Oncology & Hematology Coding Alert

Question: Our physician did a bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes. Can we report this with modifier 50 (bilateral procedure)?

New York Subscriber

Answer: When your physician does a complete pelvic lymphadenectomy, you report code 38770 (Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes [separate procedure]). You basically have to decide between reporting the following two possibilities:

1. Append modifier 50 to 38770.

2. Report two units of 38770 with LT (Left side), or RT (Right side).

For any code, you may consult the physician fee schedule database to see if a bilateral modifier is allowed (www.cms.hhs.gov/pfslookup). You may check column Z of the spreadsheet, labeled ‘BILAT SURG.’

If you see a ‘1,’ you can use modifier 50 for that code and expect to receive 150 percent payment for Medicare. Medicare Administrative Contractors of Part B services prefer reporting a bilateral service as a single unit with modifier 50, however this could vary depending on the payor. Some non-Medicare payers prefer reporting bilateral services with two line items; one with RT and 1 unit of service, and the second with LT and 1 unit of service.

Because lymph nodes are on both sides in the pelvis, removal of the nodes is considered bilateral. When using CPT® 38770, it is best that you append modifier 50 to report bilateral procedure and increase the fee of the line item to 150 percent of amount for the unilateral procedure.