Which of the following would require a procedure coded as extirpation?

Extirpation refers to the complete removal of a substance, usually a foreign body or tissue, from a specific site within the body. In this context, destruction of calculi is classified as extirpation because it involves the removal of a pathological stone (calculi) from a duct or organ. The procedure can be performed through various methods, including surgery or other techniques like lithotripsy, which break down the stones for removal.

In contrast, removal of tissue around a tumor suggests a different nature of procedure focused more on excision rather than outright removal of a substance. Insertion of a stent does not align with extirpation as it involves placing a device to support the lumen of a vessel rather than removing tissue or calculi. Lastly, destruction of tissue refers to procedures that are focused on eliminating tissue by non-invasive means but do not involve the complete removal of that tissue, which does not meet the definition of extirpation.

Thus, destruction of calculi directly fits the definition of extirpation due to its focus on the removal of solid masses that obstruct or pose a threat to organ function.