0PUB47Z
Supplement Clavicle, Left to No Qualifier with Autologous Tissue Substitute, Percutaneous Endoscopic Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | P Upper Bones |
| Operation | U Supplement |
| Body Part | B Clavicle, Left |
| Approach | 4 Percutaneous Endoscopic |
| Device | 7 Autologous Tissue Substitute |
| Qualifier | Z No Qualifier |
Operation Definition
Putting in or on biological or synthetic material that physically reinforces and/or augments the function of a portion of a body part
Procedure Overview
Supplement procedures add biological or synthetic material to reinforce or augment a bone of the skull, face, thorax, or upper limb that remains anatomically in place, rather than replacing or repairing damaged tissue. Common examples include bone grafting to reinforce a weakened area of the skull, or augmenting a thin area of the sternum or scapula with mesh or cement to add structural strength.
This approach is chosen when the native bone is largely intact and functional but needs extra support, often to prevent future fracture, to build up bone stock before another procedure, or to strengthen a surgical repair site.
Anatomy & Axis Detail
Clavicle, Left
The left clavicle connects the sternum to the shoulder and acts as a rigid strut that keeps the shoulder girdle positioned away from the chest, a function that fails when the bone develops a nonunion after fracture or is compromised by tumor resection. Supplement in this case means introducing bone graft or a substitute material to fill a defect or bridge a gap so the clavicle can resume its load-bearing role and support normal shoulder mechanics. Its thin subcutaneous covering means the graft site has little soft tissue protection, which is part of why nonunion is relatively common here. Records should specify left-sided laterality and the graft material, since technique varies with defect size and cause.
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: Autologous Tissue Substitute
Autologous Tissue Substitute identifies a device value where material harvested from the patient's own body, such as an autograft, is used to replace or reconstruct a body part. Its defining feature is tissue origin from the patient, setting it apart from Nonautologous Tissue Substitute, sourced from a donor or animal, and Synthetic Substitute, made of manufactured material.
Coding & Documentation
Coders should confirm the operative note describes material being added to reinforce a structure that stays in place, not material substituting for a removed part. The device or graft type documented determines the correct device value - autograft, allograft, synthetic substitute, or nonautologous tissue - so vague documentation of "bone graft" without a source can complicate accurate coding. A common mistake is coding supplement when the surgeon actually performed a replacement, particularly in cranioplasty cases where it's unclear whether native bone was removed first. Another frequent error is missing a supplement code entirely when a graft was placed during a repair or reposition procedure, since it may require a separate code rather than being bundled in.