0DTM4ZG
Resection Descending Colon to Hand-Assisted with No Device, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | D Gastrointestinal System |
| Operation | T Resection |
| Body Part | M Descending Colon |
| Approach | 4 Percutaneous Endoscopic |
| Device | Z No Device |
| Qualifier | G Hand-Assisted |
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
Descending Colon
The descending colon runs from the splenic flexure to the sigmoid colon along the left retroperitoneum and is supplied by branches of the inferior mesenteric artery, making it a common site for diverticular disease due to relatively lower luminal caliber and higher intraluminal pressure. Resection here is performed for descending colon carcinoma, complicated diverticulitis with abscess, fistula, or stricture, or ischemic colitis in the region, and because the descending colon lies in a watershed zone between the superior and inferior mesenteric circulations, it is particularly susceptible to ischemic compromise after ligation of feeding vessels. Mobilization requires incising the lateral peritoneal attachments along the white line of Toldt. Documentation should confirm the resected segment is limited to the descending colon rather than extending proximally to the splenic flexure or distally into the sigmoid.
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.
Qualifier: Hand-Assisted
This qualifier indicates that a laparoscopic or endoscopic procedure was performed with the surgeon's hand inserted through a separate incision to provide tactile feedback and manual assistance alongside the instruments. It distinguishes hand-assisted minimally invasive technique from standard laparoscopic approaches performed with instruments alone.
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.