0MB14ZX
Excision Shoulder Bursa and Ligament, Right to Diagnostic with No Device, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | M Bursae and Ligaments |
| Operation | B Excision |
| Body Part | 1 Shoulder Bursa and Ligament, Right |
| Approach | 4 Percutaneous Endoscopic |
| Device | Z No Device |
| Qualifier | X Diagnostic |
Operation Definition
Cutting out or off, without replacement, a portion of a body part
Procedure Overview
Excision procedures cut out a portion of a bursa or ligament without replacing it, leaving the remainder of the structure in place. This is done to remove diseased, damaged, or chronically inflamed tissue, such as a thickened bursa that has not responded to drainage or rest, or a partially torn ligament that needs debridement of frayed edges before repair.
A bursectomy, in which part of an inflamed bursa is removed, is a typical example, as is trimming away degenerated portions of a ligament during reconstructive surgery. Because only a portion of the structure is taken, the ligament or bursa continues to exist and function afterward, distinguishing this from a resection that removes the entire body part.
Excision is often performed as a standalone treatment for chronic bursitis or degenerative ligament disease, or as a preparatory step before repair or reconstruction.
Anatomy & Axis Detail
Shoulder Bursa and Ligament, Right
On the right shoulder, the subacromial and subdeltoid bursae along with the glenohumeral and coracoacromial ligaments are frequently involved in chronic impingement, rotator cuff pathology, or persistent inflammatory bursitis that has not responded to conservative treatment. Excision, most often of a thickened or fibrotic subacromial bursa, is commonly performed arthroscopically alongside procedures such as acromioplasty or rotator cuff repair to relieve mechanical impingement and improve subacromial space. Because the shoulder's bursal and ligamentous anatomy is closely tied to the joint's stability and range of motion, complete versus partial removal of a bursa should be clearly distinguished from any concurrent tendon or capsular work performed during the same operative episode.
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: Diagnostic
Applied chiefly to Excision, this qualifier marks that tissue was removed specifically for diagnostic purposes, i.e., a biopsy intended for pathologic evaluation rather than to treat disease. It distinguishes biopsy-type excisions from therapeutic excisions of the same body part, which are coded without this qualifier even though the physical technique may be identical.
Coding & Documentation
Coders should confirm the note describes cutting out and removing a specific portion of tissue that is sent to pathology or discarded, as opposed to simply releasing or draining the structure. If the entire bursa or ligament is removed, the correct root operation is Resection rather than Excision, so the extent of removal documented by the surgeon is critical.
A frequent error is coding debridement performed as part of a repair as a separate Excision when it was an integral, inherent part of the definitive procedure and should not be coded separately. Biopsies of ligament or bursa tissue also fall under Excision and require attention to the diagnostic qualifier.