05R90KZ
Replacement Brachial Vein, Right to No Qualifier with Nonautologous Tissue Substitute, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 5 Upper Veins |
| Operation | R Replacement |
| Body Part | 9 Brachial Vein, Right |
| Approach | 0 Open |
| Device | K Nonautologous Tissue Substitute |
| Qualifier | Z No Qualifier |
Operation Definition
Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part
Procedure Overview
This family describes procedures that remove a diseased or damaged segment of an upper-body vein - such as the subclavian, axillary, brachial, or innominate vein - and substitute it with a graft, whether that graft is a segment of the patient's own vein, donor tissue, or a synthetic conduit. It is performed when a portion of vein is too damaged, scarred, or obstructed to repair directly, commonly after trauma, following removal of a tumor invading the vessel wall, or as part of reconstructing venous drainage after prior surgery or radiation.
For patients, this means the surgeon is not just patching the vein but physically taking out a section and installing a replacement channel to keep blood flowing normally back toward the heart. It differs from arterial bypass grafting because it addresses the low-pressure venous system, and it is far less common than arterial replacement since veins have more collateral pathways and are often ligated rather than reconstructed.
Anatomy & Axis Detail
Brachial Vein, Right
The right brachial veins are the paired deep veins that accompany the brachial artery along the medial upper arm, draining the forearm's deep venous system before joining the axillary vein. Because they run in venae comitantes flanking the artery, isolated replacement is uncommon and typically follows penetrating trauma, iatrogenic arterial repair that damages the adjacent vein, or tumor resection involving the neurovascular bundle. When a segment is unsalvageable, reconstruction restores deep venous return and helps prevent chronic limb swelling, especially in patients whose superficial veins are already compromised. The close arterial relationship means operative notes and coding should clarify that the venous, not arterial, structure was replaced, since both vessels are frequently addressed in the same procedure.
Approach: Open
Open approach means the surgeon cuts through skin, mucous membrane, or other tissue layers to physically expose the target site to view before performing the procedure. It gives direct visualization and hands-on access, distinguishing it from Percutaneous approaches where instruments pass through a small puncture without exposing the site. Open is typical for procedures needing wide access, such as most laparotomies.
Device: Nonautologous Tissue Substitute
Nonautologous Tissue Substitute refers to biologic material sourced from a donor or another species, such as an allograft or xenograft, used to replace a body part. It differs from Autologous Tissue Substitute by tissue origin outside the patient's own body, and from Synthetic Substitute by being biologic rather than manufactured material.
Coding & Documentation
Replacement is coded when the operative note documents excision of a vein segment followed by insertion of graft material - autologous vein, cadaveric allograft, or synthetic material - to physically take over that vein's function. Look for language such as "interposition graft," "vein graft replacement," or "synthetic conduit reconstruction" tied to a specific named vein.
A frequent error is coding Replacement when the surgeon actually performed Supplement, laying graft material onto an intact vein rather than excising and substituting it; the distinction hinges on whether native tissue was removed. Coders should also confirm the graft material value is captured accurately, since autologous, nonautologous, and synthetic substitutes are each represented differently, and should avoid conflating a venous bypass graft (which creates a new route) with Replacement (which occupies the same anatomic position).