05R307Z
Replacement Innominate Vein, Right to No Qualifier with Autologous 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 | 3 Innominate Vein, Right |
| Approach | 0 Open |
| Device | 7 Autologous 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
Innominate Vein, Right
The right innominate vein, also called the right brachiocephalic vein, forms behind the sternoclavicular joint from the union of the right subclavian and right internal jugular veins and carries a large volume of venous blood from the head, neck, and right upper limb into the superior vena cava, making it a high-flow, hemodynamically significant vessel. Replacement is typically undertaken when the vein is invaded or obstructed by a mediastinal tumor, damaged by chronic catheter use, or injured during thoracic surgery, since simple repair may not be feasible when a long segment is compromised, and a graft is used to restore the primary venous outflow channel for the right side of the upper body. Its proximity to the aortic arch, phrenic nerve, and thoracic duct on the left-sided counterpart's territory makes replacement here a technically demanding mediastinal procedure requiring careful dissection.
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: Autologous Tissue Substitute
Autologous Tissue Substitute identifies a device value where material harvested from the patient's own body, such as an autograft, is used to replace or reconstruct a body part. Its defining feature is tissue origin from the patient, setting it apart from Nonautologous Tissue Substitute, sourced from a donor or animal, and Synthetic Substitute, made of 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).