General Surgery Coding Alert

Question: Which group of lymph nodes constitutes a "total pelvic lymphadenectomy" with reference to codes 38571 and 38572? If the surgeon doesn't remove all the lymph nodes but does more than a biopsy, do I need to resort to an unlisted code such as 38579?

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Answer: The bilateral external iliac, internal iliac (hypogastric), and obturator nodes are all part of a pelvic lymphadenectomy.

When considering codes, let's start by looking at the descriptors for the two procedure codes you mention:

• 38571 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy)
• 38572 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy) single or multiple).

You are correct that code 38571 does not specifically indicate the node groups being resected. Because of that, you can report 38571 for all therapeutic laparoscopic pelvic node resections no matter which of the above-listed groups the surgeon removes.

Caveat: Remember that if the surgeon performs an incomplete resection or only a unilateral resection, you should append modifier 52 (Reduced services) to 38571 and document the surgeon's work.

If the surgeon also removes nodes located higher than the pelvic nodes, such as those at and above the aortic and vena cava bifurcation, you should report 38572 for an extended node resection.

For very limited lymph node removal, you should generally turn to a biopsy code instead an unlisted code.