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Official Description

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

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 36479 refers to the procedure of endovenous ablation therapy specifically targeting incompetent veins in an extremity. This minimally invasive technique utilizes laser energy to treat veins that are not functioning properly, often due to conditions such as chronic venous insufficiency. The procedure is performed percutaneously, meaning it is done through the skin, and includes comprehensive imaging guidance and monitoring throughout the process. The treatment is designed to address multiple veins within a single extremity, provided that each vein is accessed through separate entry points. This code is used in conjunction with the primary procedure code, which is 36478, for the first vein treated. The use of imaging guidance is critical as it allows the physician to accurately locate and assess the targeted vein, ensuring effective treatment while minimizing potential complications. The procedure is performed under local anesthesia, allowing for patient comfort while maintaining a high level of precision in the treatment of the affected veins.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The endovenous ablation therapy represented by CPT® Code 36479 is indicated for the treatment of incompetent veins in the extremities. This condition often manifests as symptoms such as:

  • Chronic Venous Insufficiency - A condition where veins struggle to send blood from the limbs back to the heart, leading to swelling, pain, and skin changes.
  • Varicose Veins - Enlarged, twisted veins that can cause discomfort and aesthetic concerns.
  • Venous Reflux - A situation where blood flows backward in the veins, contributing to venous hypertension and associated symptoms.

2. Procedure

The procedure for endovenous ablation therapy using CPT® Code 36479 involves several critical steps, each designed to ensure effective treatment of the incompetent vein:

  • Preparation of the Treatment Site - The physician begins by preparing the area of the extremity where the incompetent vein is located. This includes cleaning the skin and ensuring a sterile environment to minimize the risk of infection.
  • Setup of Laser Ablation Catheter - The physician sets up the laser ablation catheter, which is the primary tool used to deliver laser energy to the vein. Equipment is tested to ensure proper functionality before proceeding.
  • Imaging Guidance - Imaging techniques, such as ultrasound, are employed to locate the targeted vein accurately. This step is crucial for mapping and marking the entire length of the vein to be treated.
  • Administration of Local Anesthetic - A local anesthetic is administered at the access site to ensure patient comfort during the procedure.
  • Incision and Venotomy - A small incision is made in the skin, and a venotomy is performed to access the vein directly.
  • Guidewire Introduction - A guidewire is introduced into the vein to facilitate the placement of the necessary instruments for the procedure.
  • Dilator and Sheath Placement - A dilator is advanced over the guidewire to create a pathway, which is then exchanged for a sheath that is secured in place with a suture.
  • Laser Fiber Introduction - The guidewire is removed, and the laser fiber is introduced and advanced along the vein under continuous imaging guidance.
  • Anesthetic Infiltration - An anesthetic is infiltrated into the perivenous space along the entire length of the vein to enhance patient comfort and minimize pain during the procedure.
  • Application of Laser Energy - The physician monitors impedance, power, and vein wall temperature throughout the procedure. Laser energy is applied as the fiber is withdrawn, effectively sealing the incompetent vein while being guided by imaging.

3. Post-Procedure

After the endovenous ablation therapy is completed, patients may experience some discomfort or bruising at the treatment site, which is typically manageable with over-the-counter pain relief. It is essential for patients to follow post-procedure care instructions provided by the physician, which may include wearing compression stockings to support the healing process and reduce swelling. Patients are usually advised to avoid strenuous activities for a short period to allow for optimal recovery. Follow-up appointments may be scheduled to monitor the treatment's effectiveness and address any concerns that may arise during the recovery phase.

Short Descr ENDOVENOUS LASER VEIN ADDON
Medium Descr ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS
Long Descr Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; 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 2
CCS Clinical Classification 63 - Other non-OR therapeutic cardiovascular procedures

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

36478 MPFS Status: Active Code APC J1 ASC A2 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
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.
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
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).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
GA Waiver of liability statement issued as required by payer policy, individual case
GC This service has been performed in part by a resident under the direction of a teaching physician
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
SG Ambulatory surgical center (asc) facility service
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
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
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2017-01-01 Changed Long description changed. Guidelines changed.
2005-01-01 Added First appearance in code book in 2005.
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