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    How to code for pelvic lymphadenectomy

    CPT 38571 is appropriate code in most instances, but beware of one caveat and one exception

    Ray Painter, MDRay Painter, MD Mark PainterMark Painter

     

    Which lymph nodes should be included to be considered a "total" pelvic lymphadenectomy/CPT 38571? When should I consider using the unlisted code or adding a –52 modifier?

    External iliac, hypogastric, and obturator nodes are all considered a part of a pelvic lymphadenectomy; however, 38571 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy) does not specifically delineate which nodes have to be removed. Therefore, 38571 should be used to report all therapeutic pelvic lymphadenectomies with one caveat and one exception.

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    The caveat: If the procedure is interrupted for some technical reason and you are unable to complete the procedure, then charge with the –52 modifier. Otherwise, charge without the modifier.

    The exception: If peri-aortic lymph nodes sampling is added to the total pelvic lymphadenectomy, then charge 38572 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling). If the intent is anything other than a total therapeutic lymphadenectomy performed through the laparoscope, you’re probably stuck with the appropriate unlisted code.

    In summary, there is no discrete delineation or line to be drawn between groups or number of nodes, only intent and accomplishment.

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    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.

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