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Excision Ulna, Left to No Qualifier with No Device, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | P Upper Bones |
| Operation | B Excision |
| Body Part | L Ulna, Left |
| Approach | 0 Open |
| 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 covers cutting out a portion of an upper bone without replacing it, most often to obtain a tissue sample for diagnosis or to remove a tumor, cyst, or damaged segment while leaving the surrounding bone intact. Rib excisions are performed for suspected malignancy or to gain surgical access to the chest, clavicle and scapula excisions address tumors or nonunion fragments, and small excisional biopsies are done on the humerus, forearm bones, or hand bones when imaging shows an indeterminate lesion.
Because only a portion of the bone is taken and the rest of the structure remains, this differs from removing an entire bone or joint segment. The excised tissue is typically sent to pathology, and the remaining bone may need grafting or fixation depending on how much structural support was lost.
Anatomy & Axis Detail
Ulna, Left
The left ulna functions as the forearm's stabilizing strut, forming the elbow's hinge articulation proximally and contributing to wrist mechanics distally through its head and styloid process. Surgeons excise portions of it to remove benign or malignant bone tumors, sequestra from osteomyelitis, or exostoses causing pain and limited rotation. Because the ulnar shaft lies subcutaneously along the forearm's medial border, excisions are often approached directly, but care is taken around the ulnar nerve as it courses near the proximal shaft and the wrist. Preserving the olecranon's articular surface and triceps attachment is critical when the lesion is near the elbow. Documentation should specify that only a discrete portion of bone was cut out, since this differentiates the excision from more extensive resection or full amputation procedures affecting the same bone.
Approach: Open
Open approach means the surgeon cuts through skin, mucous membrane, or other tissue layers to physically expose the target site to view before performing the procedure. It gives direct visualization and hands-on access, distinguishing it from Percutaneous approaches where instruments pass through a small puncture without exposing the site. Open is typical for procedures needing wide access, such as most laparotomies.
Coding & Documentation
Coders need documentation confirming that a portion, not the entirety, of the named bone was cut out, along with the specific bone and, where relevant, whether the procedure was diagnostic. A biopsy that removes only a small sample for pathology still falls under Excision, with a qualifier indicating diagnostic intent.
The most frequent error is selecting Excision when an entire bone or a whole anatomical segment such as the whole clavicle was removed, which instead falls under Resection. Another common issue is failing to code bone grafting or fixation performed immediately afterward as separate procedures when the operative note describes them as distinct steps.