Would the Cpt Code for EVLT Be the Same for 2 Consecutive Days Done on the Left Limb & Can It Be Done in 1 Day?

35475 is code for radiofrequency ablation of first vein and 36476 is used when we treat a second vein like SSV or accessory saphenous vein at the same setting. The reason the 36476 has less dollar amount is because we can use the same catheter to treat the second vein at the same setting. Now when the second vein is treated on a different day it goes back to 36475 since its all new equipment.  At our facility we treat the accessory vein along with the main vein if medically necessary and is billed as 36475 and 36476 to the insurance. If its a cash paying patient we don't add any more charges. I hope this helps.

Sounds like you were had.  One should be able to get both veins treated on the same leg at the same time.  Hence there is a CPT code for the first vein and a second CPT code for the second vein.  For the physician doing the case the reimbursement for the "second code" is 50% less than  if it were done on another visit on a different date. I can understand if there were medical concerns to break it up on 2 separate visits but that generally that is not the case. 

Yes the coding would be the same on consecutive days but different on the same day. On the same day, there would be a different code for second vein on the same day.  On different days the code would be the same 1st vein for the procedure.  For VNUS closure this would be 36475 for single vein.  For EVLT this would be 36478.  

The question is the treatment and billing of the right leg.  Did they treat a leg unnecessarily?  And to make you come on consecutive days is also questionable.  Either do them both on the same day or wait a week or two in between.  Some patients do prefer to split the procedures up so they can heal and recover in a time frame that they are comfortable with.  Also, most of my patients want to work the next day so bilateral procedures may be a bit much for some.Hope this helps and good luck!Dr Chang

I would hold the facility to their initial quote.  The procedures that you apparently were quoted was for  two treatments, one on the left leg and one on the right leg.  36475LT stands for left leg endovenous radiofrequency ablation (a single vein treatment).  The 36475RT stands for right leg endovenous radiofrequency ablation (a single vein treatment).  So even though you only needed the left leg done, they asked your insurance company to approve the same treatment on the right leg.  If they never informed you that you would be billed for 2 separate vein treatments, I would ask them to only charge you for one of the treatments. Did you not question in further detail when they asked you to come back the next day for the same thing? The big question is why did they quote you for 36475RT (right leg) if you only needed treatment on the left?  Is it because they had planned on 2 treatments to begin with, without letting you know?

Some surgical CPT codes include the procedure and the pre-op and post op care global period.  Some procedures, like gallbladder surgery carry a 90 day global period.  CPT code 36475 is for VNUS. 36478 is EVLT. 2 separate procedures---without a global period.  If your vein center completed both procedures in 1 day; they would get a 50% reduction in payment for the 2nd procedure completed on the same limb.  If the second procedure is completed on another billing day; then the vein center can bill and collect 100% for each CPT code.  This is poor medical practice form.  Timing of procedures and combinations of procedures should be based on the best medical/surgical outcome for the individual patient.  Not based on maximization of payments for the vein center. You should contact your insurance provider to question the legitimacy of the this billing practice. 

CPT code 36475 is for VNUS. 36478 is EVLT. 2 separate procedures meaning EVLT for one vein on a date of service, say Monday 8-1-2013 and another the next day for 8-2-2013 is procedure code 36478 for 8-1-2013 and another 36478 for 8-2-2013. Groupon and medicine don't mix well together. I hope that helps you understand medical coding.But, the real question is ... why did you agree to have a procedure if you didn't need it ? 

If you required a closure procedure for both the greater(long) and smaller (short) saphenous veins then they are usually done on separate days and, depending on the physician preference, they can be done on successive days or spaced days.  Each vein is billed by the same code and both codes if the same leg should be either right or left. If you had reflux demonstrated on ultrasound, then closing the saphenous may be appropriate depending on your physician's evaluation.