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Thread: endovenous laser ablation with venography

  1. #1

    Default endovenous laser ablation with venography

    AAPC: Back to School
    How to code this report myy codes are
    36005 59
    75820 26

    Please confirm
    The patient was brought into the procedure suite. Ultrasound
    examination of the left lower extremity veins was performed
    demonstrating occlusion of the greater saphenous vein below the
    sapheno femoral junction. An incompetent perforator within the
    upper thigh reconstitutes several superficial varicosities along
    the medial fine. Communication with segments of the saphenous
    vein are noted. Several large incompetent perforators are
    identified within the calf, primarily arising from the posterior
    tibial veins. The greater saphenous vein within the mid and lower
    calf is patent an incompetent. A large conglomeration of
    superficial varicosities is identified within the medial,
    posterior aspect of the mid to upper calf.

    The patient was then placed supine on the procedure table and the
    leg prepped and draped in the usual sterile fashion. The
    saphenous vein was accessed at the ankle under ultrasound guidance
    using a 21 gauge micropuncture needle. The needle was exchanged
    over a 0.018 inch guide wire for a 4 French tapered dilator. After
    exchanging for a 0.035 inch guide wire, a five French 45 cm long
    sheath was advanced to the mid calf. Venography was performed
    demonstrating communication of the saphenous vein with large
    incompetent perforators within the lower calf. An Angioynamics
    laser fiber was then advanced through the sheath. Tumescent
    anesthesia using .25% lidocaine solution was administered along
    the entire course of the vein under ultrasound guidance.
    Compression of the vein was noted throughout its course. After
    redetermining that the tip of the fiber was below the
    saphenofemoral junction, the laser was activated to the 10 Watts
    energy and slowly withdrawn with the sheath. Total pullback time
    was approximately 94 seconds. Total energy delivered was 1395 J.
    Total vein length treated was 19 cm. The laser was deactivated
    approximately 2 cm proximal to the puncture site. The sheath and
    fiber were then removed. Repeat ultrasound exam demonstrates no
    flow within the saphenous vein. The common femoral vein remains
    patent. A grade 2 thigh high compression stocking was then
    applied. The patient tolerated the procedure without incident.

    Impression: Successful endovenous laser ablation of the left
    greater saphenous vein within the calf as described above.

    The patient is to return in one month for follow-up examination.
    Sclerotherapy of incompetent perforators and superficial
    varicosities, particularly adjacent to the medial malleolus will
    be considered at that time.
    Shirley CPC,CPC-H

  2. #2



    You can only bill for the 36478. If you look at the green writing underneath the procedure code in the CPT you will see what you "Do Not Report" in conjuction with the 36478. 36005 is listed so you should not report it. I don't believe I would bill the 75820 for it looks like it is more for guidance and not medically necessary.

    Hope this help!

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