Clinical Context
A 52-year-old ambulatory patient presents to an outpatient vascular clinic with symptomatic varicose veins and clinical evidence of reflux in the great saphenous vein (GSV) of the left lower extremity. After duplex ultrasound mapping confirms reflux and identifies additional incompetent accessory or tributary veins in the same extremity, the vascular specialist schedules endovenous laser ablation (EVLA) under local tumescent anesthesia. During the planned session, the provider performs ablation of the primary GSV and, using the same percutaneous access and laser ablation catheter system, proceeds to ablate one or more additional diseased veins in the same extremity during the same operative encounter. The patient is monitored in a procedure room or ambulatory surgery center, receives post-procedure duplex confirmation of occlusion, and is discharged the same day with compression instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|
59 | Distinct procedural service | Use when a separate, distinct endovascular procedure is performed that is not normally bundled with the primary ablation and documentation supports distinct procedural elements. |
62 | Two surgeons | Use when two surgeons from different specialties share responsibility for the procedure and both perform substantial portions.
76 | Data not available in the input. | Data not available in the input.
LT | Left side | Use to indicate the procedure was performed on the left extremity when laterality is required.
RT | Right side | Use to indicate the procedure was performed on the right extremity when laterality is required.
52 | Reduced services | Use when the procedure is partially reduced or not completed as originally planned.
53 | Discontinued procedure | Use when the procedure is started but then discontinued for patient-related or clinical reasons.
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | Use when the patient returns to the procedure room shortly after the initial ablation for a complication that requires repeat invasive management.
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period.
22 | Increased procedural services | Use when the work required to perform the ablation is substantially greater than usual and well documented.
| Taxonomy Code | Specialty | Notes |
|---|
207VP0201X | Vascular Surgery | Common specialty performing endovenous thermal ablation procedures. |
208200000X | General Surgery | General surgeons with vascular training frequently perform endovenous ablations.
207T00000X | Interventional Cardiology | Some interventionalists with peripheral venous expertise perform EVLA.
2084P0800X | Interventional Radiology | Interventional radiologists commonly perform image-guided venous ablation.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
I83.11 | Varicose veins of left lower extremity with ulcer of thigh | Chronic venous insufficiency and varicosities are common indications for endovenous ablation; presence of ulceration indicates advanced disease that may prompt intervention. |
I83.10 | Varicose veins of unspecified lower extremity with ulcer | Varicose veins with ulceration on the extremity requiring treatment to address venous hypertension.
I83.219 | Varicose veins of unspecified lower extremity with inflammation | Inflammation or phlebitis of varicose veins can be an indication for definitive ablation when conservative care fails.
I87.2 | Venous insufficiency (chronic) (peripheral) | Chronic venous insufficiency with symptomatic reflux commonly treated with EVLA.
I83.90 | Varicose veins of lower extremity without ulcer or inflammation | Symptomatic varicose veins without skin breakdown are a frequent indication for endovenous treatment.
L97.909 | Non-pressure chronic ulcer of unspecified part of unspecified lower leg with unspecified severity | Venous ulcers of the lower leg may be part of the clinical picture prompting ablation to treat underlying venous hypertension.
R22.41 | Localized swelling, mass and lump, left lower limb | Leg swelling related to venous reflux may be part of the presenting symptoms leading to ablation therapy.
R53.1 | Weakness | Non-specific, may be present but not a primary indication; included rarely in comorbidity coding when relevant to perioperative assessment.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
36478 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging and monitoring; laser, first vein treated | This is the primary procedure code for endovenous laser ablation of the initial diseased vein in the extremity; 36479 is an add-on code for subsequent veins in the same session. |
36482 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging and monitoring; radiofrequency, first vein treated | Alternative primary ablation technique; relevant when radiofrequency rather than laser is used for the first vein.
36483 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging and monitoring; radiofrequency, each additional vein treated (add-on) | Analogous add-on code when radiofrequency ablation is used for subsequent veins instead of laser.
93970 | Duplex scan of extremity veins including responses to compression and mapping for treatment planning | Pre- and post-procedure duplex ultrasound mapping and confirmation commonly performed to plan and document successful ablation.
99024 | Postoperative follow-up visit global period, related to surgical procedure | Used for routine post-procedure global period visits when administrative coding requires reporting (payer-dependent).