2025 CPT code 36478
(Active) Effective Date: N/A Surgery - Cardiovascular System Feed
Endovenous ablation therapy of incompetent vein, extremity, percutaneous, laser; first vein treated.
Modifiers may be applicable to this code. Modifier 50 is used for bilateral procedures. Modifier 73 or 74 is used for discontinued procedures.Modifier 22 is used for increased procedural services. Modifier LT or RT can be used to specify the left or right side respectively.
Medical necessity for this procedure must be established. Documentation should support the presence of symptomatic varicose veins and failure of conservative treatment options, if applicable.Common indications include persistent pain, swelling, skin changes (e.g., venous eczema, lipodermatosclerosis), or the presence of venous ulcers.
The physician preps and anesthetizes the patient, creates a small skin opening, inserts a guidewire under ultrasound guidance, places a sheath over the guidewire, removes the guidewire, inserts the laser catheter through the sheath, ablates the vein with laser energy, withdraws the laser and sheath, irrigates the puncture site, and applies pressure to control bleeding.
In simple words: This procedure uses a laser to close off a varicose vein in your arm or leg through a small incision in the skin.The doctor uses imaging to guide a thin tube into the vein and then delivers laser energy to heat and seal the vein. This procedure is typically used for the initial treatment in an affected area.
Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated. This includes the destruction of the wall of a diseased vein in an extremity using a laser ablation catheter inserted through the skin.It encompasses all imaging guidance and monitoring.
Example 1: A patient presents with a symptomatic varicose vein in the greater saphenous vein of the left leg. The physician performs endovenous laser ablation using code 36478., A patient has two incompetent veins in the right leg. The physician treats one vein with endovenous laser ablation (36478) and the other with sclerotherapy (e.g., 36470)., A patient has multiple varicose veins. The first vein in the left leg is treated with endovenous laser ablation (36478) during the initial visit. During a subsequent visit, the physician treats two additional veins in the left leg with laser ablation, coding each additional vein with 36479.
Documentation should include details of the vein treated (e.g., great saphenous vein), the method of ablation (laser), imaging guidance used, and any complications encountered. Medical necessity should be documented with supporting clinical findings, such as venous reflux, pain, swelling, or skin changes.
- Payment Status: Active
- Specialties:Vascular Surgery, Interventional Radiology, Phlebology
- Place of Service:Office, Ambulatory Surgical Center, Outpatient Hospital