How should coders report primary and add-on codes for endovenous ablation when multiple veins and bilateral extremities are treated?
Assign primary code 36475 for the first vein treated by RFA or primary code 36478 for the first vein treated by laser ablation. These codes are unilateral; add modifier 50 to code 36475 and 36478 if bilateral veins are treated. Codes 36476 and 36479 are add-on codes and should not be assigned without a primary code. They may only be coded once per extremity regardless of the number of additional veins treated and only when the additional veins are treated through separate access sites. If additional veins are treated in bilateral extremities, report the add-on codes twice, not with modifier 50.
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