Urology Coding Alert

Question: I am attempting to understand the issue of laparoscopic pelvic lymphadenectomies done in conjunction with laparoscopic prostatectomies. 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 indicatethe 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 onlya unilateral resection, append modifier 52 (Reduced services) to 38571 and document the urologist’s work.

If the urologist removes nodes located higher than the pelvic nodes (e.g., those atand above theaortic 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 anatomicallymph nodes variation and therefore, the lack of coding specificity.

If the documentation shows a laparoscopic total abdominal lymphadenectomy, report ‘unlisted’ code 38579 with a detailed operative report and covering explanatory letter.