CPT® Code 37191

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

The procedure described by CPT® Code 37191 involves the insertion of an intravascular vena cava filter using an endovascular approach. This technique is specifically designed to filter blood flow within the vena cava (VC), which is a large vein that carries deoxygenated blood from the lower body to the heart. The primary purpose of this procedure is to prevent pulmonary embolism, a serious condition that can occur when blood clots, often originating from the deep veins of the pelvis or lower extremities, migrate to the lungs. The filter used in this procedure is an umbrella-shaped device that captures these clots, effectively blocking their passage to the pulmonary circulation. Before the insertion of the filter, a cavogram is performed to assess the vascular anatomy and to ensure that there are no existing thrombi within the vena cava. The procedure begins with the exposure of either the femoral or jugular vein, followed by the placement of an introducer sheath into the selected blood vessel. Under the guidance of imaging techniques such as ultrasound and fluoroscopy, a guidewire is carefully navigated through the venous system into the vena cava. Depending on the access point, the guidewire may traverse various veins, including the jugular, brachiocephalic, and superior vena cava, before reaching the inferior vena cava. Once the guidewire is in place, a catheter is advanced over it to the predetermined site for filter placement, typically located just below the renal veins in the inferior vena cava. After the guidewire is removed, contrast material may be injected to visualize any anatomical variations in the vena cava. The final step involves advancing a second catheter that contains the collapsed vena cava filter to the target site, where it is deployed once correctly positioned. Following the deployment, the catheter insertion device is removed, and additional imaging may be performed to confirm the filter's placement. The procedure concludes with the closure of the incision made in the neck or groin, ensuring that the patient is prepared for recovery.