Point32 Varicose Vein Procedures(Eff. beginning 1.1.24) Form

Chronic venous insufficiency (CVI), or Chronic Venous Disease (CVD)

Is due to abnormally high pressure in the venous system, which normally has low pressure. This high pressure is caused by venous blood not properly getting out of the leg, either due to obstruction (such as a deep venous thrombosis) or refluxing blood flow due to incompetent vein valves.

Varicose Veins

Varicose veins are dilated, tortuous veins under the surface of the skin which are commonly found in legs. While exact cause of varicose veins is unknown, factors commonly associated with increased risk of developing varicose veins include family history, age, and obesity. While many individuals with varicose veins are symptom free, some may experience pain or complications from varicose veins and require a medical intervention.

Most Common Symptoms Include:

• Heaviness
• Aching
• Swelling
• Throbbing
• Itching

In many individuals experiencing symptoms as result of varicose veins, wearing specially fitted elastic stockings is an appropriate treatment.

Varicose veins are abnormally enlarged and tortuous vessels that result when veins become incompetent, and this failure allows blood to flow in a retrograde direction (reflux). Varicose veins are most often noted on the back of the calf or on the inside of the leg between the groin and ankle but can occur anywhere on the extremity.

Chronic Venous Disease Classification

Chronic venous disease is commonly stratified using the CEAP (Clinical, Etiology, Anatomy, Pathophysiology) classification, of which the Clinical (C) grade is most commonly used, and grades venous disease based on the presence of dilated veins, (C2) edema, (C3) skin changes, (C4a and b) for ulceration (C5 healed ulcer, C6 open ulcer).

Varicose Vein Procedures

Clinical Guideline Coverage Criteria

Harvard Pilgrim Health Care uses guidance from the Centers for Medicare and Medicaid Services (CMS) for coverage determinations for its Medicare Advantage plan members. CMS National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), Local Coverage Articles (LCAs) and documentation included in the Medicare manuals are the basis for coverage determinations where available. For Harvard Pilgrim Health Care Medicare Advantage plan members, the following criteria is used:

1. LCD - Treatment of Varicose Veins of the Lower Extremities (L34536) (cms.gov)
2. LCD - Varicose Veins of the Lower Extremity, Treatment of (L33575) (cms.gov)
3. Article - Billing and