06CH4ZZ
Extirpation Hypogastric Vein, Right to No Qualifier with No Device, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 6 Lower Veins |
| Operation | C Extirpation |
| Body Part | H Hypogastric Vein, Right |
| Approach | 4 Percutaneous Endoscopic |
| Device | Z No Device |
| Qualifier | Z No Qualifier |
Operation Definition
Taking or cutting out solid matter from a body part
Procedure Overview
Extirpation in the lower veins describes removing solid material, most often a blood clot, that has formed inside a vein of the leg, pelvis, or lower abdomen. The classic example is a venous thrombectomy, where a surgeon opens the vein or threads a catheter-based device into it to pull out an obstructing thrombus, restoring blood flow and reducing the risk of the clot breaking loose or the leg swelling further from blocked drainage.
This procedure is used for deep vein thrombosis that is causing severe swelling, pain, or threatens the limb's viability, and occasionally for retrieving embolized foreign material such as a fragment of a failed device. It differs from simply dissolving a clot with medication, because here the solid material is physically taken out of the body rather than broken down chemically or left to be reabsorbed.
The approach can be open surgical, through a small incision directly into the vein, or percutaneous, using a catheter and suction or mechanical retrieval device threaded through the venous system to capture and withdraw the clot.
Anatomy & Axis Detail
Hypogastric Vein, Right
The right hypogastric, or internal iliac, vein drains the pelvic viscera, gluteal region, and perineum on the right side before joining the external iliac vein to form the common iliac vein. Thrombus within this vessel is less frequently isolated and more often identified in the context of pelvic surgery, malignancy, obstetric complications, or extension from adjacent iliac venous thrombosis, given its role collecting numerous small pelvic tributaries. Extirpation removes this material, and the vein's deep pelvic location, surrounded by the internal iliac artery, ureter, and pelvic nerves, makes exposure and dissection technically demanding. Because the internal iliac venous plexus has extensive collateral connections, clearing an obstruction here can meaningfully affect pelvic venous congestion and collateral flow patterns, so documentation should specify the extent of the procedure and any related pelvic vein involvement.
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.
Coding & Documentation
Coders need documentation identifying the specific vein involved (femoral, iliac, popliteal, or an unspecified lower vein) and confirmation that solid matter, typically thrombus, was removed rather than fragmented and left in place. The approach, open or percutaneous, must be captured accurately since it changes the character value in the code. Physician notes describing a device "pulled the clot out" or "the thrombus was extracted via catheter" support Extirpation, while notes describing the clot being macerated, dispersed, or broken into smaller pieces that dissolve naturally point toward Fragmentation instead.
A frequent error is coding Extirpation when the documentation actually describes catheter-directed thrombolysis, which is a medication-based procedure and not a root operation in this surgical section at all; that scenario typically falls under a different section for administration of a thrombolytic drug. Coders also sometimes miss that if a stent or filter is placed during the same encounter, an additional Insertion or Restriction code is needed alongside the Extirpation code.