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Thrombectomy is a surgical procedure aimed at removing a thrombus, or blood clot, from a blood vessel. In the context of CPT® Code 34490, this procedure specifically targets the axillary and subclavian veins, which are major veins located in the upper body. The procedure can be performed either directly or with the assistance of a catheter, and it involves making an incision in the arm to access the affected vein. The presence of a thrombus often occurs in areas where the vein may be narrowed or stenotic, leading to potential complications such as impaired blood flow. During the thrombectomy, the surgeon makes an incision to expose the vein, allowing for direct access to the thrombus. Vessel loops are strategically placed both above and below the thrombus to control blood flow during the procedure. The thrombus can then be removed through direct exposure, or alternatively, a catheter may be used to facilitate remote removal. This involves inserting a balloon catheter beyond the clot, inflating it, and then withdrawing it to capture and remove the thrombus. After the thrombus is removed, a venography may be performed to confirm that the vein is clear and patent, ensuring that no residual clot remains. It is important to note that CPT® Code 34490 is specifically used when the thrombus is removed via an arm incision, distinguishing it from other codes that may apply to different approaches or locations of thrombus removal.
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The thrombectomy procedure described by CPT® Code 34490 is indicated for the removal of a thrombus located in the axillary or subclavian vein. This condition may arise due to various factors, including but not limited to:
The thrombectomy procedure involves several critical steps to ensure effective removal of the thrombus. These steps include:
After the thrombectomy procedure, patients may require monitoring for any complications, such as bleeding or infection at the incision site. Recovery may involve rest and elevation of the affected arm to reduce swelling. Follow-up appointments may be necessary to assess the healing process and ensure that the vein remains patent. Additionally, patients may be advised on lifestyle modifications or medications to prevent future thrombus formation.
| Short Descr | REMOVAL OF VEIN CLOT | Medium Descr | THRMBC DIR/W/CATH AXILL&SUBCLAVIAN VEIN ARM IN | Long Descr | Thrombectomy, direct or with catheter; axillary and subclavian vein, by arm incision | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 61 - Other OR procedures on vessels other than head and neck |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| Pre-1990 | Added | Code added. |
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