Microphlebectomy for the Treatment of Varicose Veins

by  Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
July 31st, 2014

Varicose veins can be troubling for the many people who suffer from them. Pain, itching, heavy and tired legs and swelling can make varicosities next to intolerable. Fortunately, there are several treatment options available. Microphlebectomy, sometimes referred to as "stab phlebectomy," is often performed on varicosities that are too small to be treated safely with laser procedures or too large to be treated with sclerotherapy.

How is the Procedure Performed?

The physician marks the patient's legs in the areas where the incisions (stabs) will be made. The skin is anesthetized to keep the patient comfortable during the procedure and tiny incisions (or stabs) are made through the skin. A vein hook is inserted through the incision site, used to dissect the along the course of the varicose vein and then mosquito forceps are used to grab the vein and remove it. The entire procedure takes about an hour. Once done, dressings are placed over the treatment areas and the patient is allowed to go home. There may be slight bruising and discomfort associated with the procedure, which should subside in about a week and the patient is told to refrain from strenuous exercise during that time period.

Medical Necessity:

Patient's undergoing procedures to reduce varicose veins generally do so because the symptoms of the varicosities have become problematic or so bothersome, that they seek relief from the symptoms.

Remember, it is important to establish medical necessity, so documenting all symptoms and findings that support medical necessity is important. Documentation of any conservative treatments, such as the wearing of compression stockings and elevation also need to be documented. Some insurance companies will deny treatments without documentation of tried and failed conservative measures.

Coding:

Some common diagnoses that support medical necessity include:

454.0 Varicose veins; with ulcer (lower extremity)

454.1 Varicose veins; with inflammation, stasis dermatitis (lower extremity)

454.2 Varicose veins; with an ulcer and inflammation (lower extremity)

454.8 Varicose veins; with other complications such as swelling, pain or edema

To report microphlebectomy report:

37799 Stab phlebectomy of varicose veins, 1 extremity; less than 10 incisions

37765 " " 10-20 incisions

37766 " " 20+ incisions

When performed using ultrasound guidance report 93971 for unilateral or 93970 for bilateral.

Remember, report codes based on each extremity the service was performed.