Ask Dr. Z

Patient has a large pelvic tumor through the left gonadal vein, the left renal vein, and the suprarenal IVC, and a retrohepatic IVC forming a large mass filling her right atrium and causing severe R heart failure. My surgeon performed the abdominal and caval component, and the CT surgeon performed the cadiac portion. A transverse venotomy from the left renal vein and into the IVC was made, and the tumor thrombus was removed. Along with the CT surgeon the tumor was removed. The cavotomy was repaired. The tumor thrombus extending from the ovarian vein into the left renal vein was then retrieved through a separate venotomy ofn the left ovarian vein. The only code I can come up with is 34401-22, but this doesn't seem adequate for all the work that was done. Do you have any suggestions on the correct way to bill this? Would you suggest an unlisted code? And, if so, what comparable code would you use?