ICD-10-PCS Billable Code

0LT40ZZ

Resection Upper Arm Tendon, Left to No Qualifier with No Device, Open Approach

Procedural Specifications

Clinical Axis Detail Definition
Section0 Medical and Surgical
Body SystemL Tendons
OperationT Resection
Body Part4 Upper Arm Tendon, Left
Approach0 Open
DeviceZ No Device
QualifierZ No Qualifier

Operation Definition

Cutting out or off, without replacement, all of a body part

Procedure Overview

Resection removes an entire tendon, or a clearly defined tendon body part, without putting in any replacement material. This is a less common tendon procedure than repair or reposition, and it is typically performed when a tendon is so severely diseased, degenerated, or tumor-involved that removing it entirely is the safest or most effective option, rather than attempting to preserve and repair it.

Examples include excising a tendon segment infiltrated by a soft tissue tumor, removing a chronically diseased tendon that is causing ongoing pain and dysfunction with no reasonable prospect of repair, or excising an entire tendon as part of managing a severe infection that has destroyed the tissue. Because tendons connect muscle to bone, complete resection without any subsequent reconstruction can leave a functional deficit, so it is often paired with a separate reconstructive procedure, sometimes performed later, to restore movement.

Anatomy & Axis Detail

Upper Arm Tendon, Left

On the left upper arm, the distal biceps and triceps tendons may be entirely excised when chronic rupture, severe tendinosis, or tumor involvement leaves no viable tissue to repair. A retracted distal biceps tendon that has scarred into the surrounding fascia, for example, is sometimes removed outright rather than mobilized and reattached, particularly in older or lower-demand patients where restoring supination strength is a lesser priority. Because these tendons lie adjacent to the brachial neurovascular bundle, resection requires meticulous dissection even though no reconstruction may follow. The coder should confirm from the operative note whether the tendon was fully excised, which supports resection, or only debrided and reattached, which would instead represent a repair or reattachment procedure on this same tendon.

Approach: Open

Open approach means the surgeon cuts through skin, mucous membrane, or other tissue layers to physically expose the target site to view before performing the procedure. It gives direct visualization and hands-on access, distinguishing it from Percutaneous approaches where instruments pass through a small puncture without exposing the site. Open is typical for procedures needing wide access, such as most laparotomies.

Coding & Documentation

This root operation applies only when an entire named tendon body part, not merely a segment or the whole tendon down to its full anatomic extent, is being cut out and nothing biological or synthetic is placed to take its structural role. Coders should confirm the operative note describes complete excision of the tendon at that body part value, and check whether any reconstructive graft was placed at the same time, since combined excision and grafting is coded as Replacement instead.

A common assignment mistake is applying Resection when only part of a tendon was removed and the remaining tendon was repaired or trimmed, which should instead be coded as Excision or Repair depending on the amount and intent of tissue removed. Coders should also watch for tumor cases where a wider excision spans tendon and adjacent soft tissue, which may require coding to more than one body system.

Commonly Confused With

ExcisionResection is frequently confused with Excision, since both remove tendon tissue; the distinguishing factor is completeness, Resection takes the entire tendon body part while Excision removes only a portion of it.
ReplacementIt is also confused with Replacement when a tumor resection is immediately followed by grafting to rebuild the tendon, in which case the excision and reconstruction should be captured as two distinct procedures rather than one combined code.