Subfascial endoscopic perforator vein surgery
Summary
The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on subfascial endoscopic perforator vein surgery.
Description
The procedure is used for patients with either healed or active ulcers (CEAP classifications 5 or 6), caused by chronic venous insufficiency, in whom incompetent calf perforating veins are thought to be an important contributing factor, particularly where conservative management (such as leg elevation, compression therapy and medication) has failed. Deep venous occlusion and/or infected ulcers are usually contraindications to SEPS.
SEPS is a minimally invasive alternative to open subfascial perforator vein surgery.
Preoperative evaluation is performed by duplex scanning of the superficial, deep and perforator venous systems to diagnose both valvular incompetence and obstruction. During the operation, the limb is exsanguinated and two endoscopic ports are placed in the subfascial space in the calf at sites remote from the area of venous ulceration. A space-maker balloon is introduced and inflated in this subfascial space to improve access. Carbon dioxide is then insufflated to facilitate dissection. The incompetent perforating veins are clipped and divided with endoscopic scissors or, alternatively, coagulated and divided with an ultrasonic coagulator (harmonic scalpel).
OPCS code:
For endoscopic subfascial ligation surgery of perforating veins:
L83.2 Subfascial ligation of perforating vein of leg
Y76.3 Endoscopic approach to other body cavity
For perforating veins that are clipped and divided with endoscopic scissors, the following OPCS-4.5 codes are appropriate:
L83.8 Other specified other operations for venous insufficiency
Y76.3 Endoscopic approach to other body cavity
Y07.2 Clipping of organ NOC
The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS. The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided. www.connectingforhealth.co.uk/clinicalcoding
Details
Skin
Surgical procedures
Contact details:
(for general enquiries or comments)
Interventional Procedures Programme
National Institute for Health and Clinical Excellence
MidCity Place
71 High Holborn
London
WC1V 6NA
