Internal Medicine Coding Alert

Published on Fri Apr 28, 2006 PDF

Question: Does Medicare cover sclerotherapy for varicose veins with 36470 and 36471? If so, are there any specific criteria that need to be met?


Utah Subscriber


Answer: Medicare may cover sclerotherapy under specific circumstances. Best bet: Check your local Medicare carrier's local coverage determinations (LCD) to determine whether it covers 36470 (Injection of sclerosing solution; single vein) and 36471 (... multiple veins, same leg).

For instance, the Medicare carriers for Florida and Texas will pay for sclerotherapy when the patient has an ulcer, inflammation or other complications of the lower extremities. To indicate medical necessity for sclerotherapy, Florida and Texas Medicare claims must contain an ICD-9 code of:

• 454.0--Varicose veins of lower extremities with ulcer
• 454.1--Varicose veins of lower extremities with inflammation
• 454.2--Varicose veins of lower extremities with ulcer and inflammation
• 454.8--Varicose veins of lower extremities with other complications.

Florida's Medicare carrier (First Coast Health Options) also allows a diagnosis of edema (782.3) to support medical necessity for the procedure. The carrier's LCD indicates Florida Medicare "will cover the injection of sclerosing solution in the following circumstances:

• signs and symptoms of significantly diseased vessels of the lower extremities, such as stasis ulcer of the leg, significant pain, or significant edema, that interfere with activities of daily living; and/or

• in conjunction with surgical stripping or ligation."

Florida Medicare, however, does not consider duplex scanning or any ultrasound procedure for the purpose of guidance during the injection of sclerosing solution for the treatment of varicose veins medically necessary. If an internist performs ultrasound- guided sclerotherapy, Medicare will not cover the procedure.

Answers to You Be the Coder and Reader Questions answered/reviewed by Kathy Pride, CPC, CCS-P, director of consulting and training for QuadraMed in Reston, Va.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.