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The procedure described by CPT® Code 38380 involves the suture and/or ligation of the thoracic duct through a cervical approach. The thoracic duct is a critical component of the lymphatic system, serving as the primary channel for lymph fluid, which is essential for immune function and fluid balance in the body. It typically originates in the cisterna chyli, located at the level of the second lumbar vertebra, and ascends through the abdominal region, positioned anteriorly to the vertebral bodies. As it progresses into the thoracic cavity, the duct crosses from the right side to the left at approximately the fourth or fifth thoracic vertebra, ultimately draining into the left jugular-subclavian venous junction. Due to its delicate structure, the thoracic duct is vulnerable to injury, which can result in lymphatic leaks. The cervical approach for this procedure involves making a supraclavicular incision on the left side to access the thoracic duct, allowing the physician to locate and repair the site of the leak. This may involve suturing the duct or ligating it above and below the injury site to prevent further leakage. Post-repair, a gauze pad is placed over the area to monitor for any ongoing leakage, and additional reinforcement may be applied using a sealant. This procedure is essential for addressing complications arising from thoracic duct injuries, ensuring proper lymphatic drainage and preventing further complications.
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The procedure is indicated for the following conditions:
The procedure consists of several critical steps to ensure effective repair of the thoracic duct:
After the procedure, the patient is monitored for any signs of complications, including ongoing lymphatic leakage. Chest tubes may be placed following the repair to facilitate drainage and prevent fluid accumulation in the thoracic cavity. The patient will require careful observation during the recovery period to ensure proper healing and to address any potential issues that may arise. Follow-up appointments may be necessary to assess the success of the repair and to monitor the patient's overall recovery.
| Short Descr | THORACIC DUCT PROCEDURE | Medium Descr | SUTR&/LIG THORACIC DUCT CERVICAL APPROACH | Long Descr | Suture and/or ligation of thoracic duct; cervical approach | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 67 - Other therapeutic procedures, hemic and lymphatic system |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| Pre-1990 | Added | Code added. |
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