0FC90ZZ
Extirpation Common Bile Duct to No Qualifier with No Device, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | F Hepatobiliary System and Pancreas |
| Operation | C Extirpation |
| Body Part | 9 Common Bile Duct |
| Approach | 0 Open |
| Device | Z No Device |
| Qualifier | Z No Qualifier |
Operation Definition
Taking or cutting out solid matter from a body part
Procedure Overview
Extirpation covers taking solid material out of the liver, gallbladder, bile ducts, or pancreas that doesn't belong there, most often gallstones or bile duct stones, but also blood clots, sludge, or other debris obstructing a duct. Unlike excision, nothing that is normally part of the organ is cut away; the goal is simply to clear an obstruction.
This type of procedure is typically performed when a stone has lodged in the common bile duct or cystic duct, causing pain, jaundice, or infection, or when debris is blocking pancreatic drainage. It can be done through an open or laparoscopic incision, or via endoscope during a procedure such as ERCP, where instruments are passed through the mouth and stomach to reach the bile duct.
Because blocked ducts can lead to serious infection or pancreatitis if untreated, extirpation is often performed urgently rather than as scheduled surgery.
Anatomy & Axis Detail
Common Bile Duct
The common bile duct carries bile from the confluence of the hepatic and cystic ducts down to the ampulla of Vater, passing behind the duodenum and through the head of the pancreas before emptying into the small intestine. Extirpation here most often addresses choledocholithiasis, where a migrated gallstone becomes lodged and causes obstructive jaundice, biliary colic, or ascending cholangitis, and may be performed via endoscopic retrograde access or direct surgical exploration. Because the duct runs so close to the pancreatic head and the portal vein, retrieving impacted stones requires care to avoid pancreatitis or vascular injury, and the location of the stone within the duct's course can affect the chosen approach. Clear documentation of common bile duct involvement distinguishes this from stone extraction confined to the cystic duct or hepatic ducts above it.
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
Documentation should identify the material removed (stone, clot, sludge) and its exact location, since the body part value changes the code depending on whether the stone was in the gallbladder, cystic duct, common bile duct, or pancreatic duct. The approach also matters: an ERCP-based stone removal is coded differently than an open choledocholithotomy. A common assignment mistake is defaulting to Extraction because the material was 'pulled out,' when PCS defines this scenario as Extirpation since the object is abnormal solid matter rather than a body part being stripped away by force. Coders should also watch for combination procedures, such as a stone extraction performed during the same operative episode as a cholecystectomy, which may require separate codes.