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Official Description

Ligation of common iliac vein

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 37660 involves the ligation of the common iliac vein, which is a critical surgical intervention aimed at managing thromboembolic conditions. Ligation refers to the surgical technique of tying off a vein to obstruct blood flow, which is essential in preventing serious complications such as pulmonary embolism in patients who have developed thromboembolism in the femoral or iliac veins. This procedure is particularly indicated for patients who present with blood clots in these veins, as it helps to mitigate the risk of clots traveling to the lungs. During the ligation, the physician typically uses silk suture or fine wire to securely tie the vein. Prior to the ligation, a venography may be performed to accurately locate the thromboembolism, ensuring that the surgical intervention is targeted and effective. The process involves making a skin incision over the common iliac vein, which is located proximal to the thromboembolism, allowing the surgeon to expose the vein. Once exposed, the vein is carefully dissected from the surrounding tissue before being ligated to achieve the desired interruption of blood flow.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The ligation of the common iliac vein is indicated for patients who exhibit specific conditions related to thromboembolism. The primary indications for this procedure include:

  • Thromboembolism of the femoral or iliac veins - This condition involves the presence of blood clots within the femoral or iliac veins, which can lead to serious complications such as pulmonary embolism if not addressed.

2. Procedure

The procedure for ligation of the common iliac vein follows a series of well-defined steps to ensure effective intervention. The steps involved in the procedure are as follows:

  • Step 1: Venography - Prior to the ligation, a venography is performed to identify the exact location of the thromboembolism. This imaging technique allows the physician to visualize the veins and locate the clot accurately, which is crucial for the success of the procedure.
  • Step 2: Skin Incision - A skin incision is made over the common iliac vein at a point that is proximal to the identified thromboembolism. This incision is strategically placed to provide optimal access to the vein while minimizing tissue damage.
  • Step 3: Exposure of the Vein - Once the incision is made, the surgeon carefully dissects the common iliac vein free from the surrounding tissue. This step is critical to ensure that the vein is adequately exposed for the ligation process.
  • Step 4: Ligation of the Vein - After the vein is fully exposed, the surgeon proceeds to ligate the common iliac vein using silk suture or fine wire. This step effectively interrupts blood flow through the vein, thereby addressing the thromboembolic condition.

3. Post-Procedure

Following the ligation of the common iliac vein, patients may require specific post-procedure care to ensure proper recovery. Monitoring for any signs of complications, such as infection or excessive bleeding, is essential. Patients may also be advised on activity restrictions and follow-up appointments to assess the success of the procedure and manage any ongoing symptoms. The expected recovery period can vary based on individual patient factors and the extent of the procedure performed.

Short Descr LIGATION COMMON ILIAC VEIN
Medium Descr LIGATION OF COMMON ILIAC VEIN
Long Descr Ligation of common iliac vein
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) 1 - 150% payment adjustment for bilateral procedures applies.
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) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2F - Major procedure, cardiovascular-Other
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.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
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).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
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.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
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).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
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Action
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2025-01-01 Changed Short Description changed.
2017-01-01 Changed Medium description changed.
Pre-1990 Added Code added.
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