General Surgery Coding Alert

Vein ligation and stripping procedures often are rejected by payers, including Medicare, as cosmetic. But by correctly using diagnostic codes to show medical necessity and adding the right modifier, surgeons can minimize denials.

Surgical ligation and stripping is done to the main trunk of the superficial saphenous vein. If the long saphenous vein is to be removed, an incision (1-2 inches) is made in the groin. The superficial saphenous vein is located and a special surgical instrument is then fed down the vein to just above the knee on the inner thigh. An excision is made at the ending point (usually 1 inch long). If the short saphenous vein is to be removed, an incision (1-2 inches) is made behind the knee. The superficial saphenous vein is located and a special surgical instrument is then fed down the vein to just above the ankle. An incision is made at the ending point (usually 1 inch long). In both cases, the vein is then excised through these incisions.

The removal of vein clusters is performed via a small incision in the skin over localized areas of superficial varicose veins along the leg. These veins are then isolated and dissected free of neighboring tissue, and tied with sutures or stripped out bluntly.

Accurately Coding the Procedures

CPT lists two codes for vein stripping:

37720ligation and division and complete stripping of long or short saphenous veins, and
37730ligation and division and complete stripping of long and short saphenous veins.

The difference between the two is important: 37720 should be used when either the long or short vein is stripped, while 37730 is used if both long and short veins are removed.

This small difference takes on greater significance when the surgeon also removes varicose vein clusters, which are secondary vessels off the saphenous veins (37785, ligation, division and/or excision of recurrent or secondary varicose veins [clusters], one leg). Although the national Correct Coding Initiative (CCI) bundles 37785 into both 37730 and 37720, modifier -59 (distinct procedural service) may be attached to 37720 (but not 37730), overriding the CCI edit and allowing the surgeon to get paid for performing the procedure.

Note: 37720 has a CCI indicator of 1, which means that attaching the -59 modifier is permitted; 37730s indicator 0, means that use of -59 to override the edit is prohibited.

Therefore, if a surgeon removes either the long or short saphenous vein and also takes out varicose vein clusters, both procedures may be billed (with modifier -59 attached to the saphenous vein removal to indicate it was performed on a separate system on the same leg). But if both the long and short saphenous veins are taken out, [...]