W
ith 40% of women and 25% of men suffering from
varicose veins, spider veins or venous insufficien-
cy, and new treatments that are less painful and
invasive, now might be a good time to add venous
disease treatments to your case mix. In addition
to being in demand, these treatments are known for their high reim-
bursement, quick turnover and low risk of complications.
To treat achy varicose veins and their underlying causes, venous abla-
tion — which uses a catheter to apply energy to a diseased vein and
close it off — is a popular treatment. Anthony Smeglin, MD, an inter-
ventional cardiologist at the Venus Vein Center and assistant director of
the vascular invasive service line at Our Lady of Lourdes Medical
Center in Camden, N.J., says that patient comfort is essential for abla-
tion. He prescribes patients 5 mg of diazepam to take before the proce-
dure and tells them to apply a numbing EMLA cream. Dr. Smeglin also
injects lidocaine as a local anesthetic before inserting tumescent anes-
thesia — a mix of saline, sodium bicarbonate and lidocaine — around
the veins. He then inserts the catheter using ultrasound guidance, and
uses heat from either radio waves or a laser to close the targeted vein.
Patients are wrapped in elastic bandages following the ablation and can
usually return to normal activities by the next day.
Reimbursement hoops
For venous ablation, insurers typically require pre-authorization that
can involve a detailed and complex protocol. "If a patient has a med-
ical venous disease, many insurers will require 3 months of graduated
compression stockings before they'll authorize a vein procedure," says
Dr. Smeglin. Laser ablation reimbursement is usually around $1,500,
while radiofrequency ablation is paid at about $1,800, but typically has
higher per-case costs. For sclerotherapy, where patients pay up front
for the cosmetic treatment, the cost per session is usually around $400.
These procedures take between 30 and 60 minutes, and often require
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | February 2015