Billing and Coding: Treatment of Chronic Venous Insufficiency of the Lower Extremities

This billing and coding guidance supports coverage of sclerotherapy and endovenous ablation for chronic venous insufficiency of the lower extremities when clinical and diagnostic documentation (including CEAP, VCSS and venous duplex) support significant reflux and absence of deep venous obstruction. Specific CPT coding rules apply: certain sclerotherapy and ablation codes are limited to once per extremity per session (or once per extremity for subsequent-vein codes), supplies and compression dressings are included in procedure codes and may not be billed separately, and incorrect codes (e.g., CPT 37241) must not be used. A 90-day episode-of-care plan, complete operative notes, and patient-specific justification for serial procedures or perforator interventions are required in the medical record.

"Sclerotherapy (injection of sclerosing agents) is covered for treatment of symptomatic spider veins/telangiectasia of the lower extremities using CPT 36468."