2025 CPT code 36476
(Active) Effective Date: N/A Surgery - Cardiovascular System Surgery Feed
Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites.
Modifiers may be applicable in specific circumstances. For instance, modifier 59 may be used to indicate a distinct procedural service if multiple veins requiring separate access sites are treated in different anatomical locations or using different techniques. Modifier 76 may be appended if the procedure is repeated by the same physician.
Medical necessity for 36476 requires documentation demonstrating the presence of symptomatic varicose veins causing pain, swelling, or other complications that have not responded to conservative treatment. Supporting evidence may include physical exam findings, duplex ultrasound results, and patient-reported symptoms.
The physician prepares the patient and administers anesthesia, makes a small incision over each affected vein, inserts a guidewire under ultrasound guidance, and threads it through the vein. A sheath is then inserted over the guidewire, and the guidewire is removed.The radiofrequency probe is then inserted through the sheath to the target area, and radiofrequency energy is applied. Afterward, the probe and sheath are withdrawn, the site is irrigated, and pressure is applied to stop bleeding.
In simple words: This is an additional procedure performed during the same session as the ablation of the first vein, where the doctor inserts a probe through the skin to close off other diseased veins in the same extremity using radiofrequency energy.Each additional vein treated requires a separate access point.
Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure).
Example 1: A patient presents with multiple varicose veins in their right leg. The physician performs endovenous ablation on the great saphenous vein (36475) and two additional incompetent perforator veins using separate access sites (36476, 36476)., During an endovenous ablation procedure for a varicose vein in the left leg, the physician identifies two additional smaller varicose veins branching from the main vein. These subsequent veins are treated with radiofrequency ablation through separate access sites (36475, 36476, 36476)., A patient has recurrent varicose veins in their right leg after previous treatment. The physician performs radiofrequency ablation on the main varicose vein (36475) and then ablates three additional incompetent veins through individual access points during the same session (36476, 36476, 36476).
Documentation should include details of the patient's symptoms, the location and size of all treated veins, the method of ablation used, pre- and post-procedure ultrasound findings, and any complications encountered. It's crucial to note that 36476 is an add-on code and must be reported in addition to 36475.
** It is important to note that accurate coding requires careful documentation of the number of veins treated, the access sites used, and the laterality of the procedure. Always ensure the documentation supports the use of 36476 as an add-on code to 36475.Do not report 36476 more than once per extremity.
- Revenue Code: P1G
- Payment Status: Active
- Modifier TC rule: There is no TC modifier applicable to this code as it represents the entire procedure performed on subsequent veins.
- Specialties:Vascular surgery, interventional radiology, cardiology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Office