0TR707Z
Replacement Ureter, Left to No Qualifier with Autologous Tissue Substitute, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | T Urinary System |
| Operation | R Replacement |
| Body Part | 7 Ureter, Left |
| Approach | 0 Open |
| Device | 7 Autologous 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 put in biological or synthetic material that physically takes over for all or part of a urinary structure that has been removed or has failed. The clearest example is placement of an artificial urinary sphincter to manage stress incontinence, or use of a segment of bowel or synthetic material to reconstruct the bladder after part of it has been taken out.
These procedures are chosen when native tissue can no longer perform its job and a substitute - whether a manufactured device or tissue moved from elsewhere in the body - is put in its place. Candidates include patients recovering from bladder cancer surgery, those with severe incontinence unresponsive to other treatments, or people whose urethra has been damaged beyond simple repair.
Because the replaced material functions in place of the original structure going forward, these procedures are usually more involved and longer-lasting in their effect than repair or reposition.
Anatomy & Axis Detail
Ureter, Left
Replacement of the left ureter involves excising a compromised segment, often due to extensive stricture, tumor involvement, radiation damage, or a failed previous reconstruction, and substituting it with other tissue, most frequently a segment of ileum fashioned into a conduit that bridges the gap between the renal pelvis and the bladder or a lower ureteral stump. This is distinct from simple repair, which restores the ureter's own tissue, since replacement introduces nonureteral material to reestablish the urinary pathway. Surgeons must carefully orient and anastomose the replacement segment to preserve peristaltic-like drainage and reduce the risk of reflux or stricture at the anastomotic sites. A stent commonly protects the reconstruction while it heals. Coders should confirm that a ureteral segment was actually excised and substituted, not merely repaired, dilated, or bypassed.
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: Autologous Tissue Substitute
Autologous Tissue Substitute identifies a device value where material harvested from the patient's own body, such as an autograft, is used to replace or reconstruct a body part. Its defining feature is tissue origin from the patient, setting it apart from Nonautologous Tissue Substitute, sourced from a donor or animal, and Synthetic Substitute, made of manufactured material.
Coding & Documentation
Documentation must show that material - whether a device, donor tissue, or the patient's own tissue harvested from elsewhere - was put in to functionally substitute for the body part, not just reinforce or patch it. The note should identify the material used and confirm that any diseased or damaged native tissue was removed first, since Replacement often follows a Resection or Excision performed in the same operative session.
A common coding mistake is applying Replacement when the correct root operation is actually Supplement, which reinforces existing tissue without taking over its function entirely. Coders also sometimes overlook that bladder augmentation using a bowel segment qualifies as Replacement because it uses tissue to take over bladder function, and instead code it only as the harvesting procedure.