0TC40ZZ
Extirpation Kidney Pelvis, Left to No Qualifier with No Device, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | T Urinary System |
| Operation | C Extirpation |
| Body Part | 4 Kidney Pelvis, Left |
| 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 procedures that physically remove solid material from inside a urinary structure without cutting out any of the structure itself. Classic examples include removing a kidney or bladder stone through an open or endoscopic approach, clearing a blood clot obstructing the bladder, or taking out debris that has collected in a ureter. The material removed is abnormal - it does not belong there - and the underlying organ stays intact once it is gone.
Anatomy & Axis Detail
Kidney Pelvis, Left
The left kidney pelvis is the funnel-like collecting structure that gathers urine from the calyces before it passes into the left ureter, and its relatively dependent, low-flow geometry makes it a frequent site for calculus formation and crystalline debris accumulation. Extirpation here refers to the physical removal of such solid material, commonly performed via percutaneous nephrolithotomy, ureteroscopic stone basketing, or open pyelolithotomy for large or complex stones. This body part is coded distinctly from the kidney parenchyma itself, so documentation should confirm that the stone or debris originated in, and was removed from, the pelvic collecting space rather than the renal substance. Because the left kidney pelvis lies near the splenic flexure and major vasculature, access planning for percutaneous approaches often differs from the right side and should be reflected in the coded approach value.
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
The coder needs documentation confirming that the object removed was solid matter foreign to normal anatomy, such as a calculus, clot, or necrotic material, and that no tissue resection occurred alongside it. The specific site and approach (percutaneous, transurethral, open) determine the code. A common assignment error is coding stone removal as Fragmentation when the stone was broken up and then extracted as pieces - if fragments are actually retrieved and removed, Extirpation may apply to the retrieval step in addition to Fragmentation for the breaking-up step, and coders sometimes capture only one of the two.