Print Treatment of Varicose Veins/Venous Insufficiency

Treatment of Varicose Veins/Venous Insufficiency

 

POLICY NUMBER

A.7.01.124

 

DESCRIPTION

A variety of treatment modalities are available to treat varicose veins/venous insufficiency, including surgical approaches, thermal ablation, and sclerotherapy. The application of each of these treatment options is influenced by the severity of the symptoms, type of vein, source of venous reflux, and the use of other (prior or concurrent) treatments.

The venous system of the lower extremities consists of the superficial veins (this includes the great and small saphenous and accessory, or duplicate, veins that travel in parallel with the great and small saphenous veins), the deep system (popliteal and femoral veins), and perforator veins that cross through the fascia and connect the deep and superficial systems. One-way valves are present within all veins to direct the return of blood up the lower limb. Since venous pressure in the deep system is generally greater than that of the superficial system, valve incompetence at any level may lead to backflow (venous reflux) with pooling of blood in superficial veins. Varicose veins with visible varicosities may be the only sign of venous reflux, although itching, heaviness, tension, and pain may also occur. Chronic venous insufficiency secondary to venous reflux can lead to thrombophlebitis, leg ulcerations and hemorrhage. The CEAP classification considers the clinical, etiologic, anatomic, and pathologic characteristics of venous insufficiency, ranging from class 0 (no visible sign of disease) to class 6 (active ulceration).

Treatment of venous reflux/venous insufficiency is aimed at reducing abnormal pressure transmission from the deep to the superficial veins. Conservative medical treatment consists of elevation of the extremities, graded compression, and wound care when indicated. Conventional surgical treatment consists of identifying and correcting the site of reflux by ligation of the incompetent junction followed by stripping of the vein to redirect venous flow through veins with intact valves. While most venous reflux is secondary to incompetent valves at the saphenofemoral or saphenopopliteal junctions, reflux may also occur at incompetent valves in the perforator veins or in the deep venous system. The competence of any single valve is not static and may be pressure dependent. For example, accessory saphenous veins may have independent saphenofemoral or saphenopopliteal junctions which become incompetent when the great or small saphenous veins are eliminated and blood flow is diverted through the accessory veins.

Saphenous Veins and Tributaries
Saphenous veins include the great and small saphenous and accessory saphenous veins that travel in parallel with the great or small saphenous veins. Tributaries are veins that empty into a larger vein. Treatment of venous reflux typically includes the following:

  1. Identification by preoperative Doppler ultrasonography of the valvular incompetence
  2. Control of the most proximal point of reflux, traditionally by suture ligation of the incompetent saphenofemoral or saphenopopliteal junction
  3. Removal of the superficial vein from circulation, for example by stripping of the great and/or small saphenous veins
  4. Removal of varicose tributaries (at the time of the initial treatment or subsequently) by stab avulsion (phlebectomy) or injection sclerotherapy.

Minimally invasive alternatives to ligation and stripping have been investigated. These include sclerotherapy, transilluminated powered phlebotomy, and thermal ablation using cryotherapy, high frequency radio waves (200–300 kHz) or laser energy.

Sclerotherapy
The objective of sclerotherapy is to destroy the endothelium of the target vessel by injecting an irritant solution (either a detergent, osmotic solution, or chemical irritant), ultimately resulting in the occlusion of the vessel. The success of the treatment depends on accurate injection of the vessel, an adequate injectate volume and concentration of sclerosant, and compression. Historically, larger veins and very tortuous veins were not considered to be good candidates for sclerotherapy due to technical limitations. Technical improvements in sclerotherapy have included the routine use of Duplex ultrasound to target refluxing vessels, luminal compression of the vein with anesthetics, and a foam/sclerosant injectate in place of liquid sclerosant. Foam sclerosants are
commonly produced by forcibly mixing a gas (air or carbon dioxide) with a liquid sclerosant (e.g., polidocanol or sodium tetradecyl sulfate). The foam is produced at the time of treatment. Varithena™ (previously known as Varisolve, BTG Plc, London) is a proprietary microfoam sclerosant that is dispersed from a canister with a controlled density and more consistent bubble size.

Endovenous Mechanochemical Ablation
Endovenous mechanochemical ablation (MOCA™) uses both sclerotherapy and mechanical damage to the lumen. Following ultrasound imaging, a disposable catheter with a motor drive is inserted into the distal end of the target vein and advanced to the saphenofemoral junction. As the catheter is pulled back, a wire rotates at 3500 rpm within the lumen of the vein, abrading the lumen. At the same time, a liquid sclerosant (sodium tetradecyl sulfate) is infused near the rotating wire. It is proposed that mechanical ablation allows for better efficacy of the sclerosant, and results in less pain and risk of nerve injury without need for the tumescent anesthesia used with thermal endovenous ablation techniques (radiofrequency ablation [RFA] and endovenous laser treatment [EVLT]).

Thermal Ablation
Radiofrequency ablation is performed by means of a specially designed catheter inserted through a small incision in the distal medial thigh to within 1–2 cm of the saphenofemoral junction. The catheter is slowly withdrawn, closing the vein. Laser ablation is performed similarly; a laser fiber is introduced into the greater saphenous vein under ultrasound guidance; the laser is activated and slowly removed along the course of the saphenous vein. Cryoablation uses extreme cold to cause injury to the vessel. The objective of endovenous techniques is to cause injury to the vessel, causing retraction and subsequent fibrotic occlusion of the vein. Technical developments since thermal ablation procedures were initially introduced include the use of perivenous tumescent anesthesia, which allows successful treatment of veins larger than 12 mm in diameter and helps to protect adjacent tissue from thermal damage during treatment of the small saphenous vein.

Cyanoacrylate Adhesive
Cyanoacrylate adhesive is a clear, free-flowing liquid that polymerizes in the vessel via an anionic mechanism (ie, polymerizes into a solid material on contact with body fluids or tissue). The adhesive is gradually injected along the length of the vein in conjunction with ultrasound and manual compression. The acute coaptation halts blood flow through the vein until the implanted adhesive becomes fibrotically encapsulated and establishes chronic occlusion of the treated vein. Cyanoacrylate glue has been used as a surgical adhesive and sealant for a variety of indications, including gastrointestinal bleeding, embolization of brain arteriovenous malformations, and to seal surgical incisions or other skin wounds.

Transilluminated Powered Phlebectomy
Transilluminated powered phlebectomy (TIPP) is an alternative to stab avulsion or hook phlebectomy. This procedure uses 2 instruments; an illuminator which also provides irrigation, and a resector, which has an oscillating tip and can perform suction. Following removal of the saphenous vein, the illuminator is introduced via a small incision in the skin and tumescence solution (anesthetic and epinephrine) is infiltrated along the course of the varicosity. The resector is then inserted under the skin from the opposite direction, and the oscillating tip is placed directly beneath the illuminated veins to fragment and loosen the veins from the supporting tissue. Irrigation from the illuminator is used to clear the vein fragments and blood through aspiration and additional drainage holes. The illuminator and resector tips may then be repositioned, thereby reducing the number of incisions needed when compared with stab avulsion or hook phlebectomy. It has been proposed that TIPP might result in decreased operative time, decreased complications such as bruising, and faster recovery compared to the established procedures.

Treatment of Perforator Veins
Perforator veins cross through the fascia and connect the deep and superficial venous systems. Incompetent perforating veins were originally addressed with an open surgical procedure, called the Linton procedure, which involved a long medial calf incision to expose all posterior, medial, and paramedial perforators. While this procedure was associated with healing of ulcers, it was largely abandoned due to a high incidence of wound complications. The Linton procedure was subsequently modified by using a series of perpendicular skin flaps instead of a longitudinal skin flap to provide access to incompetent perforator veins in the lower part of the leg. The modified Linton procedure may be occasionally used for the closure of incompetent perforator veins that can not be reached by less invasive procedures. Subfascial endoscopic perforator surgery (SEPS) is a less invasive surgical procedure for treatment of incompetent perforators and has been reported since the mid-1980s. Guided by Duplex ultrasound scanning, small incisions are made in the skin, and the perforating veins are clipped or divided by endoscopic scissors. The operation can be performed as an outpatient procedure. Endovenous ablation of incompetent perforator veins with sclerotherapy and radiofrequency has also been reported.

Other
Deep vein valve replacement is being investigated.

Outcomes of interest for venous interventions include healing and recurrence, recannulation of the vein, and neovascularization. Recannulation (recanalization) is the restoration of the lumen of a vein after it has been occluded; this occurs more frequently following treatment with endovenous techniques. Neovascularization is the proliferation of new blood vessels in tissue, and occurs more frequently following vein stripping. Direct comparisons of durability for endovenous and surgical procedures are complicated by these different mechanisms of recurrence. Relevant safety outcomes include the incidence of paresthesia, thermal skin injury, thrombus formation, thrombophlebitis, wound infection, and transient neurologic effects.

In 2015, the VenaSeal® Closure System (Sapheon, a part of Medtronic) was approved by the U.S. Food and Drug Administration (FDA) through the premarket approval process for the permanent closure of clinically significant venous reflux through endovascular embolization with coaptation. The VenaSeal Closure System seals the vein using a cyanoacrylate adhesive agent.

In 2013, Varithena™ (formerly known as Varisolve®; BTG Plc, London), a sclerosant microfoam made with a proprietary gas mix, was approved by FDA under a new drug application for the treatment of incompetent great saphenous veins, accessory saphenous veins and visible varicosities of the great saphenous vein system above and below the knee. 

The following devices have received specific U.S. Food and Drug Administration (FDA) marketing clearance for the endovenous treatment of superficial vein reflux:

  • In 1999, the VNUS® Closure™ system (a radiofrequency device) received FDA clearance through the 510(k) process for "endovascular coagulation of blood vessels in patients with superficial vein reflux." The VNUS RFS™ and RFSFlex™ devices received FDA clearance in 2005 for “use in vessel and tissue coagulation including: treatment of incompetent (i.e., refluxing) perforator and tributary veins. The modified VNUS® ClosureFAST™ Intravascular Catheter received FDA clearance through the 510(k) process in 2008.
  • In 2002, the Diomed 810 nm surgical laser and EVLT™ (endovenous laser therapy) procedure kit received FDA clearance through the 510(k) process, "... for use in the endovascular coagulation of the great saphenous vein of the thigh in patients with superficial vein reflux."
  • A modified Erbe Erbokryo® cryosurgical unit (Erbe USA) received FDA clearance for marketing in 2005. A variety of clinical indications are listed, including cryostripping of varicose veins of the lower limbs.
  • The Trivex® system (InaVein LLC) is a device for transilluminated powered phlebectomy that received FDA clearance through the 510(k) process in October 2003. According to the label, the intended use is for “ambulatory phlebectomy procedures for the resection and ablation of varicose veins.”
  • The ClariVein® Infusion Catheter (Vascular Insights) received marketing clearance through the 510(k) process in 2008 (K071468). It is used for mechanochemical ablation. Predicate devices were listed as the Trellis® Infusion System (K013635) and the Slip-Cath® Infusion Catheter (K882796). The system includes an infusion catheter, motor drive, stopcock and syringe and is intended for the infusion of physician-specified agents in the peripheral vasculature.

 

POLICY

Great or Small Saphenous Veins

Treatment of the great or small saphenous veins by surgery (ligation and stripping), endovenous radiofrequency or laser ablation, or microfoam sclerotherapy may be considered medically necessary for symptomatic varicose veins/venous insufficiency when the following criteria have been met:

  • There is demonstrated saphenous reflux and CEAP [Clinical, Etiology, Anatomy, Pathophysiology] class C2 or greater; AND
  • There is documentation of one or more of the following indications:
    • Ulceration secondary to venous stasis; OR
    • Recurrent superficial thrombophlebitis; OR
    • Hemorrhage or recurrent bleeding episodes from a ruptured superficial varicosity; OR
    • Persistent pain, swelling, itching, burning, or other symptoms are associated with saphenous reflux, AND the symptoms significantly interfere with activities of daily living, AND conservative management including compression therapy for at least 3 months has not improved the symptoms.

Treatment of great or small saphenous veins by surgery, endovenous radiofrequency or laser ablation, or microfoam sclerotherapy that do not meet the criteria described above is considered cosmetic and not medically necessary.

Accessory Saphenous Veins

Treatment of accessory saphenous veins by surgery (ligation and stripping), endovenous radiofrequency or laser ablation, or microfoam sclerotherapy may be considered medically necessary for symptomatic varicose veins/venous insufficiency when the following criteria have been met:

  • Incompetence of the accessory saphenous vein is isolated, OR the great or small saphenous veins had been previously eliminated (at least 3 months); AND
  • There is demonstrated accessory saphenous reflux; AND
  • There is documentation of one or more of the following indications:
    • Ulceration secondary to venous stasis; OR
    • Recurrent superficial thrombophlebitis; OR
    • Hemorrhage or recurrent bleeding episodes from a ruptured superficial varicosity; OR
    • Persistent pain, swelling, itching, burning, or other symptoms are associated with saphenous reflux, AND the symptoms significantly interfere with activities of daily living, AND conservative management including compression therapy for at least 3 months has not improved the symptoms.

Treatment of accessory saphenous veins by surgery or endovenous radiofrequency or laser ablation, microfoam sclerotherapy, that do not meet the criteria described above is considered cosmetic and not medically necessary.

Symptomatic Varicose Tributaries

The following treatments are considered medically necessary as a component of the treatment of symptomatic varicose tributaries when performed either at the same time or following prior treatment (surgical, radiofrequency or laser) of the saphenous veins (none of these techniques has been shown to be superior to another):

  • Stab avulsion
  • Hook phlebectomy
  • Sclerotherapy
  • Transilluminated powered phlebectomy

Treatment of symptomatic varicose tributaries when performed either at the same time or following prior treatment of saphenous veins using any other techniques than noted above is considered investigational.

Perforator Veins

Surgical ligation (including SEPS) or endovenous radiofrequency or laser ablation of incompetent perforator veins may be considered medically necessary as a treatment of leg ulcers associated with chronic venous insufficiency when the following conditions have been met:

  • There is demonstrated perforator reflux; AND
  • The superficial saphenous veins (great, small, or accessory saphenous and symptomatic varicose tributaries) have been previously eliminated; AND
  • Ulcers have not resolved following combined superficial vein treatment and compression therapy for at least 3 months; AND
  • The venous insufficiency is not secondary to deep venous thromboembolism.

Ligation or ablation of incompetent perforator veins performed concurrently with superficial venous surgery is not medically necessary.

Telangiectsia

Treatment of telangiectasia such as spider veins, angiomata, and hemangiomata is considered cosmetic and not medically necessary.

Other

Techniques for conditions not specifically listed above are investigational, including, but not limited to:

  • Sclerotherapy techniques, other than microfoam sclerotherapy, of great, small, or accessory saphenous veins
  • Sclerotherapy of perforator veins
  • Sclerotherapy of isolated tributary veins without prior or concurrent treatment of saphenous veins
  • Stab avulsion, hook phlebectomy, or TIPP of perforator, great or small saphenous, or accessory saphenous veins
  • Endovenous radiofrequency or laser ablation of tributary veins
  • Endovenous cryoablation of any vein 
  • Mechanochemical ablation of any vein
  • Cyanoacrylate adhesive of any vein

 

POLICY EXCEPTIONS

Federal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.

 

POLICY GUIDELINES

The standard classification of venous disease is the CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic) classification system. The following is the Clinical portion of the CEAP.

Clinical Classification

C0No visible or palpable signs of venous disease
C1Telangiectasies or reticular veins
C2Varicose veins
C3Edema
C4aPigmentation and eczema
C4bLipodermatosclerosis and atrophie blanche
C5Healed venous ulcer
C6

Active venous ulcer

SSymptoms including ache, pain, tightness, skin irritation, heaviness, muscle cramps, as well
as other complaints attributable to venous dysfunction
AAsymptomatic

Medically Necessary is defined as those services, treatments, procedures, equipment, drugs, devices, items or supplies furnished by a covered Provider that are required to identify or treat a Member's illness, injury or Nervous/Mental Conditions, and which Company determines are covered under this Benefit Plan based on the criteria as follows in A through D:

A.  consistent with the symptoms or diagnosis and treatment of the Member's condition, illness, or injury; and

B.  appropriate with regard to standards of good medical practice; and

C.  not solely for the convenience of the Member, his or her Provider; and

D.  the most appropriate supply or level of care which can safely be provided to Member. When applied to the care of an Inpatient, it further means that services for the Member's medical symptoms or conditions require that the services cannot be safely provided to the Member as an Outpatient.

For the definition of Medically Necessary, “standards of good medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary.

Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

 

POLICY HISTORY

07/22/2010: Approved by Medical Policy Advisory Committee

04/20/2011: Policy reviewed; no changes.

04/26/2012: Policy reviewed; no changes.

08/09/2013: For consistency, the term “endoluminal” was with “endovenous” throughout the policy. Intent of policy statements unchanged. Mechanochemical ablation was added as an investigational technique.

02/20/2014:  Added echosclerotherapy to the investigational policy statement. Added HCPCS code S2202 to the Investigational Codes table. (Note: Procedure was previously addressed in a separate medical policy for Echosclerotherapy.)

04/01/2014: Policy statement updated to include medically necessary criteria for the treatment of accessory saphenous veins.

01/19/2015: Policy description updated regarding saphenous veins and tributaries, endovenous mechanochemical ablation, and devices. Added microfoam sclerotherapy to the medically necessary policy statements for the treatment of the greater or lesser and accessory saphenous veins. Added "techniques, other than microfoam sclerotherapy" to the investigational policy statement and removed echosclerotherapy.

09/01/2015: Code Reference section updated for ICD-10. Added ICD-9 procedure code 38.89.

02/10/2016: Terminology changed throughout policy from "greater" and "lesser" to "great" and "small." Policy description updated regarding cyanoacrylate adhesive and devices. Added CEAP class C2 or greater as a medically necessary indication for great or small saphenous veins. Removed the requirement of failure to respond to compressive therapy from the medically necessary policy statements on ulceration secondary to venous stasis and recurrent superficial thrombophlebitis. Cyanoacrylate adhesive of any vein added as investigational. Policy guidelines updated to add the clinical classification table and medically necessary and investigative definitions. Code Reference section updated to remove deleted CPT code 36469.

05/31/2016: Policy number added.

 

SOURCE(S)

Blue Cross Blue Shield Association policy # 7.01.124 

 

CODE REFERENCE

This may not be a comprehensive list of procedure codes applicable to this policy.

The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document. 

Covered Codes

Code Number

Description

CPT-4

36470

Injection of sclerosing solution; single vein

36471

Injection of sclerosing solution; multiple veins, same leg

36475

Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated

36476

Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; second and subsequent veins treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

36478

Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated

36479

Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; second and subsequent veins treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

37500

Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS)

37700

Ligation and division of long saphenous vein at saphenofemoral junction, or distal interruptions

37718

Ligation, division, and stripping, short saphenous vein

37722

Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below

37735

Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia

37760

Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open, 1 leg

37761

Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg

37765

Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions

37766

Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions

37780

Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure)

37785

Ligation, division, and/or excision of varicose vein cluster(s), 1 leg

37799

Unlisted procedure, vascular surgery

93970

Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study

93971

Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study

HCPCS

  

ICD-9 Procedure

ICD-10 Procedure

38.59

Ligation and stripping of lower limb varicose veins

06DP0ZZ, 06DP3ZZ, 06DP4ZZ, 06DQ0ZZ, 06DQ3ZZ, 06DQ4ZZ, 06DR0ZZ, 06DR3ZZ, 06DR4ZZ, 06DS0ZZ, 06DS3ZZ, 06DS4ZZ

Extraction of Greater Saphenous Vein (Ligation and Stripping), by Approach

39.92

Injection of sclerosing agent into vein

3E030TZ, 3E033TZ, 3E040TZ, 3E043TZ

Introduction of Destructive Agent into Peripheral Vein (Sclerosing Agent), by Approach

38.89

Other surgical occlusion of lower limb veins (clamping, division, ligation or occlusion of blood vessels)

06LP0CZ, 06LP0DZ, 06LP0ZZ, 06LP3CZ, 06LP3DZ, 06LP3ZZ, 06LP4CZ, 06LP4DZ, 06LP4ZZ, 06LQ0CZ, 06LQ0DZ, 06LQ0ZZ, 06LQ3CZ, 06LQ3DZ, 06LQ3ZZ, 06LQ4CZ, 06LQ4DZ, 06LQ4ZZ

Occlusion of Greater Saphenous Vein, by Approach

  

06LR0CZ, 06LR0DZ, 06LR0ZZ, 06LR3CZ, 06LR3DZ, 06LR3ZZ, 06LR4CZ, 06LR4DZ, 06LR4ZZ, 06LS0CZ, 06LS0DZ, 06LS0ZZ, 06LS3CZ, 06LS3DZ, 06LS3ZZ, 06LS4CZ, 06LS4DZ, 06LS4ZZ

Occlusion of Lesser Saphenous Vein, by Approach

ICD-9 Diagnosis

ICD-10 Diagnosis

451.0

Phlebitis and thrombophlebitis of superficial vessels of lower extremities

I80.00 - I80.03

Phlebitis and thrombophlebitis of superficial vessels lower extremities (code range)

454.1

Varicose veins of lower extremities with inflammation

I83.10 - I83.12

Varicose veins of lower extremities with inflammation (code range)

454.2

Varicose veins of lower extremities with ulcer and inflammation

I83.201 - I83.229

Varicose veins of lower extremities with both ulcer and inflammation (code range)

454.8

Varicose veins of the lower extremities with other complications

I83.811 - I83.819

Varicose veins of the lower extremities with pain (code range)

  

I83.891 - I83.899

Varicose veins of the lower extremities with other complications

459.81

Unspecified venous (peripheral) insufficiency

I87.2

Venous insufficiency, chronic, peripheral

671.00 - 67104

Varicose veins of legs code range

O22.00 - O22.03, O87.4

Varicose veins of lower extremity in pregnancy and puerperium (code range)

707.10 - 707.12

Ulcer of lower limbs, except pressure ulcer code range

L97.101 - L97.229

Non-pressure chronic ulcer of lower limb (specified part)

  

L97.901 - L97.929

Non-pressure chronic ulcer of unspecified part of leg (code range)



Investigational Codes

Code Number

Description

CPT-4

36468

Single or multiple injections of sclerosing solutions, spider veins (telangiectasia); limb or trunk

HCPCS

S2202

Echosclerotherapy

ICD-9 Procedure

ICD-10 Procedure

  

 

 

ICD-9 Diagnosis

ICD-10 Diagnosis

  

 

 

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