sclerotherapy

I was taught to use codes 36471 and 76937 (for vascular ultrasound guidance for needle placement) when ultrasound guided sclerotherapy is preformed on a patient. Now I am being told to use codes 36471, 76942 (ultrasound guidance for needle placement)and 93970 for the vein mapping done during the sclerotherapy. What are the proper codes to use?
Help!
Kelli E. Space, CPC.

Sclerotherapy

36470-36471: Injection of sclerosing solution, single vein or multiple veins, same leg; respectively.
The above CPT code could be used to describe sclerotherapy as an adjunct to vein ligation and stripping (potentially considered medically necessary), or as a stand-alone treatment of either varicose tributaries (considered investigational) or treatment of the saphenous vein (considered investigational). Thus the different applications of sclerotherapy may be difficult to distinguish based on CPT codes alone.
The following CPT code may be used for ultrasound guidance of sclerotherapy:
76942: Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision, and interpretation.
It should be noted that the bulk of the literature discussing the role of ultrasound guidance refers to sclerotherapy of the saphenous vein, as opposed to the varicose tributaries. In these situations, the use of ultrasound guidance would be considered medically necessary in the small subset of patients for whom the sclerotherapy would be considered medically necessary.(i.e. veins with proven reflux.)
However, when ultrasound guidance is used to guide sclerotherapy of the varicose tributaries, it would be considered either not medically necessary or incidental to the injection procedure.
Check payors policy.

re: Sclerotherapy

Is there documentation anywhere that indicates for sclerotherapy 76937 is to be used only for tributaries, and 76942 is to be used for the saphenous vein?

Thanks!

re: Sclerotherapy

Saphenous veins include the greater and lesser saphenous, and accessory saphenous
veins that travel in parallel with the greater or lesser saphenous veins. Tributaries are
veins that empty into a larger vein. 76937 Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)
76942 Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection,
localization device), imaging supervision and interpretation.
If ultrasound guidance (CPT® code 76942) is used to guide sclerotherapy of the
varicose tributaries, it would be considered either not medically necessary or incidental to the injection procedure.

re: Sclerotherapy

[Saphenous veins include the greater and lesser saphenous, and accessory saphenous
veins that travel in parallel with the greater or lesser saphenous veins. Tributaries are
veins that empty into a larger vein. 76937 Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)
76942 Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection,
localization device), imaging supervision and interpretation.
If ultrasound guidance (CPT® code 76942) is used to guide sclerotherapy of the
varicose tributaries, it would be considered either not medically necessary or incidental to the injection procedure.]