0BR60KZ
Replacement Lower Lobe Bronchus, Right to No Qualifier with Nonautologous Tissue Substitute, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | B Respiratory System |
| Operation | R Replacement |
| Body Part | 6 Lower Lobe Bronchus, Right |
| Approach | 0 Open |
| Device | K Nonautologous Tissue Substitute |
| 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
This family involves putting in biological or synthetic material that physically takes over for a missing or damaged portion of the respiratory tract, most notably reconstruction of the trachea using graft material after a segment is removed for stenosis or tumor invasion. Unlike a lung transplant, which replaces the entire organ from a donor and is classified separately, these procedures typically address a segment of the airway wall.
Patients undergo these procedures when the trachea has been narrowed, weakened, or destroyed to the point that simple repair won't hold, often after prior injury from prolonged intubation, tumor removal, or a congenital defect. The graft, whether from the patient's own tissue, a donor, or a synthetic conduit, is meant to permanently stand in for the missing structure.
Anatomy & Axis Detail
Lower Lobe Bronchus, Right
The right lower lobe bronchus is the largest and most posteriorly directed of the right-sided lobar airways, giving rise to the superior and basal segmental bronchi that ventilate the lower lobe. When extensive tumor involvement, post-infectious stricture, or trauma destroys a length of this airway, replacement substitutes the damaged segment with graft or synthetic conduit to maintain patency and preserve lower lobe function rather than proceeding to lobectomy. Its posterior course and relationship to the inferior pulmonary vein and lower lobe arterial branches must be respected during reconstruction to avoid vascular injury. Documentation should make clear that a substitute structure was placed to take over the airway's function, as opposed to a reposition or repair, which would leave the native bronchial tissue in continued use.
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: Nonautologous Tissue Substitute
Nonautologous Tissue Substitute refers to biologic material sourced from a donor or another species, such as an allograft or xenograft, used to replace a body part. It differs from Autologous Tissue Substitute by tissue origin outside the patient's own body, and from Synthetic Substitute by being biologic rather than manufactured material.
Coding & Documentation
Coding requires documentation confirming that material was placed to physically take the place of tissue that was removed or is absent, not merely reinforcing existing tissue. Operative notes should specify the graft or substitute material used and the segment of the airway or lung structure it replaces. A recurring error is confusing a patch graft over an existing airway wall, which is Supplement, with true segmental replacement following excision.
Commonly Confused With
The closest points of confusion are with Supplement, where original tissue remains and is only reinforced, and with Transplantation, reserved for whole-organ lung replacement from a donor. Checking whether the native structure was removed before the graft was placed, and whether the graft is a segment or an entire organ, resolves most of these distinctions.