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Resection Ascending Colon to No Qualifier with No Device, Via Natural or Artificial Opening Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | D Gastrointestinal System |
| Operation | T Resection |
| Body Part | K Ascending Colon |
| Approach | 8 Via Natural or Artificial Opening Endoscopic |
| Device | Z No Device |
| Qualifier | Z No Qualifier |
Operation Definition
Cutting out or off, without replacement, all of a body part
Procedure Overview
Resection describes the surgical removal of an entire gastrointestinal organ or a clearly defined anatomic segment of one, without putting anything in its place. Common examples include total gastrectomy for stomach cancer, complete removal of the appendix, and total colectomy for severe ulcerative colitis, where the entire designated body part as defined by the coding system is taken out rather than just a portion of it.
Surgeons choose resection when disease, most often cancer, severe inflammatory conditions, or irreversible ischemic damage, affects an entire organ or a segment that the classification treats as a whole unit, such as the cecum or the sigmoid colon. The remaining ends of the digestive tract are typically reconnected in the same operation, restoring continuity, though in some cases a stoma is created instead when reconnection is not immediately safe.
Anatomy & Axis Detail
Ascending Colon
The ascending colon is the fixed, retroperitoneal segment of the large intestine that carries stool from the cecum upward to the hepatic flexure, and it is supplied primarily by the ileocolic and right colic arteries. Resection of this segment is performed for adenocarcinoma localized to the ascending colon, a large sessile polyp not resectable endoscopically, or complicated inflammatory disease confined to this region. Because the ascending colon is fixed to the posterior abdominal wall by peritoneal attachments, mobilization along the white line of Toldt is required before the segment can be resected and the remaining bowel reanastomosed, often to the transverse colon. Coders should confirm the resection is limited to this segment rather than extending proximally into the cecum or distally past the hepatic flexure, either of which would warrant a different body part value.
Approach: Via Natural or Artificial Opening Endoscopic
Via Natural or Artificial Opening Endoscopic describes instrumentation introduced through a natural orifice or a surgically created opening while using an endoscope for visualization, as in a routine colonoscopy performed through the anus. It differs from the plain Via Natural or Artificial Opening value by the added scope, and from Percutaneous Endoscopic by using an existing passage rather than a new skin puncture.
Coding & Documentation
The key documentation requirement is that the entire body part, as defined by the specific GI body part value, was removed, not merely a partial excision of tissue from within it. When only part of a segment is taken, such as a wedge of stomach tissue, the correct root operation is Excision rather than Resection, which is one of the most common assignment errors in this family. Coders must also identify whether an anastomosis, stoma, or other reconstruction was performed and code that separately from the resection itself, since the two are distinct steps. Clear identification of the specific segment removed, such as right colon versus left colon versus total colon, is essential because each maps to a different body part value.