Wiki 38746 Thoracic lymphadenectomy

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AMBarber

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We are having a discussion regarding using this code +38746 for lymph node dissection when done via a thoracotomy. We had been using this code, however someone recently pointed out that the description of the code in the coder's desk reference and the Coding Companion both state that the approach for this code is through a large vertical chest incision over the sternum, which is split and retracted. So it would appear that this is not the correct code to use.

So what code would you use when the surgeon removes those nodes via the thoracotomy?

Thanks!

Anna Barber, CPC, CEMC
Advantage Health Physicians Network
 
It can be argued that the Coder's Desk Reference is more of a guide on how a procedure "could" be done rather than how it "has" to be done. The actual definition of 38746 in CPT does not specify what approach needs to be taken so I use this code whether my physicians perform a thoracotomy, sternotomy, or use a video-assisted thoracoscope.

I'm not sure I have this in writing but the Society of Thoracic Surgeons has also said that this code should be used for mediastinal lymphadenectomy regardless of approach.

Lisi, CPC
eharkler@nmh.org
 
Thoracic Lymphadenectomy

AMBarber said:
That was my take on it too, thanks Lisi!
Click to expand...

I know this is a super old thread, but I'm just learning Surgical Pulmonary procedures. So for anyone wanting to know, I thought I would update this post.
It's true that 32674 doesn't state the approach, but if you look at code 38746 is says:
(To report mediastinal and regional lymphadenectomy via thorascopy (VATS), see 32674.)
So that would lead me to believe that the 32674 is for VATS only.
In addition, the 38746 note says report in conjunction with....and a whole list of codes after. Why would it have that if the 38746 included all approaches.
Just sayin :)
 
more questions on thorax lymph

My physician opened the patient for a CABG and found a thumb head sized lymph node and excised it for path. I need help on how to code it. 38746 does not list a CABG code for this add on. 39010 is more than I need unless I add a 52 modifier. Any advise?
 
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