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Thoracic lymphadenectomy by thoracotomy, as denoted by CPT® Code 38746, involves the surgical removal of lymph nodes located in the thoracic region, specifically when there is evidence of malignant neoplasm metastasis to these nodes. The thoracic lymph nodes encompass various types, including intrapulmonary nodes, bronchopulmonary (hilar) nodes, tracheobronchial nodes, peritracheal nodes, intercostal nodes, mediastinal nodes, and parasternal nodes. This procedure is typically performed in conjunction with another thoracic surgical procedure that necessitates a thoracotomy, which is an incision into the chest wall. The surgeon identifies the affected lymph node chains, often utilizing lymph node mapping techniques to locate the sentinel node, which is the first node to which cancer cells are likely to spread from the primary tumor. Once the involved lymph nodes are located, they are meticulously dissected from the surrounding tissues, with particular attention given to preserving adjacent blood vessels and nerves. The excised lymph nodes are subsequently sent for pathological examination to assess the presence of cancerous cells, which is crucial for determining the extent of disease and guiding further treatment options.
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The thoracic lymphadenectomy procedure is indicated in specific clinical scenarios where there is a suspicion or confirmation of malignancy that has spread to the lymph nodes within the thoracic cavity. The following conditions may warrant this procedure:
The thoracic lymphadenectomy procedure involves several critical steps that ensure the effective removal of affected lymph nodes. The following outlines the procedural steps:
Following the thoracic lymphadenectomy, patients typically require monitoring in a recovery area until the effects of anesthesia wear off. Post-procedure care may include pain management, monitoring for any signs of complications such as bleeding or infection, and ensuring proper respiratory function. Patients may also need follow-up appointments to discuss the results of the pathological examination and to plan any further treatment based on the findings. Recovery time can vary depending on the extent of the surgery and the patient's overall health, but patients are generally advised to avoid strenuous activities for a specified period to allow for proper healing.
| Short Descr | REMOVE THORACIC LYMPH NODES | Medium Descr | THORCOM THRC W/MEDSTNL & REGIONAL LMPHADEC | Long Descr | Thoracic lymphadenectomy by thoracotomy, mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 21601 | MPFS Status: Active Code APC J1 Excision of chest wall tumor including rib(s) | 31760 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Tracheoplasty; intrathoracic | 31766 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Carinal reconstruction | 31786 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Excision of tracheal tumor or carcinoma; thoracic | 32096 | MPFS Status: Active Code APC C Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral | 32097 | MPFS Status: Active Code APC C Thoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral | 32098 | MPFS Status: Active Code APC C Thoracotomy, with biopsy(ies) of pleura | 32100 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Thoracotomy; with exploration | 32110 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Thoracotomy; with control of traumatic hemorrhage and/or repair of lung tear | 32120 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Thoracotomy; for postoperative complications | 32124 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Thoracotomy; with open intrapleural pneumonolysis | 32140 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Thoracotomy; with cyst(s) removal, includes pleural procedure when performed | 32141 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Thoracotomy; with resection-plication of bullae, includes any pleural procedure when performed | 32150 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Thoracotomy; with removal of intrapleural foreign body or fibrin deposit | 32151 | MPFS Status: Active Code APC C Thoracotomy; with removal of intrapulmonary foreign body | 32160 | MPFS Status: Active Code APC C Illustration for Code Thoracotomy; with cardiac massage | 32200 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Pneumonostomy, with open drainage of abscess or cyst | 32220 | MPFS Status: Active Code APC C Physician Quality Reporting Decortication, pulmonary (separate procedure); total | 32225 | MPFS Status: Active Code APC C Physician Quality Reporting Decortication, pulmonary (separate procedure); partial | 32310 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Pleurectomy, parietal (separate procedure) | 32320 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Decortication and parietal pleurectomy | 32440 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Removal of lung, pneumonectomy; | 32442 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Removal of lung, pneumonectomy; with resection of segment of trachea followed by broncho-tracheal anastomosis (sleeve pneumonectomy) | 32445 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Removal of lung, pneumonectomy; extrapleural | 32480 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Removal of lung, other than pneumonectomy; single lobe (lobectomy) | 32482 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Removal of lung, other than pneumonectomy; 2 lobes (bilobectomy) | 32484 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Removal of lung, other than pneumonectomy; single segment (segmentectomy) | 32486 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Removal of lung, other than pneumonectomy; with circumferential resection of segment of bronchus followed by broncho-bronchial anastomosis (sleeve lobectomy) | 32488 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Removal of lung, other than pneumonectomy; with all remaining lung following previous removal of a portion of lung (completion pneumonectomy) | 32491 | MPFS Status: Restricted APC C Physician Quality Reporting PUB 100 CPT Assistant Article Illustration for Code Removal of lung, other than pneumonectomy; with resection-plication of emphysematous lung(s) (bullous or non-bullous) for lung volume reduction, sternal split or transthoracic approach, includes any pleural procedure, when performed | 32503 | MPFS Status: Active Code APC C Physician Quality Reporting Resection of apical lung tumor (eg, Pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; without chest wall reconstruction(s) | 32504 | MPFS Status: Active Code APC C Physician Quality Reporting Resection of apical lung tumor (eg, Pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; with chest wall reconstruction | 32505 | MPFS Status: Active Code APC C Thoracotomy; with therapeutic wedge resection (eg, mass, nodule), initial | 33025 | MPFS Status: Active Code APC C Physician Quality Reporting Creation of pericardial window or partial resection for drainage | 33030 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Pericardiectomy, subtotal or complete; without cardiopulmonary bypass | 33050 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Resection of pericardial cyst or tumor | 33120 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Excision of intracardiac tumor, resection with cardiopulmonary bypass | 33130 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Resection of external cardiac tumor | 39200 | MPFS Status: Active Code APC C Physician Quality Reporting Resection of mediastinal cyst | 39220 | MPFS Status: Active Code APC C Physician Quality Reporting Resection of mediastinal tumor | 39560 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Resection, diaphragm; with simple repair (eg, primary suture) | 39561 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Resection, diaphragm; with complex repair (eg, prosthetic material, local muscle flap) | 43101 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Excision of lesion, esophagus, with primary repair; thoracic or abdominal approach | 43112 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty (ie, McKeown esophagectomy or tri-incisional esophagectomy) | 43117 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with thoracic esophagogastrostomy, with or without pyloroplasty (Ivor Lewis) | 43118 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es) | 43122 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with esophagogastrostomy, with or without pyloroplasty | 43123 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es) | 43351 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Esophagostomy, fistulization of esophagus, external; thoracic approach | 60270 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Thyroidectomy, including substernal thyroid; sternal split or transthoracic approach | 60505 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Parathyroidectomy or exploration of parathyroid(s); with mediastinal exploration, sternal split or transthoracic approach |
| 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 | CR | Catastrophe/disaster related | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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. | 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.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 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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Notes
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| 2012-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Medium description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |