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Revision Upper Bursa and Ligament to No Qualifier with Synthetic Substitute, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | M Bursae and Ligaments |
| Operation | W Revision |
| Body Part | X Upper Bursa and Ligament |
| Approach | 4 Percutaneous Endoscopic |
| Device | J Synthetic 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
Upper Bursa and Ligament
The upper bursa and ligament body part groups connective structures of the upper extremities, shoulder girdle, and trunk when a device previously placed to reinforce these tissues needs correction. Revision becomes necessary when a prior repair, graft, or implanted material has failed, shifted, become infected, or otherwise stopped functioning as intended, requiring the surgeon to adjust, reposition, or partially replace the malfunctioning component without performing an entirely new procedure. Because this body part value spans multiple regions rather than a single named ligament, documentation should indicate the general area involved and the nature of the correction performed, such as removing displaced anchors, adjusting graft tension, or addressing a device-related complication.
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.
Device: Synthetic Substitute
Synthetic Substitute designates a device made from manufactured, non-biologic material, such as mesh or prosthetic components, used to replace or augment a body part. It is distinguished from the two tissue substitute categories by its artificial composition, which carries different considerations for integration and long-term durability than biologic grafts.
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.