07WL3KZ
Revision Cisterna Chyli to No Qualifier with Nonautologous Tissue Substitute, Percutaneous Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | 7 Lymphatic and Hemic Systems |
| Operation | W Revision |
| Body Part | L Cisterna Chyli |
| Approach | 3 Percutaneous |
| Device | K Nonautologous Tissue Substitute |
| Qualifier | Z No Qualifier |
Operation Definition
Correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device
Procedure Overview
Revision procedures address a device that was previously placed in the lymphatic and hemic system and is no longer working as intended or has moved out of position, and the surgeon corrects the problem without fully removing and replacing the device. In practice this arises with implanted devices used to manage lymphatic complications, such as a clip or mechanical closure device placed around the thoracic duct that has slipped, loosened, or otherwise failed to control a chyle leak as originally intended. Repositioning or adjusting that device to restore its function falls into this family.
Because implanted lymphatic devices are uncommon compared to those used elsewhere in the body, this family is used less frequently than Revision families in other body systems, but the clinical logic is the same: correct what exists rather than start over.
Anatomy & Axis Detail
Cisterna Chyli
Revision of the cisterna chyli involves correcting a malfunctioning or malpositioned device placed during a prior procedure on this retroperitoneal lymphatic reservoir, such as an occlusion coil or plug that has shifted, failed to seal a leak, or produced a new obstruction to lymphatic drainage. Because the cisterna lies deep between the aorta and the vertebral bodies at roughly the L1-L2 level, revision is almost always performed percutaneously under fluoroscopic guidance rather than through direct surgical exposure. Clinical indications include recurrent chylous ascites or chylothorax despite an initial restriction or occlusion attempt, or device-related complications identified on follow-up lymphangiography. Documentation should distinguish revision, which corrects an existing device or repair, from a fresh restriction or occlusion procedure targeting a new site along the lymphatic pathway.
Approach: Percutaneous
Percutaneous describes entry by needle or instrument puncture through the skin or mucous membrane to reach the site of the procedure, without cutting the tissue open or using a visualizing scope. It differs from Open in that the site itself is never exposed, and from Percutaneous Endoscopic in that no endoscope is used to see internal structures. Common examples include needle biopsies and injections.
Device: Nonautologous Tissue Substitute
Nonautologous Tissue Substitute refers to biologic material sourced from a donor or another species, such as an allograft or xenograft, used to replace a body part. It differs from Autologous Tissue Substitute by tissue origin outside the patient's own body, and from Synthetic Substitute by being biologic rather than manufactured material.
Coding & Documentation
A coder should confirm the note describes fixing or repositioning a device that was already in place, rather than removing it entirely and inserting a new one. Documentation needs to identify both the device being revised and the specific problem being corrected, such as displacement or malfunction. The most common error is coding Removal followed by a fresh insertion when the surgeon actually adjusted the existing device in place, which should be captured as a single Revision instead.