Ask Dr. Z

Dr Z, I am hoping you can help me with a new issue. You may want to remove the name of the product to protect the company. One of our physicians went to a vascular conference and saw a product called "ClariVein". The Rep came to our office today. In a nutshell, it is a "peripheral infusion device" with which they are treating below the knee venous insufficiency. The device rotates, causing scarring to the vein. It also allows for delivery of a sclerosing agent directly to the “insulted” vein. He told us that doctors are billing it as an embolization, using 37204/36011/75894 and that Medicare pays for it. When I looked in my EncoderPro, ICD-9 459.81 is not listed as one of the diagnosis codes that is submitted with this CPT code. (Might not want to publish this: Of course, I explained to him that because they are legitimate codes Medicare will pay, but that is not to be confused with legitimate usage of the codes. I am apprehensive because he then stated that BCBS considers it an investigation procedure and will not pay. He also stated that the doctors needed to call it an embolization and not a sclerotherapy procedure because sclerotherapy is often considered cosmetic and this would be for venous insufficiency. He also stated that doctors are trying it out on Medicare patients because they don't have to jump through the prior authorization hoops.) He stated that it is an FDA approved device for "peripheral infusion device using drug of physician specification" but is not FDA indicated for vein occlusion. When asked if this was an off-label use of the product, he stated that it was no different than when biliary stents were used in arteries. He also stated that information available on the European web site was much better than the USA web site. (clarivein.eu) Your expertise on this matter would be greatly appreciated. If this is legitimate use of the product and coding, we would like to try it on a few patients. Thanks, Diane M. Carl, RT(R), CIRCC Billing Coordinator Advanced Vascular Surgery, PC (269)492-6511 .