Urology Coding Alert

Question: My urologist performed a "modified inguinal lymph node dissection," and I am questioning what code to use. I am looking at CPT 38770 and thinking of adding modifier 52 because the procedure was a modified dissection and not a radical resection. Is this the correct code, or is there a better one to use?

Ohio Subscriber

Answer: You should look at 38760 (Inguinofemoral lymphadenectomy, superficial, including Cloquets node [separate procedure]) and 38765 (Inguino-femoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes [separate procedure]).

Best bet: Ask your physician which procedure description is most appropriate for what he did. If he performed a superficial dissection and also a pelvic dissection, you should report the latter code, 38765. Because the urologist did a modified lymph node dissection, you'll most likely find that 38760 is the most appropriate code.

Tip: You may need to add modifier 52 (Reduced services) on 38760 or 38765 depending on what the urologist actually did.

-- Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and com-pliance officer for Urology of Indiana LLC, a 31-urologist, two-urogynecologist practice in Indianapolis.