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ICD 10 Code 04L50DZ

Occlusion of Superior Mesenteric Artery with Intraluminal Device, Open Approach
“Occlusion of Sup Mesent Art with Intralum Dev, Open Approach” for short

04L50DZ is a valid billable ICD-10 procedure code for Occlusion of Superior Mesenteric Artery with Intraluminal Device, Open Approach. It is found in the 2025 version of the ICD-10 Procedure Coding System (PCS) and can be used in all HIPAA-covered transactions from Oct 01, 2024 - Sep 30, 2025.

Occlusion involves:
Completely closing an orifice or the lumen of a tubular body part. The orifice can be a natural orifice or an artificially created orifice

Open approach involves:
Cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure

Occlusion includes:

  • Fallopian tube ligation, ligation of inferior vena cava

Superior Mesenteric Artery body part includes:

  • Ileal artery
  • Ileocolic artery
  • Inferior pancreaticoduodenal artery
  • Jejunal artery

Intraluminal Device device includes:

  • Absolute Pro Vascular (OTW) Self-Expanding Stent System
  • Acculink (RX) Carotid Stent System
  • AFX(R) Endovascular AAA System
  • AneuRx(R) AAA Advantage(R)
  • Assurant (Cobalt) stent
  • Carotid WALLSTENT(R) Monorail(R) Endoprosthesis
  • CoAxia NeuroFlo catheter
  • Colonic Z-Stent(R)
  • Complete (SE) stent
  • Cook Zenith AAA Endovascular Graft
  • Driver stent (RX) (OTW)
  • E-Luminexx(tm) (Biliary)(Vascular) Stent
  • Embolization coil(s)
  • Endologix AFX(R) Endovascular AAA System
  • Endurant(R) Endovascular Stent Graft
  • Endurant(R) II AAA stent graft system
  • EXCLUDER(R) AAA Endoprosthesis
  • Express(R) (LD) Premounted Stent System
  • Express(R) Biliary SD Monorail(R) Premounted Stent System
  • Express(R) SD Renal Monorail(R) Premounted Stent System
  • FLAIR(R) Endovascular Stent Graft
  • Formula(tm) Balloon-Expandable Renal Stent System
  • GORE EXCLUDER(R) AAA Endoprosthesis
  • GORE TAG(R) Thoracic Endoprosthesis
  • Herculink (RX) Elite Renal Stent System
  • Innova(tm) stent
  • LifeStent(R) (Flexstar)(XL) Vascular Stent System
  • Medtronic Endurant(R) II AAA stent graft system
  • Micro-Driver stent (RX) (OTW)
  • MULTI-LINK (VISION)(MINI-VISION)(ULTRA) Coronary Stent System
  • Omnilink Elite Vascular Balloon Expandable Stent System
  • Protege(R) RX Carotid Stent System
  • Stent, intraluminal (cardiovascular)(gastrointestinal)(hepatobiliary)(urinary)
  • Talent(R) Converter
  • Talent(R) Occluder
  • Talent(R) Stent Graft (abdominal)(thoracic)
  • Therapeutic occlusion coil(s)
  • Ultraflex(tm) Precision Colonic Stent System
  • Valiant Thoracic Stent Graft
  • WALLSTENT(R) Endoprosthesis
  • Xact Carotid Stent System
  • Zenith AAA Endovascular Graft
  • Zenith Flex(R) AAA Endovascular Graft
  • Zenith TX2(R) TAA Endovascular Graft
  • Zenith(R) Renu(tm) AAA Ancillary Graft
MS-DRG - Medicare Severity-Diagnosis Related Group
  • MDC 05 Diseases & Disorders of the Circulatory System
    Other Major Cardiovascular Procedures
    • DRG 270 - OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC
    • DRG 271 - OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC
    • DRG 272 - OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC
  • MDC 06 Diseases & Disorders of the Digestive System
    Other Digestive System O.R. Procedures
    • DRG 356 - OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC
    • DRG 357 - OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC
    • DRG 358 - OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC
  • MDC 21 Injuries, Poisonings & Toxic Effects of Drugs
    Other O.R. Procedures for Injuries
    • DRG 907 - OTHER O.R. PROCEDURES FOR INJURIES WITH MCC
    • DRG 908 - OTHER O.R. PROCEDURES FOR INJURIES WITH CC
    • DRG 909 - OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC
  • MDC 24 Multiple Significant Trauma
    Other Procedures for Multiple Significant Trauma
    • DRG 957 - OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC
    • DRG 958 - OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC
    • DRG 959 - OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
  • MDC 99 Other
    Non-extensive Procedure Unrelated to Principal Diagnosis
    • DRG 987 - NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
    • DRG 988 - NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
    • DRG 989 - NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

ICD-10-PCS code structure for 04L50DZ — See Table View

1: Section 0 Medical and Surgical
2: Body System 4 Lower Arteries
3: Root Operation L Occlusion
4: Body Part 5 Superior Mesenteric Artery
5: Approach 0 Open
6: Device D Intraluminal Device
7: Qualifier Z No Qualifier

See also

  • The ICD-10-PCS Index of common procedure terms.
  • Medical and Surgical terms in the ICD-10-PCS Definitions table. These definitions may also provide additional explanation and/or examples within this section.
  • The ICD-10-PCS Device Aggregation Table containing entries that correlate a specific ICD-10-PCS device value with a general device value to be used in tables containing only general device values.