The National Institute for Health and Care Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Endoscopic saphenous vein harvest for coronary artery bypass grafting in June 2014.

This document replaces previous guidance on endoscopic saphenous vein harvest for coronary artery bypass grafting (NICE interventional procedure guidance 343, May 2010).

Description

Coronary artery disease (CAD) refers to hardening and narrowing of the coronary arteries as a result of atherosclerosis. This can cause angina and myocardial infarction and result in heart failure.  

One of the treatment options for suitable patients is coronary artery bypass grafting. These coronary artery bypasses are usually made from the patient's own internal mammary artery or greater saphenous vein.

Traditionally, saphenous vein harvest is performed through an incision overlying the length of the saphenous vein using either a single long incision or a number of shorter incisions with skin bridges between them. Complications include wound dehiscence, infection, oedema of the leg and saphenous nerve damage leading to numbness or persistent pain in some patients. Endoscopic saphenous vein harvest aims to reduce these wound complications.

Coding recommendations

One of the following OPCS-4 codes is used to classify the coronary artery bypass grafting with a saphenous vein graft, depending on the number of arteries replaced:

K40.1 Saphenous vein graft replacement of one coronary artery
K40.2 Saphenous vein graft replacement of two coronary arteries
K40.3 Saphenous vein graft replacement of three coronary arteries
K40.4 Saphenous vein graft replacement of four or more coronary arteries
K40.8 Other specified saphenous vein graft replacement of coronary artery

K40.9 Unspecified saphenous vein graft replacement of coronary artery The endoscopic harvest of the saphenous vein is not coded in addition as this is implicit in the saphenous vein graft replacement code. 

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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