CPT 34451 Surgical Venous Thrombectomy Reimbursement | OpenPayer

Summary & Overview

CPT 34451: Surgical Venous Thrombectomy, Open Removal of Venous Clot

CPT code 34451 represents an open surgical venous thrombectomy involving incisions in the leg and abdomen to access and remove thrombus from the vena cava, iliac, or femoropopliteal veins. This code captures a definitive surgical approach to venous clot removal, used in cases where endovascular techniques are unsuitable or when rapid mechanical clot extraction is necessary. The procedure has implications for acute limb- and life-saving care and for utilization patterns in vascular and general surgery services nationwide. Key payers 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 34451, typical sites of service, and the types of surgical teams that perform it. The publication also presents payer coverage considerations, commonly used modifiers (listed separately), and benchmarks where available. Policy and billing updates that affect documentation, preauthorization expectations, and inpatient-versus-outpatient site-of-service determinations are summarized for national stakeholders. Clinical context explains indications for open thrombectomy versus alternative endovascular management, and operational notes address typical service lines and resource implications. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare34451CPTvenous thrombectomyvascular surgeryopen thrombectomyoperative proceduresurgical codingsite of service

Billing Code Overview

CPT code 34451 describes a surgical thrombectomy in which the provider makes incisions in the leg and abdomen to access the vena cava, iliac, or femoropopliteal vein, removes the clot, and closes the incision. This procedure is a surgical venous thrombectomy targeted at direct removal of venous thrombus from large central or peripheral veins.

Service type: Open surgical thrombectomy
Typical site of service: Inpatient or outpatient operating room or surgical suite, depending on patient stability and clinical setting

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents to the hospital with acute unilateral leg swelling, pain, and erythema. Duplex ultrasound demonstrates an extensive iliofemoral deep vein thrombosis with suspected propagation toward the femoropopliteal segment and evidence of phlegmasia or significant limb threat. The vascular surgery team evaluates the patient, obtains informed consent, and schedules open thrombectomy. In the operating room under general or regional anesthesia, the surgeon makes incisions in the groin and/or thigh and, if needed, a separate incision in the lower abdomen to expose the iliac or inferior vena cava segments. The thrombus is directly extracted from the involved vein(s). Hemostasis is achieved, wounds are irrigated, and layered closure is performed. Postoperatively the patient is monitored in a recovery area or inpatient unit, receives anticoagulation per institutional protocol, and has follow-up duplex imaging to assess venous patency and rule out recurrent clot.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity of the thrombectomy is substantially greater than typical (document reasons).
`23`	Unusual anesthesia

CPT 34421: Thrombectomy of Vena Cava, Iliac, or Femoropopliteal Vein

CPT-34471-SUBCLAVIAN-VEIN-THROMBECTOMY-OPEN-REMOVAL-CLOT

CPT 34471: Subclavian Vein Thrombectomy, Open Removal of Clot

CPT-34401-OPEN-VENOUS-THROMBECTOMY-VENA-CAVA-ILIAC-VEIN-REPAIR

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

CPT-34490-UPPER-EXTREMITY-VENOUS-THROMBECTOMY-SUBCLAVIAN-AXILLARY

CPT 34490: Upper-Extremity Venous Thrombectomy, Subclavian or Axillary Vein

Taxonomy Code	Specialty	Notes
207RX0202X	Vascular Surgery	Primary specialty performing open venous thrombectomy procedures.
2080P0230X	General Surgery	General surgeons frequently perform lower-extremity venous thrombectomy in acute settings.
207LA0401X	Interventional Cardiology	May be involved when central venous or caval access and thrombus extraction are required in coordination.
207L00000X	Thoracic and Cardiac Surgery	Involvement possible for caval thrombectomy extension into IVC under cardiothoracic care.
363L00000X	Hematology	Consults for anticoagulation management and hypercoagulable workup (consult taxonomy).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I82.401`	Acute embolism and thrombosis of unspecified deep veins of right lower extremity	Acute iliofemoral or femoropopliteal DVT is a primary indication for open thrombectomy when limb threat or failure of anticoagulation occurs.
`I82.402`	Acute embolism and thrombosis of unspecified deep veins of left lower extremity	Same relevance for left-sided extensive DVT requiring surgical thrombectomy.
`I82.403`	Acute embolism and thrombosis of unspecified deep veins of bilateral lower extremities	Bilateral extensive DVT may necessitate staged or bilateral thrombectomies.
`I82.90`	Acute embolism and thrombosis of unspecified site	Use when the precise venous segment is not specified but acute thrombus removal is required.
`I82.891`	Chronic embolism and thrombosis of deep veins of right lower extremity	Chronic organized thrombus may require surgical removal or adjunctive procedures.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37202`	Transcatheter therapy, infusion for thrombolysis, peripheral, any method; initial infusion site	Endovascular catheter-directed thrombolysis often performed before or instead of open thrombectomy or as adjunct to lyse chronic thrombus.
`37205`	Transcatheter therapy; pharmacomechanical thrombolysis, peripheral, including clot aspiration and/or removal	Used when a percutaneous pharmacomechanical approach is employed instead of open surgical thrombectomy.
`34701`	Venous graft, creation; lower extremity	Performed when concomitant bypass or venous reconstruction is needed during complex venous thrombectomy.
`36470`	Injection of thrombolytic agent; initial day	Used when thrombolytic infusion is initiated through a catheter as part of hybrid therapy.
`37618`	Ligation and division of incompetent perforating veins; with subfascial endoscopic perforator surgery	Performed in staged procedures addressing chronic venous insufficiency that may be associated with prior DVT.

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