Summary & Overview
CPT 34471: Subclavian Vein Thrombectomy, Open Removal of Clot
CPT code 34471 represents an open surgical thrombectomy of the subclavian vein via a cervical incision to remove venous thrombus, performed with or without catheter assistance. This code captures a definitive operative intervention for central upper-extremity venous occlusion that can restore venous patency, relieve symptoms, and reduce risk of complications such as propagation of thrombus or venous gangrene. Nationally, accurate coding of this procedure affects hospital and surgical reimbursement, resource allocation in vascular surgery services, and clinical documentation standards.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical indication and typical sites of service, an outline of where CPT code 34471 fits in procedural coding, and what coverage stakeholders commonly consider when adjudicating claims. The publication summarizes benchmarked payment considerations and common coding practices, highlights relevant clinical scenarios for documentation, and summarizes policy and billing issues that commonly arise with operative venous thrombectomy procedures. Data not available in the input for specific payer rates, ICD-10 pairings, and associated taxonomies is noted where applicable.
Billing Code Overview
CPT code 34471 describes a surgical procedure in which the clinician makes an incision in the neck, advances to the subclavian vein, and removes a venous clot, with or without using a catheter. This procedure is typically classified as a vascular surgical thrombectomy or open removal of thrombus from a central upper-extremity vein.
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Service type: Surgical venous thrombectomy / open venous clot removal
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Typical site of service: Hospital operating room or inpatient surgical suite; may also be performed in an outpatient surgical center when clinically appropriate
Clinical & Coding Specifications
Clinical Context
A 58-year-old male with a history of central venous catheter placement presents with acute swelling and pain of the right upper extremity and neck. Duplex ultrasound demonstrates an occlusive thrombus of the right subclavian vein with impaired venous outflow and progressive arm edema despite systemic anticoagulation. The vascular surgery team schedules an open thrombectomy via a neck incision to access the subclavian vein, remove the clot, and restore flow; a Fogarty catheter may be used intraoperatively for extraction. Typical workflow: preoperative evaluation and imaging (ultrasound, venography), informed consent, general anesthesia, transverse or oblique neck incision, exposure of the subclavian vein, thrombectomy with or without catheter-directed techniques, intraoperative hemostasis and possible venoplasty, wound closure, postoperative monitoring for bleeding, anticoagulation management, and follow-up venous duplex to confirm patency.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Service performed by the reporting provider | Use to indicate the primary surgeon performed the thrombectomy when billing requires distinction of provider responsibility |
22 | Increased procedural service |