Anesthesia Coding Alert

Question: How do we bill for anesthesia care when a surgeon removes a vena cava filter?

Virginia Subscriber

Answer: If the surgeon performs an open procedure to retrieve the filter, your best anesthesia options are 00880 (Anesthesia for procedures on major lower abdominal vessels; not otherwise specified) and 00882 (… inferior vena cava ligation).

Note: The correct anesthesia code depends on the surgical approach. If the surgeon removes the filter intravascularly, the patient might not need anesthesia.

For inserting a vena cava filter you  can use 37191 (Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance [ultrasound and fluoroscopy], when performed)  but does not have a removal code. This could partially be because removing an umbrella is very rare.

Some coders suggest using one of the codes for implant removal in this situation because the surgeon did implant the vena cava filter. Other coders say vein filter removal is more complicated than this, so opt for 37799 (Unlisted procedure, vascular surgery).

Code 01930 (Anesthesia for therapeutic interventional radiologic procedures involving the venous/lymphatic system [not to include access to the central circulation]; not otherwise specified) is another option for a less-invasive removal tactic.