Ask Dr. Z

Patient presents with severe venous stenosis and occlusion in both legs. Bilateral caths were placed, and bilateral venograms and pullback IVUS were performed. “At this point, balloon angioplasty followed with placement of a pair of 14 x 6 Atlas balloons into the inferior vena cava filter and simultaneous balloon angioplasty for opening the filter and smashing it against the wall of the inferior vena cava, and this was successful. We then proceeded to treat down to the level of the femoral vein with balloon angioplasty.” After the destruction of the filter, bilateral stents were placed in the legs. How would you code this deliberate smashing of the filter? Would it be considered repositioning, angioplasty, or unlisted? There was no mention of a return to the OR for removal of the filter.