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The procedure described by CPT® Code 37619 involves the ligation of the inferior vena cava (IVC), which is a critical intervention aimed at preventing pulmonary embolism. This condition can arise when deep vein thromboses, or blood clots, migrate from the pelvis or lower extremities to the lungs, posing significant health risks. The ligation procedure is performed using an extravascular technique, which means that the ligation is done outside the vessel itself. Before the ligation, a cavogram is conducted to assess the vascular anatomy and to ensure that there are no existing thrombi within the IVC that could complicate the procedure. The surgical approach requires an incision in the abdomen to access the IVC, which is then carefully exposed and dissected from the surrounding tissues. The procedure involves either partially or completely interrupting blood flow through the IVC, followed by the placement of a suture ligature around the vessel. Additionally, the wall of the IVC may be plicated, a technique that creates folds around the vessel to narrow its lumen, further aiding in the prevention of blood clot migration. Finally, the abdominal incision is closed in layers to promote proper healing.
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The ligation of the inferior vena cava is indicated for patients at high risk of pulmonary embolism due to the presence of deep vein thromboses. The following conditions may warrant this procedure:
The ligation of the inferior vena cava involves several critical procedural steps to ensure the safety and effectiveness of the intervention:
Following the ligation of the inferior vena cava, patients are typically monitored for any immediate complications related to the procedure. Post-operative care may include pain management, monitoring for signs of infection, and ensuring proper wound healing. Patients may also require follow-up imaging studies to assess the effectiveness of the ligation and to monitor for any potential complications. It is essential for healthcare providers to provide clear instructions regarding activity restrictions and any necessary lifestyle modifications to support recovery and prevent future thromboembolic events.
| Short Descr | LIGATION OF INF VENA CAVA | Medium Descr | LIGATION OF INFERIOR VENA CAVA | Long Descr | Ligation of inferior vena cava | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2C - Major Procedure, cardiovascular-Thromboendarterectomy | MUE | 1 | CCS Clinical Classification | 61 - Other OR procedures on vessels other than head and neck |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2020-08-03 | Changed | Medium description changed per CPT Errata |
| 2012-01-01 | Added | Added |
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