Summary & Overview

CPT 34401: Open Venous Thrombectomy and Repair of Vena Cava or Iliac Vein

CPT code 34401 represents an open surgical venous thrombectomy with repair of the inferior vena cava or iliac vein performed via an abdominal incision. This is a high-acuity vascular surgery used to remove thrombus and restore venous patency in central pelvic venous structures. Nationally, such procedures are important for preventing complications of major venous thrombosis, including limb-threatening ischemia, pulmonary embolism, and chronic venous insufficiency.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, typical sites of service, and the types of service lines that commonly bill for this code. The publication also summarizes common modifiers and coding considerations when present in claims data and highlights related billing and policy topics affecting reimbursement and utilization for open venous thrombectomy procedures.

This summary is intended to orient clinicians, coding professionals, revenue cycle staff, and policy analysts to the clinical nature of CPT code 34401, the payer landscape commonly encountered, and the key topics addressed in the full publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 34401venous thrombectomyvascular surgeryopen surgical proceduresvena cavailiac veininpatient surgery

Billing Code Overview

CPT code 34401 describes a surgical procedure in which an incision is made in the abdomen to remove a clot from the vena cava or iliac vein and to perform necessary repairs. This procedure is an open vascular operation addressing thrombotic obstruction within major pelvic or central venous structures.

Service type: Open surgical venous thrombectomy with repair of the vena cava or iliac vein
Typical site of service: Hospital operating room or inpatient surgical suite

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting with acute lower extremity swelling, pain, and signs of deep venous thrombosis with concern for a large thrombus burden extending into the iliac veins and inferior vena cava (IVC). The patient may have failed or be inappropriate for catheter-directed thrombolysis due to contraindications (recent surgery, active bleeding) or has an occlusive thrombus causing hemodynamic compromise or organ dysfunction. Imaging (venous duplex ultrasound, CT venography or MR venography) confirms extensive iliofemoral and/or caval thrombus. The vascular surgery team evaluates and determines open surgical thrombectomy via an abdominal incision to access the IVC or iliac vein is indicated.

Preoperative workflow includes focused history and examination, review of imaging and labs (coagulation profile, type and cross if needed), anesthesia evaluation, and documentation of indications and alternatives. In the operating room under general anesthesia, an abdominal incision is made to expose the IVC or iliac vein, venotomy is performed, thrombus is removed (clot extraction), and venous repairs such as venorrhaphy or patch angioplasty are completed. Intraoperative considerations include heparinization, proximal and distal control of the vein, and possible placement of an IVC filter if indicated. Postoperative management involves anticoagulation, monitoring for reperfusion injury, wound care, and imaging follow-up to confirm patency and rule out recurrent thrombosis.

Coding Specifications

Modifier	Description	When to Use
`22`

Taxonomy Code	Specialty	Notes
207K00000X	Vascular Surgery	Primary specialty performing open IVC/iliac thrombectomy and venous repair.
2080P0206X	General Surgery	May perform in centers without dedicated vascular surgeons; manages abdominal exposure and vascular control.
2086S0110X	Thoracic and Cardiac Surgeons (Vascular focus)	May be involved for complex caval procedures near diaphragm or with cardiopulmonary considerations.
207L00000X	Interventional Cardiology/Vascular Medicine	Provides endovascular adjuncts and pre-/post-procedure vascular care.
246L00000X	Anesthesiology	Provides perioperative anesthesia and intraoperative management.

ICD-10 Code	Description	Clinical Relevance
`I82.401`	Embolism and thrombosis of unspecified deep veins of right lower extremity	Common presenting diagnosis leading to iliac or caval thrombectomy when thrombus extends proximally.
`I82.402`	Embolism and thrombosis of unspecified deep veins of left lower extremity	As above for left-sided disease requiring iliac or caval intervention.
`I82.403`	Embolism and thrombosis of unspecified deep veins of bilateral lower extremities	Bilateral extensive DVT that may necessitate bilateral iliac or caval thrombectomy.
`I82.90`	Acute embolism and thrombosis of unspecified vein, unspecified site	Used when site is not otherwise specified and extensive venous thrombus requires surgical removal.
`I82.89`	Other venous embolism and thrombosis	For less specific venous thrombotic conditions involving pelvic or caval segments.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`34401`	(Primary) Incision of abdomen; removal of clot from vena cava or iliac vein with repairs	Primary open surgical thrombectomy and venous repair described.
`36010`	Introduction of a catheter, venous; for diagnostic or therapeutic purposes, not otherwise specified	May be used if intraoperative or preoperative venous access/catheterization is performed for venography or thrombolytic infusion.
`37620`	Thrombectomy, open, with or without venous patch angioplasty, upper extremity, axillary/subclavian; or lower extremity/femoral-popliteal segment (note: select appropriate anatomic code)	Related open venous thrombectomy techniques for lower extremity veins that may accompany or precede caval/iliac work.
`37184`	Transcatheter placement of an intravascular stent(s), venous	When endovascular stenting of iliac vein or caval segment is performed during the same episode, often via a hybrid approach.
`37193`	Venous mechanical thrombectomy, non-catheter based	When adjunctive endovascular mechanical thrombectomy devices are used before or after open surgery in hybrid procedures.
`76937`	Ultrasound guidance for vascular access	When intraoperative or perioperative ultrasound guidance is used for venous access or localization.

Note: If additional procedure codes are performed during the same anesthetic (e.g., IVC filter placement, patch angioplasty with a different CPT), appropriate multiple-procedure reporting and modifier use apply.

OpenPayer