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The procedure described by CPT® Code 38562 refers to a limited lymphadenectomy performed for staging purposes, specifically targeting the pelvic and para-aortic lymph nodes. This surgical intervention involves making an incision in the abdomen to access and evaluate the lymph nodes, which are critical in determining the presence of metastatic disease. The procedure begins with an exploration of the pelvic lymph nodes, which are carefully excised while preserving important anatomical structures such as the genitofemoral nerve and the psoas muscle. The surgeon meticulously strips fatty tissue from the mid-portion of both common iliac vessels and along the internal and external iliac vessels, extending to the level of the circumflex iliac vein. During the operation, the iliac, hypogastric, and obturator lymph nodes are bilaterally removed. Following this, the peritoneal cavity is opened, allowing for a thorough exploration of the abdomen and pelvis to check for any signs of metastatic disease. The para-aortic lymph nodes are then exposed, and biopsies are taken for frozen section analysis. If any para-aortic lymph nodes are found to be involved, they are excised as well. In cases where retroperitoneal lymph node staging is necessary, as indicated by CPT® Code 38564, the procedure may be approached either transabdominally or thoracoabdominally, typically starting on the same side as the malignancy. The retroperitoneum is fully exposed, and the dissection of the aortic lymph nodes commences at the renal vessels, extending laterally to the ureters and inferiorly to the bifurcation of the inferior mesenteric artery. This dissection includes lymph nodes located between the aorta and the inferior vena cava, and may also involve sampling lymph nodes along the splenic artery. The frozen section analysis of all lymph node samples is crucial for determining the extent of lymph node involvement, allowing the surgical approach to be adjusted based on the findings. Depending on the level of involvement on the ipsilateral side, lymph nodes on the contralateral side may also be sampled and excised as necessary.
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The limited lymphadenectomy for staging, as described by CPT® Code 38562, is indicated for the evaluation of lymphatic involvement in patients with suspected malignancies. The procedure is typically performed in the following scenarios:
The procedure for a limited lymphadenectomy for staging involves several critical steps, each aimed at ensuring thorough evaluation and removal of affected lymph nodes:
Post-procedure care following a limited lymphadenectomy for staging involves monitoring the patient for any complications related to the surgery, such as bleeding or infection. Patients may require pain management and should be observed for signs of lymphatic fluid accumulation. Recovery typically includes a period of rest, with gradual resumption of normal activities as tolerated. Follow-up appointments are essential to discuss pathology results from the excised lymph nodes and to plan any further treatment based on the staging outcomes.
| Short Descr | REMOVAL PELVIC LYMPH NODES | Medium Descr | LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC | Long Descr | Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic | 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) | 2 - 150% payment adjustment 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 |
This is a primary code that can be used with these additional add-on codes.
| 38900 | Addon Code MPFS Status: Active Code APC N ASC N1 Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure) |
| 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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) | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |