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Replacement Sternum Bursa and Ligament to No Qualifier with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | M Bursae and Ligaments |
| Operation | R Replacement |
| Body Part | F Sternum Bursa and Ligament |
| Approach | 4 Percutaneous Endoscopic |
| 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 this family involve putting in biological or synthetic material to physically stand in for all or part of a damaged bursa or, far more commonly, a ligament. The clearest example is anterior cruciate ligament (ACL) reconstruction, where a torn ACL is removed and replaced with a graft harvested from the patient's own patellar or hamstring tendon, from a donor, or occasionally a synthetic substitute, because the native ligament cannot be sutured back together and heal reliably.
These procedures are performed when a ligament tear is too severe, too chronic, or too central to joint stability for simple suturing to restore function - the knee, shoulder, and elbow are the joints where ligament replacement is most frequently needed. The goal is to give the joint a new structural cable capable of bearing the same mechanical loads as the original ligament, allowing patients to return to sports or daily activity with restored stability. Recovery is longer than for a simple repair, involving staged rehabilitation as the graft incorporates into the surrounding bone.
Anatomy & Axis Detail
Sternum Bursa and Ligament
The sternum's bursae and ligaments include the sternoclavicular and costosternal ligaments along with adjacent bursal tissue that stabilizes the manubrium, body, and xiphoid against the pull of the ribs and clavicles during breathing and shoulder movement. Replacement is performed when these connective structures are destroyed by trauma, infection, or resection related to sternal reconstruction, leaving insufficient tissue for primary repair. Synthetic mesh or graft material is used to reestablish the anchoring restraint between sternum and adjoining structures, which is particularly important after procedures that compromise chest wall integrity, since inadequate stabilization can affect respiratory mechanics. The confined, midline location and proximity to mediastinal structures make precise graft placement and clear documentation of the replaced ligament important.
Approach: Percutaneous Endoscopic
Percutaneous Endoscopic combines a puncture through skin or mucous membrane with insertion of an endoscope to visualize the procedure internally, as in laparoscopic cholecystectomy. It is distinguished from plain Percutaneous by the presence of scope-guided visualization, and from Via Natural or Artificial Opening Endoscopic by its route being a new puncture rather than an existing orifice or stoma.
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
Coders assign from this family when documentation clearly states that the native ligament or bursa was removed and a graft or prosthetic material was implanted to take its place - autograft, allograft, and synthetic ligament substitutes all qualify. The operative note should identify the graft source and confirm the original structure was excised rather than left in place. A common assignment error is coding Replacement when the surgeon actually augmented an intact ligament with additional material, which is Supplement; the deciding question is whether the native structure was taken out. Another pitfall is missing the correct body part value when a graft crosses two adjoining structures, such as ACL reconstruction touching both femoral and tibial attachment sites.