05C64ZZ
Extirpation Subclavian Vein, Left to No Qualifier with No Device, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 5 Upper Veins |
| Operation | C Extirpation |
| Body Part | 6 Subclavian Vein, Left |
| 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 procedures on the upper veins remove solid matter, such as an organized blood clot, plaque, or foreign material, from inside a vein while leaving the vein itself intact. This is performed when a clot has formed within the vessel, causing pain, swelling, or risk of the clot traveling elsewhere in the body, and the physician needs to clear the vessel lumen rather than remove any of the vein wall.
The procedure can be done through an open incision or percutaneously with a catheter-based device that grabs or suctions the clot out through a small puncture. Because it targets solid material specifically, it is distinct from simply draining fluid, and the goal is to restore normal blood flow through a vein that would otherwise remain obstructed.
Anatomy & Axis Detail
Subclavian Vein, Left
The left subclavian vein, situated beneath the clavicle and continuing from the axillary vein, is anatomically similar to the right but carries a higher relative incidence of effort-related thrombosis due to the more acute angle at which it crosses the thoracic outlet, predisposing it to compression between the clavicle and first rib. Extirpation is performed to clear thrombus, whether from spontaneous venous thrombosis, catheter-associated clot, or in the context of thoracic outlet syndrome, and can be done via open surgical thrombectomy or endovascular techniques. Because thoracic outlet decompression is frequently performed in conjunction with thrombus removal for this vein, the operative note must distinguish material actually extracted from the vessel lumen from any concurrent rib resection or scalenectomy performed to relieve extrinsic compression.
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
Documentation should clearly describe the material removed as solid, such as thrombus, and specify the approach used, open or percutaneous, since that determines the approach character. The named upper vein involved must be identified precisely, as the body part options are vein-specific rather than grouped by limb.
A recurring coding error is applying extirpation when the physician instead broke up the clot in place without removing it, which belongs to fragmentation rather than extirpation. Another common issue is coding a mechanical thrombectomy that also involved placement of a stent or angioplasty as extirpation alone, when the additional intervention requires its own separate code.