Urology Coding Alert

Question: What would be the correct CPT Code for a para-aortic lymph node dissection? My doctor did a nephrectomy with total ureterectomy and bladder cuff and a para-aortic lymph node dissection. I know 50234 covers the nephrectomy and ureterectomy but is the lymph node dissection included or is there a separate code? I know code 38562 is for a limited para-aortic lymph node dissection for staging, but I don’t think that is the code I need to use.

South Carolina Subscriber

Answer: For the nephroureterectomy, report 50234 (Nephrectomy with total ureterectomy and bladder cuff; through same incision). Additionally, you should report 38564 (Limited lymphadenectomy for staging [separate procedure]; retroperitoneal [aortic and/or splenic]) for the para-aortic lymphadenectomy.

More extensive? If your urologist performed a more extensive lymph node dissection, you should also consider reporting codes 38780-52 (Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal nodes ; Reduced services) or +38747 (Abdominal lymphadenectomy, regional). The latter code is an add-on code. Either one of these lymphadenectomy codes may be appropriate based on the extent of nodal resection.