CPT® Code 36474 | Case2Code

Official Description

Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

Common Language Description

Percutaneous mechanochemical endovenous ablation (MOCA) therapy is a minimally invasive procedure designed to address venous incompetence or venous insufficiency in an extremity. This technique employs a combination of mechanical and chemical methods to treat affected veins. During the procedure, a rotating wire within a catheter disrupts the endothelial lining of the vein, causing mechanical damage without the application of heat. Concurrently, a sclerosant is injected, which chemically damages the disrupted vein wall, effectively closing off the incompetent vein. This approach eliminates the need for tumescent anesthesia, making the procedure less invasive and potentially more comfortable for the patient. Imaging guidance is utilized to accurately locate the targeted vein, ensuring precise treatment. Local anesthesia is administered at the access site to minimize discomfort. The procedure involves the introduction of a sheath into the vein, followed by the catheter, which is carefully advanced under imaging guidance until the tip of the dispersion wire is positioned just distal to the treatment area. The rotating wire is activated to induce spasm in the proximal vein, and as the catheter is withdrawn at a controlled pace, a liquid sclerosant is dispersed to the damaged vein wall. The total volume of sclerosant used is determined prior to the procedure, based on the length of the vein and the patient's weight. Post-procedure, patients are advised to wear compression stockings for 24 hours and during the daytime for up to two weeks to support recovery and enhance treatment outcomes.

1. Indications

The procedure is indicated for the treatment of venous incompetence or venous insufficiency in an extremity. This condition may manifest as symptoms such as swelling, pain, or discomfort in the affected limb, and is often associated with varicose veins or chronic venous insufficiency.

Venous Incompetence - A condition where the veins are unable to efficiently return blood to the heart, leading to pooling of blood in the extremities.
Venous Insufficiency - A chronic condition characterized by the improper functioning of the venous valves, resulting in symptoms such as swelling, pain, and skin changes.

2. Procedure

The procedure consists of several key steps that ensure effective treatment of the incompetent vein.

Step 1: Preparation and Anesthesia - The patient is positioned comfortably, and local anesthesia is administered at the access site to minimize discomfort during the procedure. Imaging guidance is prepared to assist in locating the targeted vein accurately.
Step 2: Accessing the Vein - A sheath is introduced into the vein through a small incision at the access site. This sheath serves as a conduit for the catheter that will be used in the procedure.
Step 3: Catheter Advancement - A catheter is inserted through the sheath and advanced along the vein under continuous imaging guidance. The tip of the catheter, equipped with a dispersion wire, is positioned just distal to the area designated for treatment.
Step 4: Activation of the Rotating Wire - The rotating wire at the tip of the catheter is activated for a few seconds, inducing spasm in the proximal vein. This mechanical disruption prepares the vein for the subsequent chemical treatment.
Step 5: Sclerosant Dispersion - As the catheter is withdrawn at a steady pace of approximately 1 cm every 7 seconds, a liquid sclerosant is simultaneously dispersed to the damaged vein wall. This dual action of mechanical and chemical treatment effectively closes off the incompetent vein.
Step 6: Calculation of Sclerosant Volume - Prior to the procedure, the total amount of sclerosant to be used is calculated based on the length of the vein to be treated and the patient's weight, ensuring optimal dosing for effective treatment.

3. Post-Procedure

After the procedure, patients are instructed to wear compression stockings for 24 hours to support the treated area and promote healing. Additionally, they are advised to continue wearing compression stockings during the daytime for up to two weeks. This post-procedure care is crucial for enhancing recovery and ensuring the effectiveness of the treatment.

Short Descr	ENDOVENOUS MCHNCHEM ADD-ON
Medium Descr	ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS
Long Descr	Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)
Status Code	Active Code
Global Days	ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Items and Services Packaged into APC Rates
ASC Payment Indicator	Packaged service/item; no separate payment made.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P1G - Major procedure - Other
MUE	1

This is an add-on code that must be used in conjunction with one of these primary codes.

36473

MPFS Status: Active Code APC J1 ASC P3 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated

LT	Left side (used to identify procedures performed on the left side of the body)
50	Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
RT	Right side (used to identify procedures performed on the right side of the body)
X5	Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician