02RA0LZ
Replacement Heart to No Qualifier with Biologic with Synthetic Substitute, Autoregulated Electrohydraulic, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 2 Heart and Great Vessels |
| Operation | R Replacement |
| Body Part | A Heart |
| Approach | 0 Open |
| Device | L Biologic with Synthetic Substitute, Autoregulated Electrohydraulic |
| Qualifier | Z No Qualifier |
Operation Definition
Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part
Procedure Overview
Replacement procedures put in biological or synthetic material to physically take over for all or part of a heart valve, chamber wall, or great vessel segment that is diseased or damaged beyond simple repair. The most recognizable example is heart valve replacement, where a damaged aortic or mitral valve is taken out and substituted with a mechanical valve, a tissue valve from an animal or human donor, or, increasingly, a valve delivered through a catheter without open-heart surgery.
This family also includes replacing a diseased section of the aorta with a synthetic graft, as is done for an aneurysm or dissection. The underlying decision behind these procedures is that the native tissue can no longer perform its function safely, so a substitute structure is needed to physically stand in for it going forward.
Anatomy & Axis Detail
Heart
Replacement of the heart as a whole body part refers to orthotopic heart transplantation, in which the recipient's diseased native heart is excised and a donor heart is put in its place, most often for end-stage heart failure from cardiomyopathy, refractory ischemic disease, or congenital anomalies that have exhausted other surgical options. This is distinct from replacing individual heart structures such as valves or septa, and the substitute here is nonautologous, allogeneic tissue from a deceased donor rather than a synthetic device. The procedure requires cardiopulmonary bypass, careful preservation of the donor organ during transport, and anastomosis of the great vessels and remaining atrial cuffs. Because a mechanical total artificial heart is coded differently as a synthetic substitute, documentation should clearly identify whether the replacement source is a human donor organ or a device.
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.
Device: Biologic with Synthetic Substitute, Autoregulated Electrohydraulic
This value describes a biologic material combined with a synthetic electrohydraulic component that automatically regulates its own function, most notably an autoregulated artificial urinary sphincter or similar assistive device combining tissue and mechanical elements. It differs from purely synthetic pneumatic devices by incorporating biologic material and self-regulating hydraulic activation rather than manual pneumatic control.
Coding & Documentation
Coding a Replacement case requires documentation confirming that the native structure was taken out (or was already absent, as in a redo procedure) and that a device or graft material now physically occupies that role. The material matters for the device value assigned - mechanical valve, tissue valve, synthetic vascular graft, and autologous tissue graft are all coded differently, so the operative note must specify what was implanted. A common error is coding Replacement when a valve is repaired with an annuloplasty ring rather than fully replaced, since a ring supports the native valve rather than substituting for it, which belongs under Repair or Supplement. Another pitfall is missing that a transcatheter valve replacement still qualifies as Replacement despite the minimally invasive approach, since the root operation depends on what was done, not how the access was gained.