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ICD 10 Code 04LF3CW

Occlusion of Left Prostatic Artery with Extraluminal Device, Percutaneous Approach
“Occlusion of L Pros A with Extralum Dev, Perc Approach” for short

04LF3CW is a valid billable ICD-10 procedure code for Occlusion of Left Prostatic Artery with Extraluminal Device, Percutaneous 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

Percutaneous approach involves:
Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure

Occlusion includes:

  • Fallopian tube ligation, ligation of inferior vena cava

Internal Iliac Artery, Left body part includes:

  • Deferential artery
  • Hypogastric artery
  • Iliolumbar artery
  • Inferior gluteal artery
  • Inferior vesical artery
  • Internal pudendal artery
  • Lateral sacral artery
  • Middle rectal artery
  • Obturator artery
  • Prostatic artery
  • Superior gluteal artery
  • Superior vesical artery
  • Umbilical artery
  • Uterine Artery
  • Vaginal artery

Extraluminal Device device includes:

  • AtriClip LAA Exclusion System
  • LAP-BAND(R) adjustable gastric banding system
  • REALIZE(R) Adjustable Gastric Band
MS-DRG - Medicare Severity-Diagnosis Related Group
  • MDC 05 Diseases & Disorders of the Circulatory System
    Other Circulatory O.R. Procedures
    • DRG 264 - OTHER CIRCULATORY SYSTEM O.R. PROCEDURES
  • MDC 12 Diseases & Disorders of the Male Reproductive System
    Other Male Reproductive System Procedures
    • DRG 715 - OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC
    • DRG 716 - OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC
    • DRG 717 - OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC
    • DRG 718 - OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXCEPT MALIGNANCY 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 04LF3CW — See Table View

1: Section 0 Medical and Surgical
2: Body System 4 Lower Arteries
3: Root Operation L Occlusion
4: Body Part F Internal Iliac Artery, Left
5: Approach 3 Percutaneous
6: Device C Extraluminal Device
7: Qualifier W Prostatic Artery, Left

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.