How To Use CPT Code 37191

CPT 37191 describes the insertion of an intravascular vena cava filter using an endovascular approach. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 37191?

CPT 37191 is used to describe the insertion of an intravascular vena cava filter using an endovascular approach. This procedure involves the placement of a filter device in the inferior vena cava (IVC) to prevent blood clots from the lower limbs from traveling to the heart and lungs. The provider uses imaging guidance, such as ultrasound and fluoroscopy, to visualize the blood vessels and ensure accurate placement of the filter.

2. Official Description

The official description of CPT code 37191 is: ‘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.’

3. Procedure

1. The provider selects the appropriate access vein, such as the femoral vein at the groin level or the internal jugular vein in the neck.
2. A catheter and guide wire are inserted into the chosen vein and advanced to the IVC under imaging guidance.
3. The provider deploys the filter device just below the junction of the IVC and the lowest renal vein, ensuring proper alignment and position.
4. Imaging guidance, including fluoroscopy and ultrasound, is used throughout the procedure to visualize the blood vessels and confirm the deployment of the filter.
5. The guide wire and introducer sheath are removed, and pressure is applied to the puncture site to stop bleeding.
6. Images are collected and stored for interpretation.

4. Qualifying circumstances

CPT 37191 is performed in patients who require the insertion of an intravascular vena cava filter to prevent blood clots from traveling to the heart and lungs. The procedure is indicated for individuals with identified blood clots within the venous system. The provider must use an endovascular approach, including vascular access, vessel selection, and imaging guidance. The procedure requires radiological supervision and interpretation, as well as intraprocedural roadmapping. The use of ultrasound and fluoroscopy for imaging guidance is also necessary.

5. When to use CPT code 37191

CPT code 37191 should be used when a provider performs the insertion of an intravascular vena cava filter using an endovascular approach. This code encompasses all the necessary components of the procedure, including vascular access, vessel selection, radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance. It should not be separately reported for individual components of the service.

6. Documentation requirements

To support a claim for CPT 37191, the provider must document the following information:

• Patient’s diagnosis and the need for an intravascular vena cava filter
• Specific details of the procedure, including the access vein used, vessel selection, and imaging guidance techniques
• Date and duration of the procedure
• Confirmation of proper alignment and position of the filter within the IVC
• Images collected and stored for interpretation
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 37191, ensure that the procedure meets all the necessary components described in the official description. Do not separately report components of the service, such as catheterization or venography. CPT 37191 should not be reported with other codes unless additional procedures, such as open surgical interruption of the inferior vena cava, are performed. It is important to follow specific guidelines provided by payers and coding authorities for accurate billing and reimbursement.

8. Historical information

CPT 37191 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Examples

1. A provider inserts an intravascular vena cava filter using an endovascular approach to prevent blood clots from traveling to the heart and lungs in a patient with deep vein thrombosis.
2. Using imaging guidance, a provider places a filter device in the inferior vena cava to prevent pulmonary embolism in a patient with a history of blood clots.
3. A provider performs the insertion of an intravascular vena cava filter using an endovascular approach in a patient undergoing surgery who is at high risk for blood clots.