Coding Cardiovascular System Procedures, Part 2

Vol. 15 •Issue 18 • Page 10
Coding Corner

Coding Cardiovascular System Procedures, Part 2

(Editor’s note: The first case study on coding cardiovascular system procedures was published in the Aug. 1 issue.)

Preoperative Diagnosis: Recurrent varicose veins

Postoperative Diagnosis: Recurrent varicose veins

Procedure Performed: Excision and stripping of varicose veins, recurrent, both lower extremities

Indications for Procedure: The patient was marked with a marking pencil prior to placing her on the operating room table. The left lower extremity presented recurrent varicosities in the upper third of the anteromedial aspect of the left thigh and in the anterior popliteal area and also in the anteromedial aspect of the left leg and foot. On the right side, the recurrent varicosities were on the lateral and medial aspect of the right foot, and the anteromedial aspect of the right calf and popliteal area. There were no others noted.

Operative Technique: The patient was placed on the operating room table. An IV was started in the right arm, and the patient received Crystalloid during the procedure. No IV medication was given. Both lower extremities were prepped with Duraprep and draped with sterile towels and sheets.

The left lower extremity was approached first and multiple incisions were made over the previously marked varicosities. The skin was infiltrated with one-half percent Carbocaine at the skin-incision sites and between the incision sites where the veins were tunneled out, the skin and subcutaneous tissue were also infiltrated.

The veins were dissected down to multiple small branches and these were ligated with 3-0 Vicryl. An attempt was made to strip out some varicosities on the left side but this was relatively unsuccessful because the enlarged veins did not extend for great distances. The incisions were continued up to the popliteal area and then to the upper thigh and groin areas. After all the incisions were made and the veins were removed and tunneled out, the incisions were closed with interrupted and vertical mattress sutures of 4-0 Ethilon.

Attention was then turned to the right lower extremity where similar procedures were done. The most involved area was on the lateral aspect of the right foot. There was a rather large varicose vein in the anteromedial aspect of the right calf that was stripped from the foot up near the popliteal level. In addition, there was a large popliteal perforator that was exposed and ligated. After the veins were removed, these incisions were similarly closed.

Dressings of Kling rolls and elastic bandages were applied to both lower extremities. The patient had approximately nine incisions in the right lower extremity and approximately 11 in the left lower extremity. The procedure was painstaking and required more than 2.5 hours operating time to complete. Following the operation, the patient was returned to the outpatient department in good condition.

Code Assignments and Rationale

Preoperative and Postoperative ICD-9-CM Diagnoses

Recurrent varicose veins

Preoperative and Postoperative ICD-9-CM Diagnosis Codes:

454.9 Asymptomatic varicose veins

CPT Code Assignment Index/Code Range:

The surgeon performed excision and stripping of varicose veins, recurrent, both lower extremities. In the 2005 CPT manual index, check the term Varicose Vein then Removal. You will see the following collection of codes: 37720-37730, 37765-37785.

After checking the descriptors of these codes, you can determine that the correct code for the procedure (recurrent varicose veins in one leg with ligation, division and or excision) is the following:

37785 Ligation, division and/or excision of varicose vein (cluster(s)), one leg

To the above code, you must add modifier 50 (37785-50) to identify that this was a bilateral procedure. This is the correct code for both the facility and professional assignments.

Peggy Hapner is the manager of the health information management consulting division at Medical Learning Inc. (MedLearn®), St. Paul, MN.