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| About Us What Are Varicose and Spider Veins? Diagnosis/ ICAVL Accredited Vascular Lab Pre & Post Therapy Care Instruction Venous Closure Procedures Micro-Phlebectomy (Ambulatory Phlebectomy) Treatment of Spider Veins Laser and Intense Pulse Light Therapy Fees, Insurance & Office Billing Policy Information Packet Home |
Information Packet |
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| 1. | Standard definition of a cosmetic procedure is when a procedure is performed on a patient who has a condition, which is totally asymptomatic. This condition would not cause any threat to the patient and would be done purely for appearance enhancement. | ||||
| 2. | A procedure is considered non-cosmetic when it is performed to relieve a symptomatic condition especially when there is a documented underlying pathology responsible for the condition, which is symptomatic. | ||||
| 3. | Any therapy used to treat symptomatic venous disease is considered a non-cosmetic, medically necessary procedure. | ||||
| 4. | Disease of the long and/or short saphenous vein valves leads to venous varicosities, which can vary in size and location in relation to the skin. If the tortuous distended varicose veins are more than 3 mm in size and are under the skin they are usually labeled as Varicose Veins (454.9). If these varicose veins are I - 3 mm in size they are called Reticular Veins (454.9). These usually lie in the skin. If these reticular veins are less than I mm in size and are in the skin these are called, venous telangectasias, spider veins, spider angioma. spide hemangioma, or venous hemangioma (448.1 and 228.01). Acquired spider or venous hemangiomas are due to extreme proliferations of the tiny veins and are usually extremely symptomatic. Please note, that all the vein condition codes mentioned above fall under the general category, Varicose Veins, and have the same etiology and pathology. The general etiology is venous hypertension due to venous valvular insufficiency. The best way to treat these diseased veins is to destroy them, surgically or with Photoderm/Vasculight as the case may be. Cosmetics do not come into play in this situation. |
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| 5. | ICD9 codes used for patients with venous varicosities are as follows: 454.9 Varicose Veins 454.9 Reticular Veins 448.1 Venous telangectasias 448.1 Spider Veins 228.01 Acquired Spider Hemangioma 228.01 Acquired Venous Hemangioma 729.5 Leg Pain 729.81 Edema (usually recurrent) 459.81 Venous Insufficiency Please note that in some patients several of the above codes are required to be used to express their disease pathology. Majority of the patients need four to five codes to fidly describe their condition. |
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| 6. | CPT codes most commonly used for treatment are as follows: Photoderm/Vasculight less than 10 square cm 17106 Photoderm/Vasculight 10.0 to 50.0 square cm 17107 Photodema/Vasculight over 50.0 square cm 17108 Stripping and ligation of the long saphenous vein 37720 Multiple Stab Phlebectornies of a varicose vein 37785 |
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| 7. | The minor asymptomatic venous telangectasias or spider veins are usually of hormonal origin. These are mostly found on the face and chest. When present on the legs are very sparse and have no underlying venous valve disease. These types of veins are mostly left alone unless the patient desires cosmetic management and are always responsible for the cost. | ||||
| 8. | The symptoms produced by these venous telengectasias are due to many factors, the main one being venous valve insufficiency, which constitutes a very serious pathology requiring therapy. If this condition is not corrected it can eventually lead to deep venous valve incompetence, deep venous thrombosis and pulmonary embolism and death. (This does not sound like a cosmetic problem at all) The second factor causing disabling pain is the extensive involvement of the legs with these nasty spider veins (dense proliferative vascular lesions) requiring many sessions of therapy to eliminate them. Once eliminated the patients become asymptomatic (98% in our experience) |
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| 9. | The patients with varicose veins including the ones with spider veins present with multiple symptoms which include: Leg Pain 729.5 Leg Cramps 729.82 Swelling usually recurrent 729.81 Frequent itching & burning of the skin 698.9 Varicose Veins with Eczema (inflammation) 454.1 Varicose Veins with Ulcer & Inflammation 454.2 Varicose Veins with Bleeding 454.9 Superficial Phlebitis & Thrombophlebitis of the of the lower extremity 451.0 Superficial Phlebitis & Thombrophlebitis of the of the upper extremity. 451.82 |
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| 10. | We cannot reflect all of the patients symptom codes on the electronic claim forms. There is space for only four. The complete information is always available in our medical records. | ||||