2025 CPT code 37761
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Cardiovascular System - Ligation Procedures on Arteries and Veins Surgery Feed
Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg.
Modifier 50 (Bilateral Procedure) is applicable if the procedure is performed on both legs on the same day. Other modifiers may apply depending on the specific circumstances of the procedure (e.g., 22 for increased procedural services, 51 for multiple procedures).
Medical necessity for this procedure is established by the presence of symptomatic varicose veins due to incompetent perforator veins, causing pain, edema, or skin changes (discoloration, ulcers). Documentation should clearly support the clinical indication for surgical intervention.
The clinical responsibility lies with the surgeon who performs the ligation of the perforator veins. This includes pre-operative planning (possibly including ultrasound), the surgical procedure itself (incisions, ligation, excision of diseased tissue), and post-operative care.
- Surgery
- Surgical Procedures on the Cardiovascular System > Ligation Procedures on Arteries and Veins
In simple words: This code describes surgery to tie off small veins (perforator veins) under the surface of the skin in one leg.The doctor uses ultrasound to guide the surgery and closes off and removes diseased parts of the vein to treat varicose veins.Ultrasound is used to locate the vein, which is then tied off with a stitch or clip, and the area is closed up.
This CPT code represents the surgical ligation of one or more perforator veins located subfascially in one leg.The procedure involves making incisions along the affected vein, accessing the targeted perforator vein (which connects superficial and deep veins), incising through the fascia, excising nearby diseased structures, and ligating the vein using sutures or clips. Ultrasound guidance is used during the procedure.The ligated vein is secured within the fascia, and the fascial covering and wound are sutured in layers. The procedure may be repeated on other veins in the same leg.This code does not include separate billing for ultrasound guidance.
Example 1: A patient presents with symptomatic varicose veins in the right leg due to incompetent perforator veins.The surgeon performs ultrasound-guided subfascial ligation of multiple perforator veins in the affected area of the right leg.Code 37761 is reported., A patient presents with a large varicose vein and multiple smaller, associated varicose veins in their left leg.Ultrasound is used to map the affected perforator veins. The surgeon performs the ligation procedure on the multiple perforator veins; code 37761 with modifier 50 (bilateral procedure) would be reported if bilateral procedure done on the same day., A patient with severe varicose veins undergoes a combined procedure:endovenous ablation of the greater saphenous vein and ultrasound-guided subfascial ligation of multiple perforator veins in the same leg.Both procedures would be coded separately using appropriate CPT codes.
Detailed operative notes specifying the number of perforator veins ligated, location(s) (leg, specific area), method of ligation (suture or clip), extent of tissue excision, and confirmation of ultrasound guidance.Pre-operative assessment (including ultrasound imaging) and post-operative recovery notes should be included.
** The code 37761 is specifically for subfascial ligation of perforator veins.If a different approach or additional procedures are performed, those procedures must be coded separately.Always refer to the most current CPT codebook for accurate coding and billing practices.
- Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
- RVU: Information not available in provided sources. Refer to CMS fee schedules and relative value unit data for current reimbursement information.
- Global Days: Information not provided.Global surgical package days vary by payer and may depend on the extent of the procedure.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not applicable to this code, as it represents a complete surgical procedure.
- Fee Schedule: Information not provided. Consult CMS fee schedules for historical fee data.
- Specialties:Vascular Surgery, Phlebology
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)