0TL34DZ
Occlusion Kidney Pelvis, Right to No Qualifier with Intraluminal Device, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | T Urinary System |
| Operation | L Occlusion |
| Body Part | 3 Kidney Pelvis, Right |
| Approach | 4 Percutaneous Endoscopic |
| Device | D Intraluminal Device |
| Qualifier | Z No Qualifier |
Operation Definition
Completely closing an orifice or the lumen of a tubular body part
Procedure Overview
Occlusion procedures close off a urinary structure completely, most often a ureter, so that urine or another substance can no longer pass through it. This is done when a ureter must be sealed off because of an unrepairable fistula, a nonfunctioning kidney left in place, or a urinary diversion in which the natural path from kidney to bladder is intentionally interrupted. The occlusion can be achieved surgically by ligating or clipping the ureter, or by placing material inside the vessel to block flow.
Patients who undergo this procedure often have advanced disease affecting kidney function or urinary drainage, such as a kidney destroyed by long-standing obstruction, and the goal is to prevent urine leakage or infection rather than to restore normal function.
Anatomy & Axis Detail
Kidney Pelvis, Right
The right kidney pelvis is the funnel-shaped collecting chamber where the major calyces converge before urine passes into the ureter, and it lies close to renal vessels that make open surgical access more complex on this side than a simple ureteral approach. Occlusion here is generally performed when urine flow must be deliberately blocked, such as to protect a healing anastomosis, manage a fistula, or stage a nephrectomy, and it is most often achieved percutaneously with an occlusion balloon, coil, or plug placed under fluoroscopic guidance through an existing nephrostomy tract. Because the pelvis has thin, distensible walls, care is taken not to occlude so proximally that intrarenal pressure builds and threatens the parenchyma, and the laterality distinction matters for tracking outcomes and complications specific to the right renal unit.
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.
Device: Intraluminal Device
Intraluminal Device denotes a single device, such as a stent or occlusion device, positioned within the lumen of a tubular body part like a vessel, duct, or airway to maintain patency or occlude flow. It carries no drug coating or radioactivity, distinguishing it from the drug-eluting, radioactive, and bioactive intraluminal device values, and from Extraluminal Device, which sits outside rather than inside the lumen.
Coding & Documentation
Coders should confirm from the operative note that the intent was complete closure of the lumen, not narrowing or repair, since Occlusion requires that no material can pass through afterward. Documentation should specify the exact segment of ureter closed and the method used, whether suture ligation, clipping, or an endoluminal occluding device, because the approach value depends on how access was gained.
A common mistake is confusing occlusion with Restriction, which only partially narrows a lumen rather than closing it entirely; if any flow is still possible, Restriction is the correct root operation instead. Another frequent error is coding an occlusion performed as part of a larger diversion or nephrectomy procedure as a separate line item when it was an integral step of that more comprehensive procedure and should not be coded independently.
Commonly Confused With
This family is most often confused with Restriction, since both narrow a tubular structure, and with an incidental ligation performed as a step of another procedure. The key distinction from Restriction is whether the lumen is completely closed versus only partially narrowed. The distinction from an incidental ligation is whether closing the ureter was the primary objective of the procedure or merely a technical step within a more extensive operation such as a nephroureterectomy, in which case it is not coded separately.