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Official Description

Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

A superficial inguinofemoral lymphadenectomy is a surgical procedure that involves the removal of lymph nodes located in the inguinal (groin) region, specifically in continuity with a pelvic lymphadenectomy. This procedure is classified as a separate procedure, meaning it is performed independently and not as part of a larger surgical intervention. The inguinofemoral lymphadenectomy focuses on the superficial lymph nodes, which are critical in the assessment and treatment of malignancies, particularly in the context of cancers that may spread to these lymphatic regions. The procedure is particularly relevant when there is a suspicion or confirmation of malignancy in the inguinal area, as it allows for the evaluation and potential removal of affected lymph nodes. The surgical approach typically involves making an incision parallel to the inguinofemoral ligament, through which the surgeon can access and excise the lymphatic tissue. This procedure may be performed in conjunction with a pelvic lymphadenectomy, which involves the removal of additional lymph nodes located in the pelvic region, including the external iliac, hypogastric, and obturator nodes, especially if malignancy is detected in the inguinal lymph nodes. The careful dissection and removal of these lymph nodes are crucial for staging cancer and determining the appropriate course of treatment.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The inguinofemoral lymphadenectomy is indicated for the following conditions:

  • Malignancy in the Inguinal Region The procedure is performed when there is a suspicion or confirmation of cancer affecting the inguinal lymph nodes.
  • Positive Cloquet's Node If Cloquet's node, a deep inguinal lymph node, is found to be positive for malignancy, this procedure is indicated to further assess and manage the spread of cancer.

2. Procedure

The procedure involves several critical steps to ensure the effective removal of lymphatic tissue.

  • Step 1: Incision An incision is made parallel to the inguinal ligament, allowing access to the inguinal region. This incision is carefully planned to minimize damage to surrounding structures.
  • Step 2: Elevation of Skin Flaps Skin flaps are elevated while separating them from the underlying fat pad. This step is crucial for gaining access to the deeper tissues without compromising the integrity of the skin.
  • Step 3: Dissection of Deep Tissues The surgeon dissects the deep tissues at the superior aspect of the inguinal region to identify and access Cloquet's node. This node is significant as it serves as a transitional point between the inguinal and iliac regions.
  • Step 4: Identification and Excision of Cloquet's Node Cloquet's node is identified and excised. A frozen section may be performed on this node to assess for malignancy, which will guide further surgical decisions.
  • Step 5: Mobilization of Fat Pad The fat pad containing the nodal tissue is elevated and mobilized down to the inferior margin of the inguinal ligament, ensuring that all affected tissue is accessible for removal.
  • Step 6: Dissection into the Femoral Triangle The dissection continues into the femoral triangle, where the cribriform fascia is opened to access the lymphatic tissue over the common femoral vein.
  • Step 7: Removal of Inguinofemoral Nodal Tissue Once the nodal tissue is completely freed from surrounding structures, the inguinofemoral nodal tissue is removed as a single specimen for pathological evaluation.
  • Step 8: Pelvic Lymphadenectomy (if indicated) If Cloquet's node is positive for malignancy, the abdomen is incised without opening the peritoneum. The pelvic lymph nodes on the side of the malignancy are explored, and fatty tissue is stripped from the common iliac vessel and along the internal and external iliac vessels. The external iliac, hypogastric, and obturator nodes are excised and sent for separate pathological evaluation.
  • Step 9: Closure The groin and abdominal incisions are closed in layers to promote proper healing and minimize complications.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications such as infection, bleeding, or issues related to wound healing. Patients may require pain management and should be advised on activity restrictions during the recovery period. Follow-up appointments are essential to assess the surgical site and to review the pathological findings from the excised lymph nodes. The healthcare team will provide specific instructions regarding care of the incision sites and any signs of complications that should prompt immediate medical attention.

Short Descr REMOVE GROIN LYMPH NODES
Medium Descr INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC
Long Descr Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)
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) 1 - 150% payment adjustment for bilateral procedures applies.
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.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
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.)
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
CR Catastrophe/disaster related
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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