# SVC filter



## lisammy (Mar 4, 2010)

One of my surgeons put a filter in the SVC. Was wondering what you would use for this. 37620 specifically says inferior vena cava.
Thanks for you help


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## BLOWRIE (Mar 9, 2010)

You might query your physician as to the wording in the report.  My surgical coding group can not think of a time we've had a filter placed other in the IVC for blood clot protection of the lung and heart.  I have looked for a code for placing the filter in the SVC and like you, did not find one.  If he did indeed place the filter in the SVC, will you share that with us, as we are anxious to know if this placement is to prevent blockage in the neck or head area.  I only see using an unlisted code if the SVC is the spot.


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## lisammy (Mar 10, 2010)

HERE IS A COPY OF THE REPORT FOR YOU TO SHARE. THANKS FOR YOUR INPUT.


POSTOPERATIVE DIAGNOSIS:  Right upper extremity deep vein thrombosis and inability to anticoagulate.    

PROCEDURE:  

1. Ultrasound guidance of percutaneous access.    
2. Superior venacavogram with Radiological supervision and interpretation.  
3. Insertion of superior vena cava filter (Celect IJ). 

COMPLICATIONS:  None.

APPROACH:  Right common femoral vein - retrograde.  

CLINICAL HISTORY:  female who had a subdural hematoma status post evacuation a couple of weeks ago.  She has developed right upper extremity DVT which has propagated last week.  She has a history of thrombus in her left IJ as well.  Now both internal jugular veins are occluded as well as her right axillary vein.  I was asked to place a filter for inability to anticoagulate.          

TECHNIQUE:  The patient was brought to The Catheterization Suite and placed in the supine position.  After adequate anesthesia was obtained, the patient was prepped and draped in the usual sterile fashion.  The right common femoral artery was palpated and the skin medial to this was infiltrated with 1% Xylocaine.  Under ultrasound guidance, the right common femoral vein was punctured in a retrograde manner with an introducer needle followed by an 0.35 Bentson Wire which was advanced up into the superior vena cava.  The introducer needle was removed and a Celect IJ Filter, Sheath, and Dilator were advanced to the superior vena cava.  The wire and dilator were removed.  Superior venacavogram was performed to make sure no thrombus.  

VENOGRAPHIC FINDINGS:  The superior vena cava is widely patent with no signs of thrombus.  The innominate veins are identified and patent bilaterally.  

A Celect IJ Filter was then placed through the sheath with the tines placed facing up to collect any clot.  The sheath was then pulled back and the filter deployed in the SVC.  A post deployment picture revealed it to be in excellent position.  The sheath was then removed and hemostasis obtained in the groin with pressure.  The patient tolerated the procedure well.  She was taken to her room in good condition.


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## dpeoples (Mar 12, 2010)

lisammy said:


> HERE IS A COPY OF THE REPORT FOR YOU TO SHARE. THANKS FOR YOUR INPUT.
> 
> 
> POSTOPERATIVE DIAGNOSIS:  Right upper extremity deep vein thrombosis and inability to anticoagulate.
> ...



This is a very unusual scenario but it does appear that the filter was placed in the SVC to protect the head/neck area. I think your only option is unlisted code 37799.

HTH


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## lisammy (Mar 12, 2010)

Thank you so much, that is what I thinking to, I just wanted to exhaust any other ideas first.


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## tlpowers (Oct 16, 2010)

*Filter in SVC*

It is unusual but done for the same reason as the IVC filter....to protect against a pulmonary embolus.  The filter is put in the SVC when they know the clot is above the SVC.  That blood flow is still directed back towards the lungs.  Hope that helps!  (and yes, unfortunately the UPC is still the way to go)


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## preserene (Oct 17, 2010)

I feel sad about the coding limitation Scenerio for SVC.
My thought is why not and why not logically, medically, procedurewise , cause-outcome wise bieng all the same?

Patients who had upper extremity central venous thrombosis in whom anticoagulation was deemed either contraindicated or ineffective in preventing recurrent pulmonary embolism: Patients underwent percutaneous insertion of a Greenfield filter into the SVC for prophylaxis for pulmonary embolism. who had upper extremity central venous thrombosis in whom anticoagulation was deemed either contraindicated or ineffective in preventing recurrent pulmonary embolism
So,  Percutaneous insertion of a Greenfield filter into the SVC for prophylaxis for pulmonary embolism have been in vogue since more than a decade.
As such, if there is no specification about the SVC Filter code,  why  can't  we consider it as a counterpart  of IVC and assign the code of IVC Filter code 37620 / 75940-26. Why not when it merits the value? ( just like we code for bilateral ,why not for upper and lower counterparts  get the same merits?
If 37620 not applicable, can we assign 36010 for Superior vena cava filter  and  75940-26 Percutaneous placement of  IVC filter , radiological supervision and interpretation,
Level 2 HCPCS C1880 vena cava Filter

Yes xxx99 always there for our resque! 
Excuse me if I am out of court. It is just a point to ponder .


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