# Laparoscopic inguinal sentinel lymph node excision



## karey (Apr 9, 2013)

How would I code a Laparoscopic inguinal sentinel lymph node excision? This was done w/ a Lap Hysterectomy BSO 58571 and pelvic and peri-aortic lymph node dissection 38572. 

Would I use 38589-Unlisted laparoscopy procedure, lymphatic system? What code would I use for the dye injection? 38900 or 38792? 38900 sounds to be more accuarate but it is an add on code and I am not coding any of the primary procedures that this code coinsides w/. Here is a portion of the Op report:

[FONT=COURIER,sans-serif]Pneumoperitoneum was then created to a level not greater 15 mmHg.At [/FONT][FONT=COURIER,sans-serif]that time, 1 ml of Lymphazurin blue solution was placed at 3 o'clock and [/FONT][FONT=COURIER,sans-serif]9 o'clock in the cervix.[/FONT]
[FONT=COURIER,sans-serif] [/FONT]
[FONT=COURIER,sans-serif]Next the remaining three 8 mm robotic ports, 5 mm and 12 mm[/FONT]
[FONT=COURIER,sans-serif]laparoscopic ports were placed in left and right upper quadrant usual [/FONT][FONT=COURIER,sans-serif]locations without difficulty.Survey of the abdomen revealed no pelvic [/FONT][FONT=COURIER,sans-serif]or abdominal carcinomatosis.  Diaphragm smooth.Liver smooth.Surfaces [/FONT][FONT=COURIER,sans-serif]of bowel were normal appearing.Omentum was normal appearing.The left [/FONT][FONT=COURIER,sans-serif]adnexa had a smooth simple cyst which was about 5 cm in diameter. [/FONT][FONT=COURIER,sans-serif]Prior to docking the robot ICG (green) dye was injected into the cervix [/FONT][FONT=COURIER,sans-serif]at 3 o'clock and 9 o'clock as well, 1 ml was used.The robot was then [/FONT][FONT=COURIER,sans-serif]docked in the usual fashion.[/FONT]
[FONT=COURIER,sans-serif] [/FONT]
[FONT=COURIER,sans-serif]The bilateral pelvic spaces were opened.Pararectal spaces and [/FONT][FONT=COURIER,sans-serif]paravesical spaces were opened in the usual fashion.Blue dye and green [/FONT][FONT=COURIER,sans-serif]dye was not noticed in the nodes on either area after multiple [/FONT][FONT=COURIER,sans-serif]observations.The lymphatics on the left did highlight was both blue [/FONT][FONT=COURIER,sans-serif]and green within the same channels leading directly to a lymph nodes [/FONT][FONT=COURIER,sans-serif]along the proximal left external iliac basin.This node was removed and [/FONT][FONT=COURIER,sans-serif]sent separately.Otherwise there were no other sentinel nodes in the [/FONT][FONT=COURIER,sans-serif]right pelvis or in the bilateral periaortic area[/FONT]​


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## TWinsor (Apr 9, 2013)

According to your note the lymph node was along the left external iliac basin.  Just wondering if that would be included in the 38572.  I posted the lay description from encoder pro below.

The physician performs laparoscopic bilateral pelvic lymphadenectomy and peri-aortic lymph node sampling. The physician places a trocar at the umbilicus and insufflates the abdominal or retroperitoneal cavity. The laparoscope is placed through the umbilical port and additional trocars are placed into the peritoneal or retroperitoneal space. The iliac vessels are identified and the lymph nodes are dissected from the vessels and surrounded structures and removed. Dissection is continued onto the aorta and peri-aortic nodes are sampled. The trocars are removed and the incisions are closed.

just a thought.

Terri


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## karey (Apr 9, 2013)

That's what I was thinking too. Should I use the unlisted code for the dye injection since there isn't a stand alone code for this?

38999- Unlisted procedure, hemic or lymphatic system


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## TWinsor (Apr 15, 2013)

38792


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