Urology Coding Alert

Question: The surgeon removed one lymph node during a transabdominal open bilateral adrenalectomy. Can we bill code 38747 with modifier 52?

Wisconsin Subscriber

Answer: Report 60540 (Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar, or dorsal [separate procedure]) with modifier 50 (Bilateral procedure) for the open transabdominal bilateral adrenalectomy. Also include code 38564 (Limited lymphadenectomy for staging [separate procedure]; retroperitoneal [aortic and/or splenic]) for the excision of the one lymph node. 

Code +38747 (Abdominal lymphadenectomy, regional, including celiac, gastric, portal, peripancreatic, with or without para-aortic and vena caval nodes [List separately in addition to code for primary procedure]) is an inappropriate code for this clinical scenario representing an extensive node dissection with more than the removal of one node, and is also an “add on” code as indicated by the + symbol preceding the code number. An “add on” code cannot be billed as a stand alone code but must be billed in conjunction with another primary appropriate code.