The patient presented for a left femoral to peroneal artery bypass. After several attempts to find a suitable vein, it was determined that the greater saphenous would have to be utilized as an in-situ graft. The greater saphenous vein was transected free at the below knee incision, multiple branches were clipped. An endarterectomy was performed of the common and deep femoral artery and the greater saphenous vein was then anastomosed and utilized as a vein patch in the distal arteriotomy which extended into the deep femoral artery. A valvulotome was passed from the below knee greater saphenous vein up to the proximal anastomosis and the valves were lysed. Is a code assigned for the excision of the saphenous vein when an in-situ bypass is performed? Are the lysis of the valves additionally reported?
Use of the saphenous vein as a direct bypass, and lysis of vein valves, are both inherent in the bypass procedure. Similar to the use of an internal mammary artery in coronary artery bypass, it is not appropriate to assign a code for excision of the greater saphenous vein when used in an in-situ vein graft. In this type of graft, the vein remains in place and is not “cut out” or “excised.” The lysis of the valves is inherent to an in-situ vein graft procedure. Therefore, an additional code would not be assigned for the lysis of the valves.