02PW3RZ
Removal Thoracic Aorta, Descending to No Qualifier with Short-term External Heart Assist System, Percutaneous Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 2 Heart and Great Vessels |
| Operation | P Removal |
| Body Part | W Thoracic Aorta, Descending |
| Approach | 3 Percutaneous |
| Device | R Short-term External Heart Assist System |
| Qualifier | Z No Qualifier |
Operation Definition
Taking out or off a device from a body part
Procedure Overview
Removal covers taking out a device that was previously placed in the heart or a great vessel, such as a pacemaker lead, a prosthetic valve ring, a vascular occluder, or an intra-aortic balloon pump catheter. This is not a procedure aimed at treating the underlying heart tissue; it is specifically about extracting hardware that no longer needs to be there, whether because it has failed, become infected, or served its temporary purpose.
Situations that call for this include lead extraction when a pacing wire is infected or malfunctioning, removal of a temporary mechanical circulatory support device once a patient stabilizes, or taking out a closure device that migrated or failed to seat properly. The procedure can be as simple as withdrawing a catheter at the bedside or as involved as an open surgical extraction of a chronically embedded lead.
Anatomy & Axis Detail
Thoracic Aorta, Descending
Removal from the descending thoracic aorta applies to taking out a previously placed device such as an endovascular stent graft, occluder, or other implanted material from this vessel segment, not to excision of aortic tissue. Because endografts in the descending thoracic aorta are deployed to exclude aneurysms or dissections, their removal is typically performed when a device has migrated, infected, or failed to seal, and often requires open surgical exposure or a combined endovascular explant technique given the graft's fixation to the vessel wall. The operative report should specify that the procedure was directed at extracting the implanted device itself, since a concurrent aortic repair or graft replacement performed at the same time would be captured with additional codes beyond the removal.
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: Short-term External Heart Assist System
Short-term External Heart Assist System describes a mechanical circulatory support device with components located outside the body, used to provide temporary cardiac support during acute decompensation or as a bridge to further therapy. Unlike the Implantable Heart Assist System, it is not intended for durable, fully internal placement, and it is typically removed once the patient stabilizes or transitions to another device.
Coding & Documentation
Coders need documentation identifying exactly what device is being removed and confirming that nothing is being put in its place during the same operative episode - if a new device replaces the old one, the case is coded as Replacement or Insertion/Removal combination coding instead of Removal alone. The approach matters too: a lead pulled out through its existing venous entry site is coded differently than one requiring an open thoracotomy for extraction. A frequent error is coding Removal for routine adjustment or repositioning of a device that stays in the body, which instead falls under Revision.