02BH3ZZ
Excision Pulmonary Valve to No Qualifier with No Device, Percutaneous Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 2 Heart and Great Vessels |
| Operation | B Excision |
| Body Part | H Pulmonary Valve |
| Approach | 3 Percutaneous |
| 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 cut out and remove a portion of a heart structure or great vessel without replacing it with anything else. Only part of the body part is taken, distinguishing it from more extensive removal of an entire structure. This might involve removing a segment of diseased tissue, a small mass, or an abnormal growth from within a heart chamber or vessel wall.
Surgeons perform these procedures for reasons ranging from removing a tumor such as a myxoma, to taking a tissue sample for biopsy, to trimming away scarred or damaged tissue that is affecting heart function. Because only a portion of the structure is removed, the underlying body part continues to exist afterward, just in an altered or reduced form.
Anatomy & Axis Detail
Pulmonary Valve
The pulmonary valve, a trileaflet structure between the right ventricle and pulmonary trunk, is less frequently diseased in adults than the left-sided valves but is a focus of congenital anomalies such as stenosis, dysplasia, or absence syndromes, and can be affected by carcinoid heart disease or endocarditis in intravenous drug users. Excision of the pulmonary valve is performed when its own leaflets are removed, either to correct severe stenotic or regurgitant disease with subsequent replacement, or as part of harvesting during a Ross procedure is instead recorded under the aortic valve since the pulmonary valve there is transferred rather than excised. When native pulmonary leaflets are simply cut out due to intrinsic disease, documentation should note the degree of annular involvement, since concurrent annular enlargement or conduit placement is common and separately coded.
Approach: Percutaneous
Percutaneous describes entry by needle or instrument puncture through the skin or mucous membrane to reach the site of the procedure, without cutting the tissue open or using a visualizing scope. It differs from Open in that the site itself is never exposed, and from Percutaneous Endoscopic in that no endoscope is used to see internal structures. Common examples include needle biopsies and injections.
Coding & Documentation
Coders need operative documentation confirming that only part of the body part was removed and that nothing was excised in its entirety, since removal of an entire body part changes the root operation to Resection. Biopsies are a frequent source of confusion: when a sample is taken purely for diagnostic purposes it is still coded as Excision, and the qualifier for diagnostic intent should be applied when documentation supports it. A common error is coding Excision when the surgeon actually removed the entire structure, such as an entire appendage or vessel segment between two anatomic landmarks, which instead requires Resection; another is missing that tissue removed as an inherent part of a more extensive procedure, like debris cleared during a bypass, is not separately coded.