02RK0KZ
Replacement Ventricle, Right to No Qualifier with Nonautologous Tissue Substitute, 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 | K Ventricle, 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
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
Ventricle, Right
The right ventricle pumps deoxygenated blood into the pulmonary circulation and, unlike the left ventricle, is rarely replaced as tissue because its thinner wall is less commonly the target of structural substitution; when this code applies, it typically reflects extensive reconstruction after resection of an invasive tumor, severe trauma, or repair of a complex congenital anomaly where native free wall tissue is excised and replaced with a patch or conduit. This differs from right ventricular outflow tract reconstruction using a valved conduit, which is more often coded to the pulmonary valve or trunk depending on the segment addressed. Because right ventricular geometry directly affects pulmonary blood flow and tricuspid valve function, any true tissue replacement here requires careful attention to preserving chamber volume and outflow alignment, and the operative note should clearly document the extent of native tissue excised.
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 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.