CPT Code 36475 | Description, Procedure & Billing Guidelines (2022)
CPT 36475 may be used for an endovenous ablation procedure with radiofrequency to treat venous insufficiency.
1. What Is CPT Code 36475?
CPT 36475 covers a procedure in which a surgeon helps a patient with venous incompetency by destroying the wall of a diseased vein with a radiofrequency probe.
The probe is specially designed for this purpose and introduced through the patient’s skin. The 36475 CPT code can be used to treat the first vein.
2. What Is Venous Incompetence/Insufficiency?
Patients with venous incompetence (or insufficiency) have veins that fail to close their one-way valves. The valves prevent blood from flowing backward.
Patients with venous incompetency experience;
- changes in skin color;
- changes in skin texture;
- painful veins;
- swollen veins; and/or
- ulcers.
The CPT code 36475 describes a procedure to treat venous incompetence with endovenous ablation by using radiofrequency to seal and burn the vein.
3. Description
The CPT book describes CPT 36475 as follows: “Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated.”
4. Procedure
The 36475 CPT code procedure starts with prepping and anesthetizing the patient before the surgeon makes a small opening (over the affected vein) in the patient’s skin.
Then, they use ultrasound guidance to insert a guidewire into the vein that needs to be treated. They then move it towards the targeted location and insert a sheath (hollow tube) over the guidewire.
Then, they remove the guidewire before they pass a radiofrequency probe through the sheath toward the targeted location. Finally, the vein is ablated with radiofrequency energy.
Once the procedure is completed, the surgeon pulls back the sheath and the probe before irrigating the site and applying pressure to control the bleeding.
5. How To Use CPT 36475
Use CPT code 36475 only for the first vein ablation. After that, you may use the add-on code CPT 36476 for other veins.
You can not report ultrasound guidance separately because it is already included in this procedure.
Report CPT 36475 and CPT 36470 for endovenous sclerotherapy and ablation therapy for a single vein.
6. Resources
https://www.aetna.com/cpb/medical/data/1_99/0050.html
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52870&ver=31
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56914&ver=8
https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-venous-insufficiency
https://www.vascularsociety.org.uk/patients/procedures/11/endovenous_ablation
