CPT® Code 36473

Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated

Percutaneous mechanochemical endovenous ablation (MOCA) therapy is a minimally invasive procedure designed to address venous incompetence or venous insufficiency in an extremity. This technique employs a combination of mechanical and chemical methods to treat affected veins. During the procedure, a rotating wire within a catheter disrupts the endothelial lining of the vein, causing mechanical damage without the application of heat. Simultaneously, a sclerosant is injected, which chemically damages the disrupted vein wall, effectively closing off the incompetent vein. This approach eliminates the need for tumescent anesthesia, making the procedure less invasive and potentially more comfortable for the patient. Imaging guidance is utilized to accurately locate the targeted vein, ensuring precise treatment. Local anesthesia is administered at the access site to minimize discomfort. The procedure involves the introduction of a sheath into the vein, followed by the catheter, which is carefully advanced under imaging guidance until the tip of the dispersion wire is positioned just distal to the treatment area. The rotating wire is activated to induce spasm in the proximal vein, and as the catheter is withdrawn at a controlled pace, it disperses the liquid sclerosant to the damaged vein wall. The total volume of sclerosant used is determined prior to the procedure, based on the length of the vein and the patient's weight. Post-procedure, patients are advised to wear compression stockings for 24 hours and during the daytime for up to two weeks to support recovery and enhance treatment outcomes.