# Excision of deep-subfascial inguinal lymph node



## erubritz

OPERATION:  Excision left inguinal lymph node-single-lymphadenectomy-deep-subfascial

PROCEDURE:  Left inguinal palpable lymph node marked preoperatively with indelible ink was palpabled again and a local field block was achieved using Marcaine with ephinephrine.  An oblique incision was made in the skin crease in Langer's lines through the skin and subcutaneous tissue down below the Scarpa's fascia down deep subfascial where an ovoid, enlarged lymph node measuring approximately 2.5 to 3 cm was then identified and this was removed using hemoclips thus ligating the lymphatic channels and venous and arterial blood supply.  Specimen was removed and sent to pathology.  This was not sent for flow cytometry as this is a lymphadenopathy as a reation/response to infrection of the left leg from an insect bite.  Wound was irrigated out.  No bleeding seen Deep tissue and Scarpa's fascia were reapproximated with subcuticular 4-0 Vicryl suture.


I'm sorta at a loss as to how to code/bill this one since there isn't an actual code for it.  Unless I use the unlisted procedure code 38999, but then my concern is that my doc won't get any RVU's for this procedure, which is how they get paid.


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## wcarmignani

Per the last CPT assistant it is coded with 38500, which doesn't make sense since it even covers deep but its all I could find:

Jan 2009 CPT Assistant: Question: What is the most appropriate code to report a simple, deep lymph node excision of the inguinal area (not a radical lymphadenectomy)? 

Answer: From a CPT coding perspective, code 38760, Inguinofemoral lymphadenectomy, superficial, including Cloquets node (separate procedure), represents a procedure for a superficial dissection of the inguinal lymph nodes (groin nodes) and is commonly performed for malignancy. Code 38765, Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure), represents the work described by code 38760 plus a deep dissection of the pelvic lymph nodes on the same side as the superficial dissection. If a full dissection is not performed (regardless of depth or regions), depending on the technique used, either code 38500, Biopsy or excision of lymph node(s); open, superficial, or code 38505, Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary), is reportable.


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## erubritz

Thank you!  I appreciate the information!


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## stephanie7480

If ultrasound (inguinal) lymph node mapping is performed prior to the open excision is it separately reportable?


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