0KTF4ZZ
Resection Trunk Muscle, Right to No Qualifier with No Device, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | K Muscles |
| Operation | T Resection |
| Body Part | F Trunk Muscle, Right |
| 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
This family of procedures covers the complete surgical removal of an entire named muscle, without any replacement tissue put in its place. Surgeons turn to muscle resection most often when a tumor has grown within or fixed itself to the muscle body, when infection has destroyed the muscle beyond salvage, or when severe trauma has left the tissue non-viable. Removing the whole muscle, rather than trimming away only the diseased portion, is typically chosen when partial removal would leave behind disease or dead tissue that could spread infection or allow a cancer to recur.
Because an entire muscle is taken, these operations often affect movement or strength at the joint the muscle once controlled, so they are frequently paired with reconstructive planning, physical therapy, or a transfer procedure using a nearby muscle to take over the lost function. Patients considering or recovering from this kind of surgery are usually managing a serious underlying condition such as sarcoma, gas gangrene, or a crush injury rather than a routine orthopedic complaint.
Anatomy & Axis Detail
Trunk Muscle, Right
Trunk muscle on the right side refers to structures such as the latissimus dorsi, serratus anterior, and paraspinal muscles that stabilize the torso and assist in shoulder and spinal movement. Resection of an entire named trunk muscle is performed for soft tissue sarcomas, extensive desmoid tumors, or radiation-damaged tissue that has become nonviable, and because these muscles are broad and often used as flaps in reconstructive surgery elsewhere in the body, their removal here is coded distinctly from harvesting for transfer. The trunk's musculature overlies the ribs, pleura, and major vessels, so the depth of dissection is a key factor the surgeon documents to confirm the operation stayed within muscle rather than extending into thoracic or abdominal cavities.
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
The operative note must clearly document that the entire named muscle was excised, not just a margin, lesion, or portion of it - phrases like "total resection of the gastrocnemius" support this code, while "debulking" or "partial excision" point toward Excision instead. The pathology or surgeon's description of the specimen (whole muscle versus a wedge or nodule) is the deciding factor coders rely on when the note is ambiguous. The most frequent assignment error is defaulting to Resection whenever a muscle mass is removed, without confirming the surgeon took the entire muscle rather than just the tumor within it. A second common mistake is missing laterality or the specific muscle name, which affects the body part value and can misrepresent the extent of surgery performed.
Commonly Confused With
Resection is easily confused with Excision, which cuts out only a portion of the muscle - the distinguishing question is always "all of the muscle or part of it?" It is also sometimes mixed up with Detachment, used when a limb or body part is amputated at a joint level rather than a single muscle being taken out, and with Destruction, which eliminates tissue with energy (such as cautery) rather than cutting it out and removing a specimen.