07L93DZ
Occlusion Lymphatic, Internal Mammary, Left to No Qualifier with Intraluminal Device, Percutaneous Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 7 Lymphatic and Hemic Systems |
| Operation | L Occlusion |
| Body Part | 9 Lymphatic, Internal Mammary, Left |
| Approach | 3 Percutaneous |
| 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 lymphatic vessel or duct so that fluid can no longer pass through it, most notably ligation of the thoracic duct to control a chylous leak or chylothorax where lymphatic fluid is escaping into the chest. A surgeon ties off, clips, or otherwise seals the vessel, either through an open approach or thoracoscopically, redirecting or stopping the flow of lymph at that point.
This is a targeted response to a specific mechanical problem, a duct that's leaking or that needs to be interrupted, rather than a treatment aimed at disease within the node or organ itself. It's used when conservative measures like dietary changes or drainage haven't resolved persistent lymphatic leakage, often following thoracic or cardiac surgery, trauma, or in association with certain tumors.
Because the vessel is completely closed rather than partially narrowed or removed, the tissue beyond the occlusion loses its normal drainage pathway, which is why the procedure is typically reserved for cases where an alternate route for lymph flow exists or the leak itself poses the greater risk.
Anatomy & Axis Detail
Lymphatic, Internal Mammary, Left
The left internal mammary (internal thoracic) lymphatic chain courses parallel to the left internal mammary vessels along the deep surface of the anterior chest wall, draining the left breast, anterior thoracic wall, and adjacent structures. Because the left internal mammary artery is a preferred conduit for coronary artery bypass grafting, lymphatic occlusion in this region can arise as an adjunct during cardiac revascularization harvest or in oncologic procedures for left-sided breast or chest wall disease, where a persistent lymphatic leak after mastectomy or lymph node dissection may require deliberate closure of the channel. The retrosternal location places this chain near the internal mammary vessels and pleura, so careful dissection is required to avoid injuring adjacent structures. Laterality distinguishes this code from its right-sided counterpart and must be confirmed from the operative documentation.
Approach: Percutaneous
Percutaneous describes entry by needle or instrument puncture through the skin or mucous membrane to reach the site of the procedure, without cutting the tissue open or using a visualizing scope. It differs from Open in that the site itself is never exposed, and from Percutaneous Endoscopic in that no endoscope is used to see internal structures. Common examples include needle biopsies and injections.
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
The note should specify the duct or lymphatic vessel occluded, most commonly the thoracic duct, and the technique used - ligation, clipping, or another method that completely closes the lumen - along with the clinical reason, typically a documented chylothorax or chyle leak. Confirming that the vessel is fully closed, not just narrowed or partially interrupted, supports Occlusion over another root operation.
Coders sometimes misassign a percutaneous lymphatic embolization procedure to the wrong root operation by not distinguishing embolic material placed to occlude the duct from a device left for another purpose, or by missing that thoracic duct ligation performed incidentally during a larger thoracic operation still needs its own separate code.
Commonly Confused With
Restriction is the operation most likely to be confused with Occlusion, since both narrow or block a passage, but Restriction only partially narrows the lumen while Occlusion closes it completely - a detail that has to come directly from the operative description of what was accomplished. Ligation for hemostasis during an unrelated procedure, where a small lymphatic is tied off incidentally to control oozing, generally isn't coded separately from the primary procedure, unlike a deliberate therapeutic duct ligation performed to treat a leak.