General Surgery Coding Alert

Question: For a patient with abdominal lymphadenopathy, our surgeon performed a laparoscopic lymphadenectomy, removing several mesenteric nodes from the right lower abdominal quadrant. The procedure involved two ports, one through an incisional hernia from a prior surgery. Following the lymph node removal, the patient exhibited intraabdominal bleeding that led the surgeon to perform a laparotomy, connecting the port wounds and extending above the umbilicus, The surgeon controlled the bleeding, then repaired the incisional port hernia and closed the surgical site. Can we separately report the laparoscopic lymphadenectomy, the laparotomy, and the hernia repair?

Virginia Subscriber

Answer: No, you should not code three separate procedures (laparoscopic mesenteric lymph node biopsy, laparotomy with bleeding control, and incisional hernia repair).

You should treat the service as a laparoscopic procedure converted to an open procedure, and report only the most extensive (open) code. CPT® provides many specific lymphadenectomy codes for superficial and deep nodes from certain regions, and for limited (for staging) and radical procedures, but there is not a code specifically for the lymph node biopsy you describe.

Do this: The best code for your procedure is 38999 (Unlisted procedure, hemic or lymphatic system).

You can determine a billing amount based on your surgeon's estimation of the work involved in the procedure relative to comparable codes. Because this is an unlisted code, you can account for both the lymphadenectomy and the hernia repair in your pricing calculation.