0QBN4Z2
Excision Metatarsal, Right to Sesamoid Bone(s) 1st Toe with No Device, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | Q Lower Bones |
| Operation | B Excision |
| Body Part | N Metatarsal, Right |
| Approach | 4 Percutaneous Endoscopic |
| Device | Z No Device |
| Qualifier | 2 Sesamoid Bone(s) 1st Toe |
Operation Definition
Cutting out or off, without replacement, a portion of a body part
Procedure Overview
Excision procedures on the lower bones remove a portion of a bone in the pelvis, hip, leg, ankle, or foot without replacing what's taken out. Surgeons perform these when a piece of bone needs to come out but the rest of the bone can stay in place - trimming a bone spur pressing on a nerve, taking a wedge sample from a suspicious lesion to send for biopsy, or shaving down a prominent area that's causing pain or skin breakdown.
Because only part of the bone is involved, the surrounding structure typically remains functional. Recovery often centers on protecting the area while it heals rather than rebuilding lost function, though larger excisions near a joint may need a period of limited weight-bearing.
Anatomy & Axis Detail
Metatarsal, Right
The right metatarsals are the five long bones forming the mid-foot arch, bridging the tarsals to the toe phalanges and bearing significant load during push-off in gait. Excision here removes a portion of a metatarsal without replacing it, typically for a bone tumor, chronic osteomyelitis, or a symptomatic bunionette deformity affecting the fifth metatarsal head. Because these bones sit close together and support the transverse arch, even a partial resection can shift weight-bearing mechanics onto adjacent rays, so documentation should specify which metatarsal (first through fifth) and whether the head, neck, or shaft segment was taken. Surgeons often approach dorsally, and coders should distinguish this cutting-away procedure from a complete ray amputation, which would instead code to a different root operation entirely.
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.
Qualifier: Sesamoid Bone(s) 1st Toe
Sesamoid Bone(s) 1st Toe specifies the small sesamoid bones embedded within the tendons at the base of the great toe as the qualifying structure in a foot bone procedure. These bones are commonly involved in bunion surgery and are distinguished from the metatarsal or phalangeal bones of the same toe that they sit beneath.
Coding & Documentation
Assign an excision code when the operative note describes cutting out a discrete portion of a lower bone - an exostosis, an osteophyte, a bone biopsy specimen, or margins around a tumor - without inserting a device or graft to replace the missing bone. The note should specify the bone and the general region (e.g., femoral neck, calcaneus) since Lower Bones is subdivided by specific bone. A common assignment error is coding excision when the surgeon actually removed the entire bone or a full bony process, which is resection; another is missing that a biopsy taken via excisional technique still codes as excision even though it's diagnostic rather than therapeutic.