07B94ZZ
Excision Lymphatic, Internal Mammary, Left to No Qualifier with No Device, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 7 Lymphatic and Hemic Systems |
| Operation | B Excision |
| Body Part | 9 Lymphatic, Internal Mammary, Left |
| Approach | 4 Percutaneous Endoscopic |
| Device | Z No Device |
| Qualifier | Z No Qualifier |
Operation Definition
Cutting out or off, without replacement, a portion of a body part
Procedure Overview
Excision procedures remove a portion of a lymph node, the spleen, the thymus, or another lymphatic or hemic structure, without replacing it, most commonly to obtain a tissue sample for diagnosis. Lymph node biopsies fall squarely in this family and are frequently used to stage cancers such as lymphoma or breast cancer, or to investigate unexplained swelling.
Because these excisions are usually diagnostic, the tissue removed is sent to pathology for microscopic examination, and the results often guide decisions about further treatment such as chemotherapy or additional surgery. A partial splenectomy performed to preserve some immune function while removing damaged tissue is another example within this family.
These procedures range from a quick outpatient biopsy under local anesthesia to a more involved surgical excision requiring general anesthesia, depending on the location and size of the tissue being sampled.
Anatomy & Axis Detail
Lymphatic, Internal Mammary, Left
The left internal mammary nodes run alongside the internal mammary vessels beneath the costal cartilages near the sternal border, draining primarily the medial and central portions of the left breast, and their involvement is assessed when a tumor's location or sentinel node mapping suggests parasternal spread rather than the more common axillary route. On the left side, the proximity of the internal mammary vessels to the pericardium and anterior mediastinal structures adds another consideration during dissection, alongside the ever-present risk of pneumothorax from entering the parasternal space. Because this nodal chain is not routinely dissected during standard breast surgery, its excision is typically a targeted, image- or mapping-guided procedure rather than part of a standard axillary clearance. As with the right side, involvement of these nodes can influence staging and radiation planning even when axillary nodes are negative.
Approach: Percutaneous Endoscopic
Percutaneous Endoscopic combines a puncture through skin or mucous membrane with insertion of an endoscope to visualize the procedure internally, as in laparoscopic cholecystectomy. It is distinguished from plain Percutaneous by the presence of scope-guided visualization, and from Via Natural or Artificial Opening Endoscopic by its route being a new puncture rather than an existing orifice or stoma.
Coding & Documentation
A code from this family requires documentation that a portion of the lymphatic or hemic structure was physically cut out and removed from the body, with the rest of the structure left in place. The body part value must match the specific node group or organ documented, such as an axillary versus inguinal lymph node.
A persistent source of error is distinguishing an excisional lymph node biopsy from a full lymph node dissection, where an entire chain or region of nodes is removed; the latter is typically coded as Resection rather than Excision. Coders should also check whether the entire structure, such as the whole spleen, was removed, which again points to Resection instead.