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Revision Lower Bursa and Ligament to No Qualifier with Nonautologous Tissue Substitute, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | M Bursae and Ligaments |
| Operation | W Revision |
| Body Part | Y Lower Bursa and Ligament |
| Approach | 0 Open |
| 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
This family covers procedures that correct a problem with a device previously placed in or on a bursa or ligament, such as a suture anchor, tendon graft fixation device, or synthetic ligament augmentation that has shifted, loosened, or is otherwise not functioning as intended. Rather than replacing the device outright, the surgeon repositions it, tightens or adjusts hardware, or removes broken pieces and debris while leaving the rest of the construct in place. These situations typically arise after ligament reconstruction surgery, such as an ACL repair using a graft anchored with screws or buttons, or after a bursa-related implant used to manage chronic bursitis.
Patients usually undergo this type of procedure when imaging or symptoms such as instability, pain, or a popping sensation suggest that hardware from an earlier operation has migrated or partially failed. The goal is to salvage the original repair and restore normal joint mechanics without starting over with a completely new reconstruction.
Anatomy & Axis Detail
Lower Bursa and Ligament
The lower bursa and ligament body part encompasses connective tissue structures of the lower extremities and pelvis when a previously placed device or graft requires correction rather than complete replacement. This situation arises when hardware used in a prior ligament repair, such as suture anchors or a synthetic graft, has loosened, migrated, broken down, or caused a complication that needs surgical adjustment. Revision preserves as much of the original repair as possible while correcting the malfunctioning element, distinguishing it from removal or a fresh reconstruction. Given that this code applies broadly across the lower body rather than one specific joint, the operative note should describe the general anatomic region and the exact nature of the corrective action taken.
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.
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
Coders assign a code from this family when the operative note describes correcting the position of an existing device or repairing a malfunctioning component, not simply removing and replacing it with an identical device, which would instead point toward Change or a removal/insertion pair. Supporting documentation should identify the specific device involved, its original location, and the nature of the correction, such as tightening a graft fixation screw or repositioning a migrated anchor. A common assignment error is coding the entire ligament repair as though it were a fresh procedure rather than isolating the revision to the device itself; another is confusing partial hardware removal, which belongs here, with complete device removal followed by a new device, which requires separate root operations.