Wiki Confusion on coding Scleratherapy inj

[Coder2009]

CLINICAL INDICATION: [ venous malformation of the left foot ]]

Informed consent was obtained from the patient's parent.

With the patient under general anesthesia, the skin over the affected area was
prepped and draped.

Doxycycline was reconstituted in a concentration of 25 mg/mL of contrast.

The palpable lesion [ along the lateral aspect of the left forefoot ] was
punctured using a 21-gauge needle. When blood flowed back through the needle,
contrast was injected documenting the correct intralesional positioning of the
needle, absence of
extravasation of contrast, no significant communication with normal venous
system. A total of [ 200 ] mg of doxycycline was instilled in this location.

The second needle puncture was also made using a 21-gauge needle, into the
medial aspect of the hindfoot. When blood flowed back through the needle,
contrast was injected documenting the correct intralesional positioning of the
needle, absence of
extravasation of contrast, no significant communication with normal venous
system. A total of 300 mg of doxycycline was instilled in this location.

The third needle puncture was made into the plantar soft tissues, using a 21-
gauge needle.When blood flowed back through the needle, contrast was injected
documenting the correct intralesional positioning of the needle, absence of
extravasation of
contrast, no significant communication with normal venous system. A total of
100 mg of doxycycline was instilled in this location.

The fourth needle puncture was made into the superficial component along the
anterior surface of the ankle at the junction with the midfoot, using a 21-gauge
needle.When blood flowed back through the needle, contrast was injected
documenting the correct
intralesional positioning of the needle, absence of extravasation of contrast,
no significant communication with normal venous system. A total of 100 mg of
doxycycline was instilled in this location

This is an Interventional Radiologists, and what the doc is saying and the cpt that they are wanted to use is confusing.

36000 X4 36005 X4 77002 X4 HELP PLEASE

 

[dpeoples]

CLINICAL INDICATION: [ venous malformation of the left foot ]]

Informed consent was obtained from the patient's parent.

With the patient under general anesthesia, the skin over the affected area was
prepped and draped.

Doxycycline was reconstituted in a concentration of 25 mg/mL of contrast.

The palpable lesion [ along the lateral aspect of the left forefoot ] was
punctured using a 21-gauge needle. When blood flowed back through the needle,
contrast was injected documenting the correct intralesional positioning of the
needle, absence of
extravasation of contrast, no significant communication with normal venous
system. A total of [ 200 ] mg of doxycycline was instilled in this location.

The second needle puncture was also made using a 21-gauge needle, into the
medial aspect of the hindfoot. When blood flowed back through the needle,
contrast was injected documenting the correct intralesional positioning of the
needle, absence of
extravasation of contrast, no significant communication with normal venous
system. A total of 300 mg of doxycycline was instilled in this location.

The third needle puncture was made into the plantar soft tissues, using a 21-
gauge needle.When blood flowed back through the needle, contrast was injected
documenting the correct intralesional positioning of the needle, absence of
extravasation of
contrast, no significant communication with normal venous system. A total of
100 mg of doxycycline was instilled in this location.

The fourth needle puncture was made into the superficial component along the
anterior surface of the ankle at the junction with the midfoot, using a 21-gauge
needle.When blood flowed back through the needle, contrast was injected
documenting the correct
intralesional positioning of the needle, absence of extravasation of contrast,
no significant communication with normal venous system. A total of 100 mg of
doxycycline was instilled in this location

This is an Interventional Radiologists, and what the doc is saying and the cpt that they are wanted to use is confusing.

36000 X4 36005 X4 77002 X4 HELP PLEASE

I would ask for some clarification on whether or not doxyclycline could be considered a sclerosing solution. I think that is what they are using it for in this case. I would look at using cpt 36471 or an unlisted code to reflect this procedure. I would not code 36000 or 36005 in addition because the primary code for this procedure includes the access necessary to treat. In any case, 77002 should be billed only once per session.

HTH

 

[Coder2009]

Thanks

 

[MLS2]

I submitted a similar question to ZHealth and received these responses:

"If treating true venous malformations via direct puncture access, we recommend 37799"

Q&A:

Question: DR. Z, Sclerotherapy of AVM for lower extremity. Needle used to access the 3 venous sites involved in the AVM, scleorsed with Sodium Tetracyclic Sulfate infusion. This is done for all 3 areas. We are charging this with 37799 76496 36299. Then bilateral superficial spider veins were sclerosed with STS. Can we also charge 36468 with '50' for this additional procedure? Thanks

Answer: I don't see why not. It is a different procedure that has a code describing spider vein treatment. Dr.z

not sure if this helps or not...