0PR63KZ
Replacement Scapula, Left to No Qualifier with Nonautologous Tissue Substitute, Percutaneous Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | P Upper Bones |
| Operation | R Replacement |
| Body Part | 6 Scapula, Left |
| Approach | 3 Percutaneous |
| 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
Replacement procedures in the upper bones involve removing all or part of a bone in the skull, face, thorax, or upper limb and substituting it with a device or biological material that takes over its structural role. Cranioplasty with a synthetic plate after a skull defect, and prosthetic reconstruction of a portion of the humerus or clavicle following tumor removal, are typical examples.
These procedures are performed when a bone is too damaged, diseased, or absent to be repaired or repositioned, and the patient needs a physical substitute to maintain the shape of the skull or the mechanical function of a limb. The material can be a synthetic implant, such as titanium mesh or bone cement, or biological tissue, such as an allograft.
Anatomy & Axis Detail
Scapula, Left
On the left side, the scapula again serves as the flat girdle bone anchoring the rotator cuff, trapezius, and rhomboids while forming the socket half of the shoulder joint through its glenoid process. Bone replacement is typically performed after wide oncologic resection, a severely comminuted fracture, or osteomyelitis with segmental loss, situations uncommon enough that each case tends to involve custom or allograft reconstruction rather than an off-the-shelf implant. The surgeon must recreate the coracoid and spine contours closely enough to preserve muscular leverage for arm elevation and rotation. Coders should confirm laterality against the operative note and distinguish scapular body replacement from replacement limited to the glenoid cavity, since these are captured as separate body parts.
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: 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 from this family requires documentation that a body part was actually taken out and something physically put in its place, not simply reinforced. The device value must match the material used - synthetic versus autologous versus nonautologous tissue - so operative notes describing the graft source matter for accurate code selection. A recurring error is coding replacement when the native bone was left in place and only augmented, which belongs under supplement instead. Coders should also confirm whether the replaced segment is a full bone or only a portion, since this affects the body part value chosen.