Annual review, no changes made.

10/06/2022 R3

Revision Effective: 10/06/2022

Revision Explanation: Annual review, no changes made.

09/30/2021 R2

Revision Effective: 09/30/2021

Revision Explanation: Annual review, no changes made.

09/15/2020 R1

Revision Effective: N/A

Revision Explanation: Annual review, no changes made.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
09/27/2024 10/03/2024 - N/A Currently in Effect You are here
11/07/2023 11/16/2023 - 10/02/2024 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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