Ob-Gyn Coding Alert

Question: I am attempting to understand the issue of laparoscopic pelvic lymphadenectomies done in conjunction with other laparo­scopic surgery. In the CPT®  book, there are two codes for laparoscopic pelvic lymphadenectomies: 38571 and 38572. I have been unable to find a list of lymph nodes (or groups of lymph nodes) that constitute a laparoscopic “bilateral total pelvic lymphadenectomy.” I have several questions since I haven’t been able to find this information:

• Do you know which group of lymph nodes would constitute a “total pelvic lymphadenectomy”?
• Do you know which lymph nodes are excised using a “common template,” and would it constitute a total pelvic lymphadenectomy?
• If the surgeon removes fewer lymph nodes than a total (partial pelvic lymphadenectomy), would you recommend the unlisted code (38579) since the provider is doing more than a lymph node biopsy (38570)?

Connecticut Subscriber

Answer: First, let’s look 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 periaortic lymph node sampling (biopsy) single or multiple.

The external iliac, internal iliac (hypogastric), and obturator nodes are all part of a pelvic lymphadenectomy. However, procedure 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 groups are removed.

Caveat: Remember if the surgeon performs an incomplete resection or only a unilateral resection, append modifier 52 (Reduced services) to 38571 and document the ob-gyn’s work.

If the ob-gyn removes nodes located higher than the pelvic nodes (e.g., those at and above the aortic and vena cava bifurcation), submit 38572 for an extended node resection. Finally, clinically there is no discrete delineation between the groups of nodes because of the many anatomical lymph nodes variation and therefore, the lack of coding

It would be appropriate to use the unlisted code for a limited laparoscopic lymphadenectomy.