ICD-10-PCS Billable Code

0DT88ZZ

Resection Small Intestine to No Qualifier with No Device, Via Natural or Artificial Opening Endoscopic Approach

Procedural Specifications

Clinical Axis Detail Definition
Section0 Medical and Surgical
Body SystemD Gastrointestinal System
OperationT Resection
Body Part8 Small Intestine
Approach8 Via Natural or Artificial Opening Endoscopic
DeviceZ No Device
QualifierZ 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

Small Intestine

This value applies when the small intestine is resected as a whole without documentation specifying which of its three named subdivisions was involved, or when the excised segment spans across duodenal, jejunal, and ileal boundaries. The small intestine is the primary site of nutrient absorption, and its resection is performed for conditions such as extensive Crohn's disease, mesenteric ischemia, volvulus, or diffuse tumor involvement that crosses anatomic segments. Because absorptive capacity and the risk of short bowel syndrome depend heavily on how much small bowel is removed, surgeons document resection length and the segments involved whenever possible. Coders should default to this general body part only when the operative report genuinely does not localize the resection to the duodenum, jejunum, or ileum specifically; otherwise the more precise segmental code should be used.

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.

Commonly Confused With

ExcisionResection is most frequently confused with Excision, where only a portion of the body part is cut out rather than the whole defined segment, making the extent of removal the deciding factor.
DestructionIt is also distinguished from Destruction, which eliminates tissue without physically extracting it, such as through cautery or ablation, and from Detachment, which applies to external body parts rather than internal GI structures.
ReplacementWhen resection is followed by insertion of graft material to replace the organ's function, the additional step should be coded as Replacement.