0FC58ZZ
Extirpation Hepatic Duct, Right to No Qualifier with No Device, Via Natural or Artificial Opening Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | F Hepatobiliary System and Pancreas |
| Operation | C Extirpation |
| Body Part | 5 Hepatic Duct, Right |
| Approach | 8 Via Natural or Artificial Opening Endoscopic |
| 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
Hepatic Duct, Right
The right hepatic duct drains bile from the right lobe of the liver before joining its left-sided counterpart to form the common hepatic duct, running within the porta hepatis alongside the right portal vein and hepatic artery branches. Extirpation targets solid material obstructing this duct, such as an impacted stone or inspissated debris, which can cause right-sided biliary obstruction and localized cholangitis if left untreated. Because the right hepatic duct is short and can have anatomic variants in its branching pattern, imaging beforehand often guides the approach to avoid missing a stone lodged in a segmental branch. Documentation should reflect that the procedure addressed the right duct specifically, since obstruction here produces a different drainage pattern than blockage of the left duct or the common hepatic duct downstream.
Approach: Via Natural or Artificial Opening Endoscopic
Via Natural or Artificial Opening Endoscopic describes instrumentation introduced through a natural orifice or a surgically created opening while using an endoscope for visualization, as in a routine colonoscopy performed through the anus. It differs from the plain Via Natural or Artificial Opening value by the added scope, and from Percutaneous Endoscopic by using an existing passage rather than a new skin puncture.
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.