0VTL4ZZ
Resection Epididymis, Bilateral to No Qualifier with No Device, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | V Male Reproductive System |
| Operation | T Resection |
| Body Part | L Epididymis, Bilateral |
| Approach | 4 Percutaneous 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 procedures remove an entire body part of the male reproductive system without replacing it with other material. Orchiectomy - removal of one or both testes - is the most common example, performed for testicular cancer, as part of treatment for advanced prostate cancer, for severe trauma, or occasionally for chronic pain or infection unresponsive to other treatment. Other resection procedures in this family include removal of the entire epididymis or complete removal of the prostate and seminal vesicles.
These are typically definitive procedures aimed at eliminating diseased or damaged tissue rather than preserving it. Because the organ is removed in full, resection often has permanent effects on fertility and hormone production, which is part of why patients considering these procedures discuss options like sperm banking or hormone replacement beforehand.
Anatomy & Axis Detail
Epididymis, Bilateral
Bilateral resection of the epididymides removes the coiled ducts on both sides in a single operative encounter, eliminating the site of sperm maturation and storage on each testis while typically leaving both testes in place if the underlying condition permits. This procedure is performed for bilateral chronic epididymitis, bilateral epididymal tumors, or extensive cystic disease affecting both sides symmetrically, and it results in infertility due to loss of the ductal pathway even though testicular hormone production continues. The operative documentation should confirm removal of both epididymides during the same surgical episode for the bilateral body part value to apply, distinguishing this from two separate unilateral procedures performed at different times.
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.
Coding & Documentation
Coders assigning Resection need pathology or operative documentation confirming the entire organ was removed, not just a portion. A frequent error is coding Resection when only a partial excision was performed, such as a partial orchiectomy for a small testicular mass with preservation of remaining tissue - that scenario belongs under Excision instead. Laterality also matters: unilateral versus bilateral orchiectomy uses different body part values, and the note should state clearly whether one or both testes were removed.