Summary & Overview
CPT 34421: Thrombectomy of Vena Cava, Iliac, or Femoropopliteal Vein
CPT code 34421 defines a surgical thrombectomy via a leg incision to remove clot from the vena cava, iliac, and/or femoropopliteal veins, with or without catheter assistance. This code captures a high-acuity vascular surgical procedure used to restore venous patency in patients with extensive deep venous thrombosis. Nationally, accurate use of this code matters for appropriate surgical documentation, facility and professional payment classification, and tracking of complex venous interventions.
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 intent of the service, typical site-of-service expectations, and the common payer landscape for this type of vascular surgery. The publication also outlines relevant benchmarks and policy developments affecting billing and coverage for major venous thrombectomy procedures, plus clinical context on indications and procedural scope. Policy updates and payer-specific coverage nuances are summarized to inform coding accuracy and billing workflows.
Where input data were incomplete, the publication notes missing elements and focuses on available procedural description and payer coverage. The goal is to clarify billing semantics, support correct code selection for complex venous thrombectomy, and summarize the payer environment for this high-complexity surgical service.
Billing Code Overview
CPT code 34421 describes a surgical thrombectomy performed through an incision in the leg to remove thrombus from the vena cava, iliac, and/or femoropopliteal veins. The procedure may be performed with or without catheter assistance and involves direct surgical access to the affected deep venous segments.
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Service type: Surgical thrombectomy for deep venous thrombosis involving the iliac, femoral, popliteal, and/or inferior vena cava.
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Typical site of service: Operating room or surgical suite, often within an acute care hospital or inpatient surgical setting.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a middle-aged adult presenting with acute or subacute lower-extremity venous thrombosis extending into the femoropopliteal, iliac, or inferior vena cava segments causing limb-threatening ischemia, severe swelling, or significant thrombus burden despite anticoagulation. The patient often has risk factors such as recent immobility, malignancy, recent surgery, or a hypercoagulable state. Initial evaluation includes duplex ultrasonography and cross-sectional venography (CT or MR venography) to define thrombus extent. Anticoagulation is started unless contraindicated. When percutaneous catheter-directed techniques are insufficient or thrombus burden/anatomy requires open exposure, the vascular surgeon performs a surgical thrombectomy via an incision in the leg to access femoral or popliteal veins and remove clot material; this may be combined with intraoperative venography, catheter thrombectomy, or caval/iliac exploration. Postoperative care includes anticoagulation management, limb monitoring, and imaging follow-up to confirm patency and detect residual thrombus or complications such as bleeding or recurrent thrombosis.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use when no modifier applies and service is billed as usual |
22 |