The introduction of the new CPT code 37241 in January 2014 has created some confusion regarding coding for treatment of incompetent extremity veins. Here is the full descriptor for 37241:

Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles).

In addition, CPT provides further clarification regarding the intended use for 37241 by including the following instructions:

  • For sclerosis of veins or endovenous ablation of incompetent extremity veins, see 36468–36479

  • Do not report 37241 in conjunction with 36468, 36470, 36471, 36475–36479, 75894, 75898 in the same surgical field

DISTINGUISHING 37241 FROM EXISTING CODES

The possibility of using 37241 for the treatment of incompetent extremity veins was discussed by the CPT Editorial Panel with the societies proposing the new code. It was agreed that the new code would not be used with or in place of the existing code for endovenous radiofrequency or laser ablation of incompetent extremity veins or for sclerosis of spider veins/telangiectasia. This decision was based on the existence of codes that describe well-defined services in clearly defined vascular beds. Therefore, these procedures were specifically excluded from code 37241 for purposes of definition and valuation. It is not the method of occlusion or route of injection that determines the coding for lower extremity procedures. The panel and their advisors determined that the ubiquity of lower extremity venous incompetency and the different treatment regimens of that disease were best reported with the existing codes and that, while in some ways similar to the work described by 37241, therapies for treating incompetent venous disease in the extremities should not be included in the work described by 37241.

Because it was recognized that the work described by 37241 is very similar to the work of venous ablation and sclerosis of incompetent extremity veins, spider veins, and telangiectasia, the potential for confusion was recognized, and clarifications were added in the parentheticals with the new code. These parentheticals specifically direct users to the existing codes for injection of sclerosant(s) to treat spider veins in the limb, trunk, or face or to treat incompetent veins in the extremities (36468–36471); for radiofrequency ablation of incompetent extremity veins (36475–36476); and for laser ablation of incompetent extremity veins (36477–36478). In addition, the instructions specify that 37241 cannot be reported in addition to any of these codes (36468–36478) in the same surgical field, which would be anywhere in the ipsilateral extremity for these procedures.

Reports of practices trying to substitute 37241 for any of the older codes (36468–36478) have been received from multiple carriers. If the carriers pay for 37241, it is anticipated that this will not be a sustained practice and that carriers may require repayment of the overpayment difference, if any, between 37241 and the correct codes.

New technology for the treatment of incompetent lower extremity veins has been introduced as an alternative method of therapy. This new technology utilizes a device that achieves venous closure with the use of sclerosants delivered with the new device. There are no specific codes that describe this new procedure (the existing codes include use of radiofrequency ablation or laser occlusion), and because the CPT Panel and societies proposing the venous embolization code 37241 determined that lower extremity venous incompetency should be treated as a separate entity from a coding perspective, the unlisted vascular procedure code, 37799, will be required to report these procedures until codes that specifically describe this procedure are proposed and developed. The reported recommendation by individual sales representatives to use 37241 for these procedures is incorrect.

INTENDED USE OF 37241

The following are examples (not intended to be an all-inclusive list) of procedures that 37241 describes:

  • Embolization/occlusion of gastric/esophageal varices;
  • Embolization/occlusion of varicoceles;
  • Embolization/occlusion of incompetent ovarian vein for pelvic congestion syndrome;
  • Embolization/occlusion of patent perforators siphoning flow from dialysis access fistula;
  • Embolization/occlusion of patent perforators siphoning flow from lower extremity venous bypass grafts;
  • Injection/occlusion/embolization of vascular malformations that are primarily venous;
  • Injection/occlusion/embolization of vascular malformations that are primarily lymphatic.

Katharine L. Krol, MD, FSIR, FACR, is an interventional radiologist and has recently retired from active clinical practice. She has disclosed that she has no financial interests that pertain to this topic. Dr. Krol may be reached at (317) 595-9413.

CPT copyright 2013 American Medical Association. All rights reserved.