06BJ3ZZ
Excision Hypogastric Vein, Left to No Qualifier with No Device, Percutaneous Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 6 Lower Veins |
| Operation | B Excision |
| Body Part | J Hypogastric Vein, Left |
| Approach | 3 Percutaneous |
| Device | Z No Device |
| Qualifier | Z No Qualifier |
Operation Definition
Cutting out or off, without replacement, a portion of a body part
Procedure Overview
This family covers surgical removal of a portion of a vein in the leg, groin, pelvis, or lower abdomen, without replacing the tissue taken out. In the lower extremities this most often means cutting away a segment of a varicose or diseased superficial vein, such as a stab avulsion of tributary branches during varicose vein surgery, or taking a wedge or segment of a deeper vein like the femoral or popliteal for diagnostic biopsy. The vein tissue removed is typically sent to pathology or discarded because it is no longer functioning normally.
Surgeons perform these procedures to relieve symptoms from varicose disease (aching, swelling, skin changes), to diagnose suspected vascular tumors or inflammatory conditions of the vein wall, or to remove a vein segment that will be reused elsewhere in the body, such as harvesting the greater saphenous vein for coronary or peripheral bypass grafting. Unlike stripping the entire length of a vein, excision here refers to taking out a defined portion while leaving the rest of the vein bed intact.
Patients typically undergo this under local, regional, or general anesthesia depending on how extensive the removal is, and recovery is usually brief for isolated segment excisions such as saphenous vein harvest or stab avulsions.
Anatomy & Axis Detail
Hypogastric Vein, Left
The left hypogastric vein mirrors its right-sided counterpart, collecting blood from the left pelvic organs, gluteal muscles, and perineal structures before draining into the external iliac vein. Excision addresses a discrete segment involved by pelvic tumor extension, a venous malformation, or fibrosis following prior pelvic surgery or infection, and it is distinguished from the more common practice of ligating individual tributaries during hysterectomy or prostatectomy for hemostasis. Given the dense plexus of collateral pelvic veins on this side, removing a length of the main trunk rarely compromises venous return, but the operative record should note the segment's extent and its relationship to the ureter and internal iliac artery, both of which run close by.
Approach: Percutaneous
Percutaneous describes entry by needle or instrument puncture through the skin or mucous membrane to reach the site of the procedure, without cutting the tissue open or using a visualizing scope. It differs from Open in that the site itself is never exposed, and from Percutaneous Endoscopic in that no endoscope is used to see internal structures. Common examples include needle biopsies and injections.
Coding & Documentation
A coder should confirm the operative note describes cutting out a discrete portion of vein, not stripping the entire vessel with a stripper device and not simply ligating or tying it off. Documentation should specify the named vein (great saphenous, small saphenous, femoral, popliteal, or an unspecified lower extremity vein) and confirm no graft or substitute material replaced the excised segment. Saphenous vein harvest for later use as a bypass conduit still codes to Excision in this body system even though the vein is destined for use elsewhere, because nothing replaces it at the harvest site.
The most common assignment error is confusing Excision with Extraction when the operative report actually describes stripping the full length of the saphenous vein with a stripper wire or endovenous device, which is Extraction because force is used to pull the vessel out rather than cut it in sections. Coders also sometimes default to Excision for stab avulsion phlebectomy of varicose tributaries when the documentation actually supports a different root operation if the vein is being obliterated in place rather than physically removed.