Medical Coding for Ambulatory Phlebectomy Procedure

Medical Coding for Ambulatory Phlebectomy Procedure

Ambulatory phlebectomy is a common treatment choice for people suffering from varicose veins. The article details the procedure along with their medical codes.

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Bulging, enlarged and distended veins that appear right under the skin surface are the clearest sign of varicose vein disease. The veins commonly affected are those in the legs and feet, and appear dark purple or blue.

When veins deeper in the leg become diseased and blood fails to return to the heart normally and collect in the veins, it is a condition known as venous insufficiency. Ambulatory phlebectomy is the surgical removal of visible varicose veins through small, slit-like keyhole incisions in the skin. Since veins are highly collapsible, the enlarged varicose veins can be removed through these small incisions. When performed for the appropriate medical reasons, phlebectomy has a 90% long-term success rate in treating varicose veins and completely eliminates any associated symptoms. Generally performed on an outpatient basis under local anesthesia, the surgical procedure usually lasts 15-60 minutes depending on the location and amount of varicose veins. Once the vein is removed, the body will naturally redirect blood flow to the healthy veins, resolving the symptoms caused by the damaged vein. General surgery medical billing and coding for this condition is quite complex, as there are several coding rules related to reporting

the

procedure

accurately.

Phlebologists

or

vascular

and

interventional radiologists performing phlebectomy must correctly document the procedures performed in the patients’ medical records. Medical billing outsourcing is a practical

solution for physicians

to simplify their

documentation process.

Also referred to as stab avulsion or mini-phlebectomy, the procedure is recommended for people who have medium to large varicose veins that are near the surface of the skin. It is generally not effective for deep veins or veins that contain clots or that are attached to other veins. In some cases, it is essential for vein specialists to treat clots or other conditions before performing ambulatory phlebectomy procedures.

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Why Is Ambulatory Phlebectomy Done?

Ambulatory phlebectomy is one of the most common treatment choices for people suffering from varicose veins. The procedure is ideal for bulging varicose veins that are close to the surface of the skin. As the affected vein is removed from the body entirely during the procedure, all of the associated symptoms are eliminated immediately. Phlebologists or vascular surgeons generally conduct this procedure to treat different types of varicose veins including 

Lipoedema and Varicose Veins



Asymptomatic and Symptomatic varicose and reticular veins



Pelvic, Vulval and Pregnancy-Related Varicose Veins



Chronic Venous Disease

Like all surgical procedures, ambulatory phlebectomy carries its own set of unique complications. Possible complications of this procedure include - an allergic reaction to the local anesthetic used, nerve injury to the skin, temporary bruising and inflammation, skin numbness (caused by injury to adjoining sensory nerves), severe bleeding or swelling, thrombophlebitis and numbness or pain in the feet. Patients who happen to experience any of the above mentioned complications should report these symptoms to his/her physician immediately.

How Is the Procedure Performed?

Before

the

procedure,

physicians

will

conduct

a

thorough

physical

examination along with detailed review of symptoms. They will thoroughly examine the patient’s legs and check the location and type of varicose veins.

A detailed assessment and diagnostic ultrasound of the legs - called a NonInvasive Vascular Assessment (NIVA) is used to evaluate how blood flows throughout the legs. This ultrasound, also called sonography, uses high-

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frequency sound waves to obtain continuous real-time images of leg blood flow. The procedure takes approximately 45 minutes per leg. The results of the procedure enable the vascular surgeon to determine what type of combination treatment works best.

Typically, ambulatory phlebectomy is performed on an outpatient basis. As part of the procedure, physician will numb the area with a local anesthetic and mark the affected veins with a marker while the patient is standing up, as veins deflate when the body is in a horizontal position. Once the affected veins have been identified, the physician will make a series of small, tiny incisions in the area of the enlarged veins. For larger varicose veins, incisions may need to be slightly larger. A phlebectomy hook (a tiny instrument with a blunt tip and a straight shaft) is inserted under the surface of the skin to remove the varicose vein through the tiny incisions. Through these incisions, the problem vein will be removed.

In most cases, patients will not experience any pain or discomfort during the procedure, but may feel the pressure of the phlebectomy hook being inserted and removed. The incisions are so tiny that no stitches are necessary. Once the procedure is completed, Steri-strips are then applied to the incisions and a bandage and compression stocking will be put on the leg.

Often, ambulatory phlebectomy is performed in conjunction with ablation procedures that close veins using either radiofrequency or laser technology in order to maximize results. However, these options can be discussed prior to treatment.

Applicable Medical Codes General surgery medical coding for this condition is challenging, as it involves

many

rules

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related

to

reporting

the

procedure

accurately.

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Phlebologists or vascular surgeons performing ambulatory phlebectomy must use the relevant ICD-10 codes and CPT codes to bill for the procedure.

ICD-10 Codes I83.9 - Asymptomatic varicose veins of lower extremities 

I83.90 - Asymptomatic varicose veins of unspecified lower extremity



I83.91 - Asymptomatic varicose veins of right lower extremity



I83.92 - Asymptomatic varicose veins of left lower extremity



I83.93 - Asymptomatic varicose veins of bilateral lower extremities

CPT Codes 

37765 - Stab phlebectomy of varicose veins, one extremity, 10-20 stab incisions



37766 - Stab phlebectomy of varicose veins, one extremity, more than stab 20 incisions

Recovery after the Procedure The recovery period following the phlebectomy procedure will be different for each

person. Soon

after the

procedure,

bandages are

applied and

compression stockings are to be worn for a week or more. In most cases, the incisions are minute hence no stitches are involved but steristrips will be applied to help heal the incision site. Most patients experience little to no pain and resume normal activity within two weeks.

Medical billing and coding requires a high level of knowledge regarding appropriate coding modifiers. Payer-specific medical billing is essential for correct and on-time reimbursement. With all the complexities involved, the support of a reliable and experienced medical coding service provider can prove useful for correctly reporting ambulatory phlebectomy procedure.

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