How To Use CPT Code 34490

CPT 34490 describes a procedure known as thrombectomy, which involves the removal of a blood clot from the axillary and subclavian veins. This article will provide an overview of CPT code 34490, 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 34490?

CPT 34490 is a code used to describe the surgical procedure of thrombectomy. This procedure involves the removal of a blood clot from either the axillary or subclavian vein. The provider makes an incision in the arm to access the affected vein and removes the clot, either directly or with the assistance of a catheter. Thrombectomy is typically performed when a blood clot obstructs the normal blood flow in the vein, causing symptoms and potential complications.

2. Official Description

The official description of CPT code 34490 is: ‘Thrombectomy, direct or with catheter; axillary and subclavian vein, by arm incision.’

3. Procedure

1. The provider begins by making an incision in the arm to access the subclavian or axillary vein.
2. Once the vein is exposed, the provider detaches the surrounding structures to gain better access to the affected area.
3. The provider identifies the site of the blood clot and places clips on either side of the clot, if possible.
4. The clot is then carefully removed from the vein, either directly or with the assistance of a catheter.
5. In some cases, a balloon catheter may be introduced into the vein past the clot. The catheter is inflated and then withdrawn, pulling any remaining clots out with it.
6. After the clot has been removed, the provider repairs the vein and checks for normal blood flow through the repaired vessel using techniques such as Doppler ultrasound.
7. Finally, the incision is closed with sutures in layers to promote proper healing.

4. Qualifying circumstances

CPT 34490 is typically performed on patients who have a blood clot in either the axillary or subclavian vein. These veins are responsible for returning blood from the arm to the heart. The procedure is indicated when the clot obstructs blood flow, causing symptoms such as pain, swelling, and potential complications. It is important to note that this procedure requires a skilled provider who is experienced in performing thrombectomy.

5. When to use CPT code 34490

CPT code 34490 should be used when a provider performs a thrombectomy procedure on the axillary or subclavian vein. It is important to ensure that the procedure is performed through an incision in the arm and involves the removal of a blood clot. If the procedure is performed on a different vein or does not involve the removal of a clot, a different CPT code should be used.

6. Documentation requirements

When documenting a thrombectomy procedure with CPT code 34490, the provider should include the following information:

• Patient’s diagnosis indicating the presence of a blood clot in the axillary or subclavian vein
• Description of the procedure performed, including the use of an incision in the arm and the method of clot removal (direct or with a catheter)
• Date of the procedure
• Details of the clot removal process, such as the use of clips or a balloon catheter
• Confirmation of normal blood flow through the repaired vessel, documented through techniques like Doppler ultrasound
• Closure of the incision with sutures

7. Billing guidelines

When billing for CPT code 34490, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The provider should document the use of an arm incision, the removal of a blood clot from the axillary or subclavian vein, and any additional procedures performed during the thrombectomy. It is also important to follow any specific billing guidelines provided by insurance companies or payers to ensure accurate reimbursement for the procedure.

8. Historical information

CPT code 34490 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 axillary vein. The provider performs a thrombectomy using an arm incision, removing the clot directly. CPT code 34490 would be used to bill for this procedure.
2. During a surgical procedure, a provider discovers a blood clot in the subclavian vein. The provider performs a thrombectomy using a catheter, removing the clot and restoring normal blood flow. CPT code 34490 would be used to report this procedure.
3. A patient with a history of deep vein thrombosis develops a blood clot in their axillary vein. The provider performs a thrombectomy through an arm incision, removing the clot and ensuring proper blood flow. CPT code 34490 would be used to bill for this procedure.
4. Following a traumatic injury, a patient develops a blood clot in their subclavian vein. The provider performs a thrombectomy using a balloon catheter, successfully removing the clot and restoring normal blood flow. CPT code 34490 would be used to report this procedure.
5. A patient with a history of clotting disorders presents with a blood clot in their axillary vein. The provider performs a thrombectomy through an arm incision, removing the clot and confirming proper blood flow. CPT code 34490 would be used to bill for this procedure.