04LT0DZ ICD-10-PCS Code: Occlusion of Right Peroneal Artery with Intraluminal Device, Open Approach

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

The MS-DRG grouper treats this as an operating room procedure. It appears in the surgical logic of 9 MS-DRGs:

• MDC 05 — Other Vascular Procedures: DRG 252, DRG 253, DRG 254
• MDC 21 — Other O.R. Procedures for Injuries: DRG 907, DRG 908, DRG 909
• MDC 24 — Other O.R. Procedures for Multiple Significant Trauma: DRG 957, DRG 958, DRG 959

From the CMS MS-DRG Definitions Manual, Appendix E. Actual DRG assignment depends on the complete claim.

Related Codes

Same operation — other Body Part

Same table and root operation, differing only in the body part character.

04LP0DZ — Occlusion of Right Anterior Tibial Artery with Intraluminal Device, Open Approach, 04LQ0DZ — Occlusion of Left Anterior Tibial Artery with Intraluminal Device, Open Approach, 04LR0DZ — Occlusion of Right Posterior Tibial Artery with Intraluminal Device, Open Approach, 04LS0DZ — Occlusion of Left Posterior Tibial Artery with Intraluminal Device, Open Approach, 04LU0DZ — Occlusion of Left Peroneal Artery with Intraluminal Device, Open Approach, 04LV0DZ — Occlusion of Right Foot Artery with Intraluminal Device, Open Approach, 04LW0DZ — Occlusion of Left Foot Artery with Intraluminal Device, Open Approach, 04LY0DZ — Occlusion of Lower Artery with Intraluminal Device, Open Approach, +22 more

Same operation — other Approach

Same table and root operation, differing only in the approach character.

04LT3DZ — Occlusion of Right Peroneal Artery with Intraluminal Device, Percutaneous Approach, 04LT4DZ — Occlusion of Right Peroneal Artery with Intraluminal Device, Percutaneous Endoscopic Approach

Same operation — other Device

Same table and root operation, differing only in the device character.

04LT0CZ — Occlusion of Right Peroneal Artery with Extraluminal Device, Open Approach, 04LT0ZZ — Occlusion of Right Peroneal Artery, Open Approach

Same procedure category (CCSR), other tables

AHRQ's Clinical Classifications Software Refined groups these ICD-10-PCS procedures with this one under Ligation and embolization of vessels (Cardiovascular Procedures); listed here are the members in other PCS tables. Source: Clinical Classifications Software Refined (CCSR), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, November 2025.

03LV4ZZ — Occlusion of Left Thyroid Artery, Percutaneous Endoscopic Approach, 03LY0CZ — Occlusion of Upper Artery with Extraluminal Device, Open Approach, 03LY0DZ — Occlusion of Upper Artery with Intraluminal Device, Open Approach, 03LY0ZZ — Occlusion of Upper Artery, Open Approach, 03LY3CZ — Occlusion of Upper Artery with Extraluminal Device, Percutaneous Approach, 03LY3DZ — Occlusion of Upper Artery with Intraluminal Device, Percutaneous Approach, 03LY3ZZ — Occlusion of Upper Artery, Percutaneous Approach, 03LY4CZ — Occlusion of Upper Artery with Extraluminal Device, Percutaneous Endoscopic Approach, 03LY4DZ — Occlusion of Upper Artery with Intraluminal Device, Percutaneous Endoscopic Approach, 03LY4ZZ — Occlusion of Upper Artery, Percutaneous Endoscopic Approach, 05L00CZ — Occlusion of Azygos Vein with Extraluminal Device, Open Approach, 05L00DZ — Occlusion of Azygos Vein with Intraluminal Device, Open Approach, 05L00ZZ — Occlusion of Azygos Vein, Open Approach, 05L03CZ — Occlusion of Azygos Vein with Extraluminal Device, Percutaneous Approach, 05L03DZ — Occlusion of Azygos Vein with Intraluminal Device, Percutaneous Approach, 05L03ZZ — Occlusion of Azygos Vein, Percutaneous Approach, 05L04CZ — Occlusion of Azygos Vein with Extraluminal Device, Percutaneous Endoscopic Approach, 05L04DZ — Occlusion of Azygos Vein with Intraluminal Device, Percutaneous Endoscopic Approach, 05L04ZZ — Occlusion of Azygos Vein, Percutaneous Endoscopic Approach, 05L10CZ — Occlusion of Hemiazygos Vein with Extraluminal Device, Open Approach, +813 more

Contextual Map

Every relationship of 04LT0DZ in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run 04LT0DZ with these 5 related codes in Claim Check

PCS table

• 04L[PCS table]— CMS ICD-10-PCS tables
• Medical and Surgical — Section: Medical and Surgical[Section]: “Medical and Surgical”— CMS ICD-10-PCS tables
• Lower Arteries — Body System: Lower Arteries[Body System]: “Lower Arteries”— CMS ICD-10-PCS tables
• Occlusion — Operation: Occlusion[Operation]: “Occlusion”— CMS ICD-10-PCS tables

MS-DRG participation (9)

• DRG 252 — OTHER VASCULAR PROCEDURES WITH MCC[MS-DRG]: “OTHER VASCULAR PROCEDURES WITH MCC — Other Vascular Procedures (MDC 05)”— CMS MS-DRG Definitions Manual (Appendix E) · FY2026
• DRG 253 — OTHER VASCULAR PROCEDURES WITH CC[MS-DRG]: “OTHER VASCULAR PROCEDURES WITH CC — Other Vascular Procedures (MDC 05)”— CMS MS-DRG Definitions Manual (Appendix E) · FY2026
• DRG 254 — OTHER VASCULAR PROCEDURES WITHOUT CC/MCC[MS-DRG]: “OTHER VASCULAR PROCEDURES WITHOUT CC/MCC — Other Vascular Procedures (MDC 05)”— CMS MS-DRG Definitions Manual (Appendix E) · FY2026
• DRG 907 — OTHER O.R. PROCEDURES FOR INJURIES WITH MCC[MS-DRG]: “OTHER O.R. PROCEDURES FOR INJURIES WITH MCC — Other O.R. Procedures for Injuries (MDC 21)”— CMS MS-DRG Definitions Manual (Appendix E) · FY2026
• DRG 908 — OTHER O.R. PROCEDURES FOR INJURIES WITH CC[MS-DRG]: “OTHER O.R. PROCEDURES FOR INJURIES WITH CC — Other O.R. Procedures for Injuries (MDC 21)”— CMS MS-DRG Definitions Manual (Appendix E) · FY2026
• DRG 909 — OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC[MS-DRG]: “OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC — Other O.R. Procedures for Injuries (MDC 21)”— CMS MS-DRG Definitions Manual (Appendix E) · FY2026
• DRG 957 — OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC[MS-DRG]: “OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC — Other O.R. Procedures for Multiple Significant Trauma (MDC 24)”— CMS MS-DRG Definitions Manual (Appendix E) · FY2026
• DRG 958 — OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC[MS-DRG]: “OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC — Other O.R. Procedures for Multiple Significant Trauma (MDC 24)”— CMS MS-DRG Definitions Manual (Appendix E) · FY2026
• and 1 more

Clinical classification (CCSR)

• CAR010 — Ligation and embolization of vessels[CCSR category]: “Ligation and embolization of vessels — Cardiovascular Procedures”— AHRQ CCSR for ICD-10-PCS Procedures (HCUP) · v2026.1

MDC crossing · diagnoses (16966)

• MDC 05 — Diseases and Disorders of the Circulatory System[MDC crossing]: “Diseases and Disorders of the Circulatory System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026
• MDC 21 — Injuries, Poisonings and Toxic Effects of Drugs[MDC crossing]: “Injuries, Poisonings and Toxic Effects of Drugs — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026
• A36.81 — Diphtheritic cardiomyopathy[Same-MDC diagnosis]: “Diphtheritic cardiomyopathy — grouped in MDC 05, the diagnosis side of this code's crossing.”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• A39.50 — Meningococcal carditis, unspecified[Same-MDC diagnosis]: “Meningococcal carditis, unspecified — grouped in MDC 05, the diagnosis side of this code's crossing.”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• A39.51 — Meningococcal endocarditis[Same-MDC diagnosis]: “Meningococcal endocarditis — grouped in MDC 05, the diagnosis side of this code's crossing.”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• A39.52 — Meningococcal myocarditis[Same-MDC diagnosis]: “Meningococcal myocarditis — grouped in MDC 05, the diagnosis side of this code's crossing.”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• A39.53 — Meningococcal pericarditis[Same-MDC diagnosis]: “Meningococcal pericarditis — grouped in MDC 05, the diagnosis side of this code's crossing.”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• and 16961 more

Nearest codes

• 04L00DZ — Occlusion of Abdominal Aorta with Intraluminal Device, Open Approach[One axis away]— CMS ICD-10-PCS tables
• 04L10DZ — Occlusion of Celiac Artery with Intraluminal Device, Open Approach[One axis away]— CMS ICD-10-PCS tables
• 04L20DZ — Occlusion of Gastric Artery with Intraluminal Device, Open Approach[One axis away]— CMS ICD-10-PCS tables
• 04L30DZ — Occlusion of Hepatic Artery with Intraluminal Device, Open Approach[One axis away]— CMS ICD-10-PCS tables
• 04L40DZ — Occlusion of Splenic Artery with Intraluminal Device, Open Approach[One axis away]— CMS ICD-10-PCS tables
• 04L50DZ — Occlusion of Superior Mesenteric Artery with Intraluminal Device, Open Approach[One axis away]— CMS ICD-10-PCS tables
• 04L60DZ — Occlusion of Right Colic Artery with Intraluminal Device, Open Approach[One axis away]— CMS ICD-10-PCS tables
• 04L70DZ — Occlusion of Left Colic Artery with Intraluminal Device, Open Approach[One axis away]— CMS ICD-10-PCS tables