37193

Retrieval (removal) 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

CPT code 37193 represents the percutaneous, endovascular retrieval (removal) of an intravascular vena cava filter, most commonly an inferior vena cava (IVC) filter. IVC filters are originally placed in patients who are at high risk for pulmonary embolism (PE) and have a contraindication to, or have failed, standard systemic anticoagulation therapy. While some filters are permanent, many modern devices are retrievable and are intended to be removed once the patient's transient risk for venous thromboembolism has sufficiently diminished, or once the patient can safely tolerate therapeutic anticoagulation. Prompt retrieval of these temporary devices is clinically advocated to mitigate the risk of long-term filter-related complications, such as filter fracture, device migration, caval thrombosis, and caval wall perforation. The procedure to remove the filter is minimally invasive and performed via an endovascular approach. The vascular surgeon or interventional radiologist typically utilizes the right internal jugular vein or the common femoral vein as the access site, depending on the specific design and orientation of the previously implanted filter. The provider first utilizes ultrasound guidance to gain safe percutaneous access to the targeted vein and subsequently places an introductory vascular sheath. Under continuous fluoroscopic guidance, the physician advances a specialized retrieval kit, often consisting of a snare, a recovery cone, or graspers, through the central venous system until it reaches the vena cava filter. The physician meticulously maneuvers the retrieval device to engage the retrieval hook located at the apex of the vena cava filter. Once securely captured, the physician advances the retrieval sheath over the filter to physically collapse the struts of the device. After the filter is completely sheathed, the entire system is smoothly withdrawn from the patient's body. The provider then applies manual pressure to the access site to achieve hemostasis. The comprehensive nature of CPT code 37193 inherently encompasses all integral components of this procedure, including the initial vascular access, vessel selection, intraprocedural roadmapping, any required radiological supervision and interpretation, and all necessary imaging guidance, such as both ultrasound and fluoroscopy. Therefore, these imaging and access elements should not be coded or billed separately. Understanding the exhaustive clinical parameters of 37193 ensures accurate reporting for this definitive therapeutic extraction procedure.

Clinical Indications

  • Resolution of the transient risk for pulmonary embolism (PE).
  • Patient is now able to safely tolerate and maintain therapeutic systemic anticoagulation.
  • Prophylactic removal of a retrievable filter to prevent long-term complications such as caval penetration or filter fracture.
  • Device migration requiring extraction.
  • Thrombosis within or surrounding the filter apparatus requiring removal and potential alternative therapy.
  • Completion of a surgical procedure for which the filter was placed purely for perioperative PE prophylaxis.

Procedure Steps

  1. Obtain informed consent and position the patient appropriately (typically supine) on the fluoroscopy table.
  2. Administer local anesthesia to the planned venous access site, usually the right internal jugular vein or common femoral vein.
  3. Utilize ultrasound guidance to locate the vein, confirm patency, and guide percutaneous puncture.
  4. Insert a guidewire through the access needle, remove the needle, and advance a vascular introducer sheath into the vein.
  5. Under fluoroscopic guidance, advance a retrieval snare, cone, or specialized grasper through the central venous system to the site of the vena cava filter.
  6. Perform intraprocedural venography or roadmapping to verify the filter's position, assess for significant captured thrombus, and visualize the retrieval hook.
  7. Carefully manipulate the snare to capture the apical hook of the vena cava filter.
  8. Advance the retrieval sheath over the captured filter, applying steady traction to collapse the filter struts into the sheath safely.
  9. Once the filter is completely captured within the sheath, withdraw the entire assembly (sheath, snare, and filter) from the patient's body.
  10. Remove the introducer sheath and apply manual pressure to the access site until hemostasis is achieved.
  11. Apply a sterile dressing to the puncture site and transfer the patient for post-procedural monitoring.

Coding Guidelines

  • CPT code 37193 is a comprehensive code that includes all imaging guidance (ultrasound and fluoroscopy) used during the procedure; do not report 76937, 76000, or 77001 separately.
  • Vascular access and vessel selection are inherently included in 37193 and should not be coded separately.
  • Radiological supervision and interpretation, as well as intraprocedural roadmapping, are included and not separately reportable.
  • Diagnostic venography is generally included in the procedure unless a medically necessary, distinctly separate diagnostic study is performed, which may require a modifier (e.g., 59 or XU) if supported by documentation.
  • If the filter retrieval is attempted but unsuccessful (e.g., the filter is embedded in the caval wall and cannot be safely collapsed), report 37193 with modifier 52 (Reduced Services) or 53 (Discontinued Procedure), depending on payer policy.
  • Do not report 37193 in conjunction with 37191 (Insertion of IVC filter) or 37192 (Repositioning of IVC filter) for the same filter during the same session unless clinically justified and allowed by NCCI edits.

Associated ICD-10 Codes