How To Use CPT Code 34421

CPT 34421 describes a procedure known as thrombectomy, which involves the removal of a blood clot from the vena cava, iliac, or femoropopliteal vein. This article will provide an overview of CPT code 34421, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 34421?

CPT 34421 is a code used to describe a specific procedure called thrombectomy. This procedure involves the surgical removal of a blood clot from the vena cava, iliac, or femoropopliteal vein. The provider makes an incision in the leg to access the affected vein and removes the clot using various techniques, including the use of catheters if necessary.

2. Official Description

The official description of CPT code 34421 is: ‘Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by leg incision.’

3. Procedure

1. During the thrombectomy procedure, the patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the leg to access the femoropopliteal vein.
3. The provider identifies the site of the clot and places clips on the vessel on either side of the clot.
4. An incision is made in the vessel to reach the clot, and the provider excises the clot.
5. If necessary, a balloon catheter may be introduced into the vein and advanced past the clot. The catheter is inflated and then pulled out to remove all the clots.
6. The provider repairs the vein and checks for normal blood flow through the repaired vessel using techniques such as Doppler ultrasound.
7. The incision is closed with sutures in layers.

4. Qualifying circumstances

CPT 34421 is used when a patient requires thrombectomy of the vena cava, iliac, or femoropopliteal vein. This procedure is typically performed on patients with blood clots that obstruct blood flow in these veins. The provider must make an incision in the leg to access the affected vein and remove the clot. The use of catheters may be necessary depending on the specific circumstances of the procedure.

5. When to use CPT code 34421

CPT code 34421 should be used when a provider performs a thrombectomy procedure on the vena cava, iliac, or femoropopliteal vein through a leg incision. It is important to accurately document the specific details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 34421, the provider must document the following information:

• Patient’s diagnosis necessitating the thrombectomy procedure
• Details of the procedure, including the specific veins involved and the use of catheters if applicable
• Date of the procedure
• Start and end time of the procedure
• Techniques used during the procedure, such as the use of clips, balloon catheters, and Doppler ultrasound
• Confirmation of normal blood flow through the repaired vessel
• Details of the incision closure

7. Billing guidelines

When billing for CPT 34421, ensure that the procedure meets the criteria outlined in the official description. It is important to accurately document the specific details of the procedure to support the use of this code. Additionally, be aware of any specific guidelines or modifiers that may be required by the payer. It is also important to review any applicable coding guidelines or policies to ensure accurate and appropriate billing.

8. Historical information

CPT code 34421 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient presents with a blood clot in their femoropopliteal vein. The provider performs a thrombectomy procedure through a leg incision to remove the clot.
2. A patient is diagnosed with a blood clot in their vena cava. The provider performs a thrombectomy procedure through a leg incision to remove the clot.
3. A patient has an iliac vein clot. The provider performs a thrombectomy procedure through a leg incision to remove the clot.
4. A patient presents with blood clots in both their femoropopliteal veins. The provider performs a thrombectomy procedure through leg incisions to remove the clots.
5. A patient has a blood clot in their vena cava and iliac vein. The provider performs a thrombectomy procedure through a leg incision to remove the clots.
6. A patient presents with a blood clot in their femoropopliteal vein. The provider performs a thrombectomy procedure through a leg incision, using a catheter to aid in clot removal.
7. A patient is diagnosed with a blood clot in their vena cava. The provider performs a thrombectomy procedure through a leg incision, using a catheter to aid in clot removal.
8. A patient has an iliac vein clot. The provider performs a thrombectomy procedure through a leg incision, using a catheter to aid in clot removal.