# Para-aortic lymph node dissection



## KaylaRieken (Jan 5, 2021)

My provider did a da vinci assisted laparoscopic nephrouretectomy, da vinci assisted laparoscopic para aortic lymph node dissection, and a cystoscopy with a stent removal. I am going to code this as 50548, 38589, and 52310. I am having trouble on what CPT code to benchmark the lymph node dissection to. Would it be 38564, 38747, or 38780? He removed 7 lymph nodes. I don't think these are regional lymph nodes.


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## csperoni (Jan 5, 2021)

Benchmarking for an unlisted involves some discretion since the whole point is that there is no existing code.  If there is an equivalent open procedure, that is what I benchmark.  If I feel due to the particular circumstances documented that this case was a little more complex than the open, in my appeal letter I will specify why and ask for 120% of the open benchmark code.  
The 3 codes you are considering:
38564  Limited lymphadenectomy for staging (separate procedure); retroperitoneal (aortic and/or splenic)            
38747  Abdominal lymphadenectomy, regional, including celiac, gastric, portal, peripancreatic, with or without para-aortic and vena caval nodes (List separately in addition to code for primary procedure)                                                                                                                    
38780  Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal nodes (separate procedure)
I don't see how 38747 or 38780 could even be close when it was 7 para-aortic nodes, which would leave 38564.  

PS - I work in gynonc, not urology, but I don't think I've ever seen pelvic laparoscopic surgery where they removed para-aortic but not pelvic.  Of course the kidneys are higher up than the uterus, so that could be why.  To me, another possible option would 38572-52 since no pelvic nodes.  

Hope some of that helps.


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## daniel (Jan 21, 2021)

If you follow the logic below, you could tell the provider if questioned. That you can't code the lymph node dissection based on this.
But if you work around this, I'd like it to 38564.


Per Medicare
2. CPT code 38747 (abdominal lymphadenectomy, regional, including celiac, gastric, portal, peripancreatic, with or without para-aortic and venal caval nodes...) shall not be reported for the excision of lymph nodes that are in the operative field of another surgical procedure. For example CPT code 38747 shall not be reported for the excision of lymph nodes in the operative field of a gastrectomy, pancreatectomy, hepatectomy, colectomy, enterectomy, or nephrectomy.


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