Cardiology Coding Alert

Question: I have an operative report to code and I’m not sure of the correct CPT^® choices. Can you help me? The cardiologist introduced a thin, long, flexible guide wire and catheter into the patient’s femoral vein at groin level. He removed the needle and connected the catheter to a fluoroscope to obtain digitally subtracted images of the blood vessels. The cardiologist then assessed the anatomic structure of the IVC and determined the diameter of the target vein. The cardiologist then removed the catheter. He advanced an introducer sheath along with the enclosed filter into the access vein along the guide wire to reach the IVC. With the help of the visual imaging guidance, the cardiologist gently deployed the filter just below the junction of the IVC and the lowest renal vein. Under fluoroscopy, the cardiologist confirmed the deployment and adequate alignment and position of the filter within the IVC. He then removed the guide wire and introducer sheath. The images were archived for interpretation. The cardiologist applied pressure the puncture site to stop bleeding.

North Dakota Subscriber

Answer: You should report 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) for a new permanent or temporary filter that your physician places in the inferior vena cava IVC.

IVC filters defined: Your physician may place filters in the IVC in patients who are immobile or bedridden for long periods and develop clots in the leg veins. The filters in the IVC prevent blood clots in the lower limbs from traveling up to the heart and lungs. Your physician will use IVC filters in patients with deep vein thrombosis (DVT) or blood clots. These filters help to prevent clots from traveling through the vena cava vein to the lungs.

Do not distinguish temporary or permanent filters: You may spot the terms “temporary” or “permanent” filters in the procedure note. Temporary IVC filters can be subsequently repositioned or removed. However, whether the filter is temporary or permanent does not impact the codes you choose from for reporting the IVC filter procedures.