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Basics of CPT code 37191, 37192 & 37193

An inferior vena cava (IVC) filter is placed most commonly for refractory deep vein thrombosis and pulmonary embolism or when anticoagulation is contraindicated. We have different procedure codes for insertion (CPT code 37191), reposition (CPT code 37192) and retrieval (CPT code 37193) of intravascular vena cava filter. The physician uses a needle to take access in the femoral (or internal jugular) vein and then advances a guide wire through this needle.

The physician then passes the filter through the introducer sheath into the IVC under guidance. Fluoroscopic guidance is used generally for these procedures. The physician removes the sheath once the IVC filter is placed in correct position. We have different CPT codes for IVC filter placement, removal and retrieval, which are used very frequently in interventional radiology.

CPT codes for Intravascular Vena Cava filter

There are three common CPT codes used for IVC filter. We have separate code for insertion, removal and retrieval of IVC filter. These CPT codes have all the small procedures included in them. Below are the CPT codes used for IVC filter

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.

The physician places or inserts a IVC filter to filter blood flow in the vena cava (VC) to prevent pulmonary embolism due to migration of deep vein thromboses (blood clots), usually from the pelvis or lower extremity to the lungs.

37192 – Repositioning 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 provided.

The physician repositions a vena cava filter that has migrated or one that is being used temporarily to prevent fibrosis and permanent fixation of the filter to the wall of the vena cava.

37193 – Retrieval (removal) of intravascular vena cava endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed.

Intra-service Performed for CPT code 37191, 37192 & 37193

Conscious sedation is administered and adequate conscious sedation monitoring is verified. A suitable access vein is cannulated using micropuncture technique and ultrasound guidance. A 5 French vascular sheath is placed. A standard access 0.035 wire and catheter are manipulated into the IVC with fluoroscopic guidance either via the femoral vein or in a trans-atrial fashion via the internal jugular vein. Breath-hold DSA imaging is obtained with calibrated pigtail catheter for sizing, documentation of anatomy, and assessment for central thromboembolism or stenosis. The position and number of renal veins is documented and marked to plan for optimal filter placement.

A second stiff guide wire is advanced and the pigtail catheter is removed. Sequential dilation of the venotomy site is performed and using fluoroscopic guidance the filter delivery sheath is advanced. The filter is slowly deployed under fluoroscopic guidance subjacent to the lowest renal vein. Proper filter deployment is confirmed under magnified fluoroscopy and/or spot imaging in at least two projections. Final venography is performed to ensure proper alignment of the filter with the cava and appropriate position relative to the most inferior renal vein. The filter delivery sheath is removed and hemostasis is obtained with manual compression (with or without hemostasis assist device) or surgical closure of the venotomy.

Do and Don’t with CPT code for 37191, 37192 and 37193

The CPT code 37191, 37192 and 37193 includes the conscious sedation. Moderate conscious sedation should not be coded separately.

Do not code any guidance separately with CPT code 37191, 37192 and 37193. These codes include all the respective guidance like ultrasound or fluoroscopic done during these procedures.

Never code CPT code 37192 with 37191. Insertion and Repositioning of IVC filter should not be coded together.

Do not code 37193 with 37197

Do not code Supervision and Interpretation CPT Codes with these procedures. All S&I codes are included with CPT codes 37191, 37192 and 37193.

Catheterization of vessel is included with CPT codes 37191, 37192 and 37193 and hence should not be coded separately